I thought of calling this – in the style of old fashioned writings – “In which I have a breakdown and fail my Final Examinations” but that sounds a little sad. My memories of medical school were mostly happy – even happy-go-lucky. Blood? Yes – plenty of that, both actual and metaphorical. It seems to be the first thing people talk to you about when you go up to med school.

Being in hospital in 2009, with the tables turned on that young medical student who was me, I can see the importance of blood in all it’s symbolic glory and of the relationships, connections and links it represents.

Above all though it represents the kindness of strangers; those who gave me their blood literally during my operation, and those who, years earlier, made it possible for me to become a doctor myself, when I could so easily have failed and taken another path.

The summer of 1963 was indeed a very unhappy time for me. After three years on the wards at the Middlesex Hospital, I came up to my final medical exams.

I suppose one likes to feel one has had some sort of excuse for having a nervous breakdown. My mother was ill and I had just got married to another student, I felt hugely conflicted. I had begun to hate medicine and medical school. I knew I had to finish and this would require passing the exams, and doing a year as a House Officer before I could give it all up, as the internship was needed to complete the degree.

I remember weeping at a bus stop from the cold, with Roger my husband massaging my gloveless hands as we made the long trip to Croydon to see my mother. I felt guilty at seeing her so little and even more guilty when I went, losing the hours of study and being even more incapacitated when I returned, having seen how hard it was for my father, virtually on his own and over 80.

Of course my predicted crash happened.

In retrospect, a breakdown can be the best and most necessary response to bad things happening. It allows others to be kind and care for you and you to learn firsthand that this is the most important thing you can do for others.

The most important rule for doctors is said to be, rightly, “First do no harm.” The second rule should be a recognition that we are all vulnerable, all would have a breaking point, all deserve and need as much respect, if not more than the seemingly well and mentally strong.

Several times I tried to get some help with the revision, talking to the tutors and consultants on the firms about my fear that I was going to fail the exams and that I wasn’t coping. Always I was patted down with platitudes like “You’ll be fine.” “Everybody feels that way.” “So, your mother is ill, but we all have to learn to cope.”

So, why have I actually called this chapter The Kindness of Strangers, when it seemed to me at the time that nobody around Roger and I even noticed a need for kindness? Because I met this kindness at the time of greatest need from people outside the medical school itself. They would have been astonished to know the immense effect they had; I’m sure they felt they were only doing their job, but they did it with care and compassion.

I went into the examination halls on the afternoon of the first exam in a fog of denial, sleeplessness and despair. All the final examinations in the University of London took place in a central building devoted to nothing else. Big rooms with rows of desks, an usher, administrators and supervisors. You filed into this impersonal emporium, sat at a desk, turned over the exam paper when you were told to and wrote away for three hours, or however long it was. Then you repeated the whole thing until all six papers were done, before the clinicals and vivas.

I sat down in this fogged and blank state and turned the paper over. I could not read it. I had completely lost the ability to make sense of these strange black marks on white paper. I remember the enormous relief of that moment, as I sat for a while studying this incomprehensible sheet, and the reasoning in my head went, “ You can’t read, so you can’t do the exams. No problem.”

It was a classic example of what was called in those days ‘hysterical’, but would now be called – less pejoratively – a ‘dissociative’ phenomenon. Sometimes when the human psyche is put under too much stress it simply tunes out, blocks cognitive processes and blocks certain abilities. For example, I could have had a paralysis of my writing arm, or a sudden psychogenic blindness with the same effect; being unable to sit my exam.

This defence mechanism, dissociation, though sometimes extreme, actually works very well in its own way. It not only reduces the unbearable anxiety, but goes even further – it abolishes it. I will never forget the amazing calm of what is called the ‘belle indifference’ [beautiful unawareness] of that moment and the pseudo-rational ideation of, “I can no longer read so I can go home.”

When I got up, very calmly, and walked out at the back, I was stopped by a quiet middle-aged man, the usher. Very gently and deferentially he told me I should stop and talk to the woman in the office, close by. I argued a bit, but I was basically lamblike with calm and agreed to go and sit with her and explain.

Under her equally gentle and kindly questioning, she conveyed back to me that I was undergoing some sort of breakdown, that this was very common in the circumstances. I didn’t need to feel bad about it, but maybe I needed help? That was easy to accept, but it was harder for her to get me to go back and sit through the exam, even without doing anything at all, “If you don’t go back you can’t sit any of the exams”, she said, and I felt that was a marvellous solution as I didn’t want to sit any of them.

She shifted tack, took me to the nurse in another office, who made me a cup of tea, and between them they persuaded me to keep my options open and go back in for the rest of that exam and again the next morning. An arrangement was made for the coming days. I sat in a daze on my own at the back with my cup of tea, until we were released. I slipped out, saw the nurse again, who gave me an appointment later that day with a local GP.

Talking to that doctor was a luminous experience for me, and very helpful in terms of a role model. He did not take refuge in a sphinx-like silence as was the prevailing orthodoxy but showed and expressed sympathy and understanding, He explained the dissociative experience as an understandable response to the extreme pressures I had been under, prescribed a mild sedative and returned me to my worried husband, Roger, to be cosseted. We cried a lot and comforted each other

Every day of those exams the nurse and the administrator looked out for me. I was seated at the back, near the door so I didn’t feel claustrophobic. Halfway through each three-hour exam, the nurse came in and took me out for a ten-minute break and a cup of tea. The GP managed to arrange some counselling.

To my astonishment, although I predictably failed the other three subjects, I passed Surgery, and therefore had one less to sit in the next six months. I had come to my senses and truly wanted to qualify and become a doctor. I haunted the path labs and the tutors, informally, and made up all the missed bits, passing the Pathology exam respectably a short time later.

I passed the Midwifery and Gynae papers later on, but failed the Clinical, probably because I had done my midder in Dublin, a wonderful experience, but that’s another story. I passed without any trouble the next time around, qualifying as a doctor a year later than I should have, but much more knowledgeable and far wiser than if I had got through the first time on cramming.

Belatedly, the medical school arranged for a Senior House Officer to tutor me in clinical practice. Though rather bored and superior, making it clear he was not at all pleased to be given this extra burden, he conscientiously stuck with it twice a week.

I had always found hearing heart murmurs difficult on ward rounds, so – for example – after trying to make out the differing ‘lub-dups’ and ‘lub-didups’ in the past I would give up and pretend I’d heard it [I’m not the only one to confess to this years after!] too aware of the impatience of the other six students and the stoicism of the patient.

Now, with the benefits of a one to one, I would refuse to leave the bedside till I truly understood the heart condition. When I sat the final exams again I was told, unofficially, that I had achieved a standard equivalent to distinction in the general medicine papers.

I’m not sure who was more astonished, me or the Registrar. He attributed it, mostly correctly, to his expert tutoring.

I can’t even remember his name, but here was another person just doing the job he was told to in spending time and trouble with me, not particularly kind, but I am so grateful to him. I hope he had a stellar career and a happy life.

I have only one regret. The resits were done elsewhere, and in my recovery and the hectic pace of medical studies and my family problems – which of course did not go away – it never, I’m afraid, occurred to me to go back to the examination halls and thank the staff or acknowledge I probably owe my career to them. If they had not done their job properly I would almost certainly have left medicine and done something else.

If I have ever shown consideration for admin and support staff it is probably no more than a small repayment on the roundabout of Kindness to Strangers.