On Monday, Mrs Patrick had told me that her headaches were 11 out of 10 on a pain scale, but nonetheless I feebly apologised for somehow causing them to increase by one-million-fold.
Now, I don’t wish to sound unsympathetic. Headaches are horrible. Millions suffer from them, including myself, and they cause untold misery. In fact, a great many of my patients have chronic long-standing health complaints that we muddle through together and I would like to think that I mostly offer empathy and support. My issue with Mrs Patrick is that she seems to actually revel in her ill health. Despite her clear disdain for me and the majority of the medical profession, she seems almost addicted to spending an enormous amount of her free time sitting in front of me and numerous hospital specialists recounting her torment. My computer told me that it was her 31st consultation with me in the nine months since I had arrived at the surgery. During this time, both Mrs Patrick and I would fervently agree that we had made absolutely no advancement whatsoever in resolving her headaches or any other of her ever-increasing catalogue of ailments. Despite my failure to provide her even the smallest morsel of symptom relief, here she was, sat before me, yet again reciting the persistent misery of her symptoms.
This particular morning’s consultation followed the normal routine and once she had offloaded the wretchedness of her headaches, we moved on to the dizzy spells, persistent nausea, sneezing fits and funny turns. Without fail, each effort I made to suggest a possible solution was met with disdain and rejection until I was left slumped in my chair simply waiting for the torture to end. After 30 minutes, I sensed that Mrs Patrick was tiring and the consultation was finally reaching its closing stages. Unfortunately, any relief I might get from her eventual departure was tarnished by the knowledge that it would only be a few days until she would be back in to see me and the whole painful process would be repeated all over again.
‘Mrs Patrick, I’ve got an idea,’ I almost shouted, interrupting her mid-flow in her fifth complaint of the session.
Mrs Patrick looked at me suspiciously.
‘Would you agree that we’ve tried lots and lots of things to try to resolve your headaches, dizzy spells, nausea, sneezing and funny turns?’
‘Well, yes, tried a lot, but they’ve all been bloody useless, haven’t they?’
‘Exactly!’ I declared triumphantly, as if this was in fact something to be pleased about.
‘So, I’ve got a new plan.’ I paused for effect. ‘We’re going to stop all your medications and we’re not going to prescribe any new ones or refer you to any specialists.’
‘Eh?’ Mrs Patrick looked at me as if I had completely lost the plot.
‘Well, we’ve failed, haven’t we? I mean, you’ve seen me 31 times in the last nine months and before me there was Dr Bailey and many other doctors before him.’
‘Well, yes, but you can’t just stop my pills?’
‘Sometimes we just have to accept as doctors that some medical problems are beyond our realm of knowledge. It is important to know when to throw up our hands and admit defeat. You said yourself that not a single one of your tablets makes even the first bit of difference to any of your symptoms, so let’s stop them all.’
‘But not the painkillers?’
‘Yep, all those painkillers that don’t stop your pain. We’re going to stop all of those.’
‘But not the creams and the nasal sprays?’
‘The creams that don’t clear up your invisible rash and the nasal sprays that don’t do a thing for your snuffly nose. We’re going to stop those too.’
‘So, can’t I come and see you any more?’
‘Of course you can, but we’re just going to agree that medical science will never cure you of your symptoms, so instead we’re going to talk about other things that might help.’
‘Er, like what?’ Mrs Patrick asked, looking visibly nervous.
‘Have you ever had a dog?’
‘A dog?’
‘Or joined a choir?’
‘Are you okay, Dr Daniels?’
‘Yes, I really am,’ I said, meaning it.
‘Getting a dog and joining a choir?’
‘Yes, or whatever else inspires you to smile and enjoy yourself ! You can still come and see me and we’ll talk about all the other things you’re going to do in your life rather than take medicines and go to hospital appointments.’
‘But we’re not going to talk about my headaches?’
‘Exactly!’
‘Or my dizzy spells, or sneezing, or nausea, or funny turns?’
