This morning I saw a young woman who has been depressed since her husband left her for another woman. She began by telling me how she felt physically sick when she thought of her husband with someone else. I felt some sympathy for this unfortunate woman whose life has been wrecked by a faithless man. Then she asked me to prescribe the contraceptive Pill, which made my ears prick up. She added that she is currently having protected sex, but it often happens when she gets "wrecked" (i.e. extremely drunk) at the weekend. I've been in this job long enough to be unsurprised by anything, but I regraded her problem in my mind from "moral crisis" to "adjustment reaction". I also advised her that reducing her alcohol consumption would speed her recovery.
Later I saw a mother of two young children who recently developed postnatal depression almost a year after the birth of her second son. Something similar happened after her first son was born, so she recognised the problem. I first saw her four days ago, less than an hour after a crisis: under the influence of several stressors she had snapped and torn up one of her three-year-old's books. It was a tense consultation, with the baby sitting forlornly in the pushchair and the three-year-old walking around uneasily and ignoring the toy box. The depression did not seem too severe, there were no psychotic features and she had no thoughts of harming herself or her children, so I let her go with a prescription for an antidepressant. The talk with a reassuring professional was probably just as therapeutic. (Not because of me, you understand, but because of a reassuring professional who happened to be me.)
Today the atmosphere was much better. The baby sat on mother's lap (except when I got to cuddle him while mother filled in The Questionnaire which, surprise! surprise!, showed mild depression) and the three-year-old played happily with some toys. As they left the three-year-old began to tell me about some of the toys he has at home. "You are a lucky boy" I said.
That is exactly the sort of thing my grandmother used to say when I was his age and she was mine. I looked at my hands, which I have known so long, and noticed how they are thickening, becoming wrinkled and developing liver spots. I seem to have metamorphosed into a late-middle-aged avuncular reassuring figure, everyone's favourite mature GP. Indeed, I am frequently confused with a partner some twelve years older than I. This is most odd, as I still feel immature and insecure on the inside. If Trotsky said "old age is the most unexpected of all the things that can happen to a man" then he might have added that late middle age is a bit surprising, too. But the alternative is worse, and I am resolved to enjoy Shakespeare's Fifth Age with my fair round belly and my wise saws and modern instances.