Being good and staying alive

When I was young and hopeful and sixteen, striving for dreams and ideas, I learnt German at school. I must have learnt quite a lot, because I read Bertolt Brecht and listened to Lieder, and was probably quite a pain in the arse. I’ve forgotten most of it since, but there is a phrase that has been repeating itself recently in my mind, which I have finally tracked down to Bertolt Brecht’s Der Gute Mensch von Sezuan (The Good person of Szechwan).

It is this:

Euer einstiger Befehl

Gut zu sein und doch zu leben

Zerriß mich wie ein Blitz in zwei Hälften

It translates roughly as: Your earlier command, to be good and still to live, ripped me like a lightening flash into two halves.

It is extraordinarily evocative, even without the context of the desperate and wretched young woman, rewarded by the gods, who has to invent a ‘cousin’ to manage her life when the small degree of prosperity they provide drives it out of control. I suppose the question is how can anyone be good in the less than good circumstances of life?

The next question might be what the nature of goodness is, and why do we strive for it? My literary and intellectual dreams were largely put on hold when I started as a medical student at the age of seventeen, and I’ve worked in medicine, mostly psychiatry, ever since, other than when I’ve been ill. I think that I have felt, in some way, that I was being good doing so, yet there’s no doubt that the financial and societal rewards of being a doctor are considerable, so I’m not sure it counts. I do feel good if I think I’m helping someone – but it’s my job, like any other. Being good is, in a fashion, part of my job, making it easier to live.

When I’ve been a patient, the whole concept of goodness has been far less clear. What is a good patient? Perhaps someone who agrees with their doctor and takes their medication, and never argues or complains; the problem is that mental illness, by its very nature, tends not to be like this. I want to live, but I want it to be a life worth living, not marred by distress and medication side effects; unfortunately this may not be possible and sometimes lesser living is perhaps the price paid for goodness. The right thing is not always the thing we want to do, and sometimes its rightness is only apparent after the event.

Ultimately, many of these questions lie within the system, however. For example, I might try to be a very good doctor – thoughtful, questioning, going that extra mile for my patients – but if I am not given the tools to do so, then I will become fed-up and burnt-out, and am unlikely to continue trying so hard. These might be little things, like having a desk and a computer and WiFi. It might be feeling heard by bosses and supported in pursuing better care for patients. It might even just be listening to me over a cup of coffee, then saying – ‘I don’t think so, Rebecca,’ but explaining why. I’ve experienced both the positives and the negatives at different times, and I know which works. I know I can’t be good without the support of others, and I probably can’t live very well either.

As a patient, a broken system is even more catastrophic. I see patients falling through gaps because they don’t fit referral criteria, or being discharged too soon because there is no capacity. I have a serious mental illness, and am lucky to have continuity of care and a rough idea as to what to do if I become ill, but I know that’s almost certainly because I’m a consultant psychiatrist myself. Sometimes patients become angry and upset when they cannot understand how to access treatment, something which probably lessens their chances of receiving it. They have become the bad person, but only because they want to live.

I’m glad that I had the chance to read Brecht before I started medicine. Stories in any language help us to understand life at a different level, even if we don’t remember much and can’t attempt intellectual analysis. I think this particular quote re-emerged when I was reading about the GP crisis, about which I have very conflicting views. It’s like one of those visual illusions, when you can only see one picture at once. I want to be able to see my GP face-to-face, and I want my patients to be able to do this too – that’s one picture. But I also understand the sheer volume of work they have to manage, and something is definitely wrong with that system. How can they be good doctors, and still live, themselves? And for me, there’s a third picture – I trained as a GP, but moved into psychiatry because I just didn’t think I could do it, given the volume and stress. I’ve no regrets, but I do have some insight into what they’re facing, even though my GP days were many years ago.

My aim is to remain moderately good and mainly alive, and to read more stories before it’s too late. Maybe life was easier at some unspecified time in the past – I’m doubtful, but not completely so. And so I will end with one of the other very few German quotes that I know, this time by Schiller, and currently prominent on our bookshelves as the title of the new book by Sally Rooney – Beautiful World, where are you? The original is Schöne Welt, wo bist du? But in my head, I hear it as Shining World – this may not be an accurate translation, but I’d like to think there was a shining world once.