‘That’s right.’
‘A dog and a choir?’ Mrs Patrick repeated to herself quietly as she left the room.
This was going to go one of two ways. I was either going to make a massive breakthrough and after 40 years finally free Mrs Patrick and the medical profession from much of her torment. Or I was going to end up being struck off the medical register for suggesting singing and dog walking as a cure for some sort of rare medical syndrome that Mrs Patrick’s next doctor was going to cleverly diagnose.
Danni II
‘You’ve gotta sort this out, Doc. I can’t get no business.’
Danni was pointing to an unpleasant looking cold sore on her upper lip. It had become infected and scabby lesions were spreading up to her nose and cheek.
As a sex worker, the infection on her face meant that she couldn’t get any clients and so couldn’t earn any money. If she had been a teacher with a hoarse voice or a carpet fitter with bad knees I could have given her a sick note so that she could get sick pay, but in her line of work there wasn’t that sort of safety net.
‘I can’t even hide it with make-up.’
Danni had been my patient for some time and I knew her biggest concern about not working would be that she couldn’t afford to buy herself any heroin or crack.
‘How are you buying your gear if you can’t work?’
‘I’ve had to go to the clinic and get some methadone.’
I had once thought that methadone was used to wean people off opiates, but my patients who are drug users mostly just use it to keep them going if they can’t get hold of any heroin. Some of them stay on methadone for years and years, constantly putting off the gradual reduction of the dose that is supposed to wean them off drug dependency for good.
‘Are you on benefits?’ I ask.
‘No, most of the girls are on benefits, but I don’t think it’s right getting money from the government when I’m earning.’
I was surprised by Danni’s moral stance. It seemed odd when someone who was living so far outside of what might be considered ‘morally normal’ was taking a principled stand about claiming benefits. I doubt she ever paid tax on her earnings, but even so her sense of ethical responsibility was admirable.
Danni only ever came in to see me for emergency appointments. I could often help with the superficial problems, such as dealing with an abscess from where she had injected heroin, or treating a sexually transmitted infection, as I had last time she had been in. Frustratingly, I could never get to the real root of her problems, which was depression and addiction.
It didn’t take long to prescribe Danni some antibiotics for the infection on her face, but she didn’t seem to want to leave. ‘While I’m here, Doctor, I wondered if I could just talk to you about something else?’
‘Well, not really, Danni. I fitted you in for an emergency appointment and I’m already running late. The waiting room is heaving.’
‘Oh yeah, of course, Doctor, I’m sorry. I don’t wanna waste your time.’
I felt instantly guilty for cutting Danni short. It was true that I was running late and the waiting room was full, but the other reason I was keen for Danni to leave was that she always made me feel so bloody useless. Her life was so complex and chaotic that I never felt able to even scratch the surface of her problems. I couldn’t cure the general sense of misery that ran at the heart of her day-to-day existence. There was nothing I could do to make her life anything close to resemblin
g happy, so I really just wanted her to leave my room so that someone whom I could actually help might come in.
I once heard someone say that life was like treading water in a swimming pool of raw sewage and that the job of a GP is to direct people to the shallow end. Danni was drowning in the deep end and if I couldn’t dive in and drag her out, the least I could do was offer her a sympathetic ear while she flailed around in the faeces.
‘Sorry, Danni, what were you going to ask me?’
‘Well, it’s just that I’ve got no money, and until my face gets better I can’t earn anything and well … I’m just really hungry.’
A tide of genuine shame washed over me. Danni was suffering from that such basic but unpleasant of human sensations – hunger. And oddly enough that was one of her few problems I could help with. There wasn’t a huge amount of food in the building, but I found an apple, four packets of spicy tomato and vegetable cup-a-soup and half a packet of chocolate digestives. I shoved them all into a carrier bag and pressed it into Danni’s hand. It didn’t constitute the most appetising or nutritious of suppers, but it was likely to contain more calories than she had eaten in days. I did at one point consider giving her a tenner so she could buy herself a hot dinner, but giving cash to patients is crossing a boundary too far, and besides, however hungry she was, the money would have been spent on drugs rather than food.
Danni clearly felt a bit awkward accepting my gift but hunger soon took precedence over pride and she gratefully shoved the food parcel into her handbag.
‘You really didn’t have to do that, Doctor. I could have nicked myself something from Sainsbury’s.’
‘It’s no bother, Danni. The last thing you need is to get caught shoplifting again.’
Danni gave me a smile and left. She looked genuinely touched by what she perceived to be a great act of kindness. The reality was that I was relieved to be able to do something simple, practical and worthwhile rather than squirm in my chair feeling completely useless in the way I normally did. Danni was still drowning in the swimming pool of excrement, but at least she could nourish herself with a few chocolate digestives chucked at her from the side.
Unnoticed
Sue, our receptionist, was always the first to know everything about everyone in our surgery, so it was no surprise that she was the one to tell us that Mr Brading had died. ‘Oh yeah, Mr Brading. Not seen him for a while,’ was my comment when she first told me the news.
‘Well, that’s not surprising. His neighbours reported a smell coming from his flat. When the police broke in they found him half decayed with an army of maggots having taken up residence. There was unopened post from over four months ago.’
I could actually remember Robert Brading very well. He was a big chap who smoked and drank too much. He came in fairly often and he liked to talk about his time doing military service and his love for motorbikes. I mostly lectured him on stopping smoking and improving his diet. At his last appointment with me I organised a blood test and asked him to come back and see me the following week. He made the appointment, but didn’t turn up. That was four months ago and was probably the week he died. How could no one on the planet have noticed he was gone for all that time?
Perhaps saddest of all is the fact that last month was his 70th birthday. Rather than celebrating with family and friends, he had been lying decaying in his armchair, the day passing by unnoticed. I hope that the pile of unopened mail on his doormat included at least one or two birthday cards.
I, of course, am equally guilty of being oblivious to Mr Brading’s sudden demise. I had sat at this desk seeing patient after patient with ailment after ailment. I was focused on those in front of me rather than wondering why a patient had suddenly stopped visiting me. Scrolling through the notes of our previous consult-ations, I see that we had seen each other numerous times in the few months before his death. Never once did I ask about family or friends or find out who he was as a person. All that I appeared to have offered him was a series of lectures on improving his lifestyle: Give up smoking! Lose weight! Eat less salt! A bombardment of instructions guided by my computer flashing up a succession of targets that Mr Brading was failing to meet. He had wanted to talk to me about motorbikes and his days in the army but I hadn’t had time for that.
I went home that night trying to imagine how anyone could live for 70 years and then die unnoticed. I hadn’t known Mr Brading personally, but surely there must have been times in his life when he had friends and family. Was there a moment that he knew he was dying and if so, did he regret how isolated he had become? Bronnie Ware, an Australian palliative care nurse, wrote a fascinating essay listing the biggest regrets of the dying. She consistently observed that one of the biggest regrets of those soon to depart was losing touch with old friends. I spent the evening phoning a couple of old university friends who I hadn’t seen for far too long. A reunion was organised and after some happy hours of catching up with old chums, I quietly toasted Mr Brading for reminding me of life’s priorities.
Man flu
Man flu can be a cruel, cruel illness. My empathy levels for grown men coming to see me with a sore throat and the sniffles might be low, but when I myself am afflicted with this unforgiving disease, I crumble into a ball of snuffling self-pity and will complain endlessly to anyone who has the misfortune of my company.
On this particular Friday afternoon my captive audience was Vanessa, my medical student; she had been sitting in with me for three weeks. I like to try to convince myself that the medical students see me as a young, trendy doctor barely much older than themselves. I ask them what music they listen to and make sure they call me Ben rather than Dr Daniels. As each year goes by I find this an increasingly difficult undertaking to pull off. Bright eyed and enthusiastic, Vanessa seemed to take an interest in absolutely everything and everyone. Not once had I witnessed her display even the slightest hint of cynicism and it was perhaps this overwhelming positivity, even more than her youthful looks, that made me feel so very much older than her.
‘I never get colds,’ Vanessa gushed brightly as I explained my ill health.
Good for you, Vanessa, I thought as I wallowed further in the misery wreaked by the combination of afternoon surgery and my terrible man-flu symptoms. The constant stream of patients was exhausting but just about manageable and although Vanessa’s incessant enthusiasm could be grating, her high energy levels were keeping me awake.
Before surgery started, I had eaten three cloves of raw garlic in a vain attempt to ward off my snuffles. I’m not sure there is any scientific evidence that raw garlic cures a cold, but anecdotally at least my pungent breath seemed to be helping prevent patients from overstaying their welcome.
Just when I thought the end of surgery was in sight, I spotted that a certain Mrs Patrick had been added to the end of my consultation list. If I’m honest, my master plan to wean her off her constant visits by encouraging non-medical interventions had failed. With some delight she informed me that getting a dog was out due to the terrible dog hair allergy that she was bound to develop, and she couldn’t join a choir because the light in the hall where they rehearse might trigger off her photosensitivity reaction. Instead, she came to visit me so she could offload her ailments in the normal fashion. I would nod and listen sympathetically, but in recent weeks I had prided myself at being able to stand strong and bravely bat away her inappropriate requests for unhelpful medication and unsuitable referrals.
As she walked into my room, her first words were a damning complaint about our appointments system. Normally I would counter this by pointing out that she had in fact managed to get an appointment with me the very afternoon she called, despite having not a single ailment that could be considered even the slightest bit urgent. Instead, in my viral induced misery, I simply conceded an apology hoping to move the consultation along. Surrendering this morsel to Mrs Patrick was a catastrophic error. Spotting I was ill, she smelled my weakness and like a shark with the taste of blood she went in for the kill.
By the end of the consultation, Mrs Patrick had managed to glean from me two inappropriate referrals, some expensive medication she didn’t need and a course of antibiotics, even though she didn’t have the slightest hint of an infection. I simply did not have the energy to say no to her list of extensive demands and once I had said yes once, my resolve and spirit collapsed in a broken heap. As the appointment broke the 30-minute mark, I even resorted to breathing heavily in her direction, but even with my pungent garlic halitosis I was powerless to stop her. Such was the scale of her momentum, I think even a stake through the heart would have failed to bring the consultation to an end. When she did finally get up out of her chair, I could sense her indulgently wallowing in her splendid triumph. On her way out she briefly turned around and I think I may have seen the slightest upturn of the corners of her mouth. It might have just been a twitch, but if I’m not mistaken I was quite possibly, for the first time ever, witnessing her smile.
Slumped, exhausted and broken, I glanced up at Vanessa who looked at me with what I took to be pity in her eyes. I could imagine her wondering what had become of me that I could be so thoroughly physically and emotionally broken by a middle-aged woman with a few health phobias and a pathological addiction to coming to the surgery.
‘Don’t worry,’ I offered meekly. ‘She may have won this battle, but I’ll win through at the end. This is like the end of The Empire Strikes Back when the Jedis are all but beaten, but when I’m well again next week I’ll fight back Return of the Jedi style.’
Vanessa gave me a very puzzled look.
‘The first “Star Wars” films,’ I said, surprised that this should need an explanation.
‘Oh yes, I think I’ve heard of them. My dad probably likes them.’
Medical students
As I’d been supervising medical students like Vanessa for a little while, the local medical school asked me to be on the interview panel to help select the next year’s first-year student doctors. It was a Thursday morning in late November and there was a steady stream of nervous but enthusiastic teenagers with sweaty palms and bitten nails waiting to be interviewed by a panel of three doctors, of which I was one.
Further Confessions of a GP (The Confessions Series) Page 9