Cradle to grave: Through the generations

One of the fundamental concepts of being a family doctor is the idea of looking after families "From the cradle, to the grave."

I remember using this oversold phrase to buttress my passion for the career choice when I interviewed for my training post some 15 years ago.

Fast forward all these years later, to my reality of managing multi-generational mind sets. 

Patient 1: The Baby boomer

He's a 72 year old man who has recently had a routine health check. His blood tests have shown that his cholesterol levels are a bit raised and he has been advised that he would benefit from medication to lower his cholesterol to reduce his risk of heart attacks and/or strokes.

All other checks and tests are perfectly fine. In fact, he is in significantly better health than most people of his age. He has booked an early morning appointment to discuss this further. He is very well dressed in a smart shirt, jumper and chinos, and I notice that he is wearing smart, polished shoes. This is something I admire about the Babyboomer  generation. They're up early and smartly dressed, born out of habits from many years in one career in the same job.

"I have lived a good life" He tells me. "I have had a good career and good family, all my children are grown and independent. I have tried to live as healthy as I can but obviously my body is failing" He pauses for me to appreciate the seriousness of the situation.  

"I wouldn't exactly put it like that." I start saying. 

"Yes, I know what you're saying but what I would like is for you to sign me a "Do Not Resuscitate" form since I might have a heart attack or stroke soon. I want to go peacefully. I am not ready to end up on many medicines,  I am ready to face the worst."

Very confused, I spend the rest of the consultation reassuring him that he is not dying and indeed, in better shape than most of his mates. 

He walks away even more upright, with a spring in his step.

Patient 2: Generation X.

She is going through the menopause and everything is falling down. 

She cannot entertain the effects of the menopause in this very busy period in her life. She has a high profile managerial job and feels her team will obviously crumble without her, so she can not drop the ball now. The hot sweats and irritability are not helping. 

Her daughter has just returned from university saying she no longer enjoys the course she is studying and is lying in bed all day trying to figure out what to do with her life. Her father has had another fall in the care home and ended up in hospital. 

Her husband's construction business is not doing well and their mortgage is not fully paid. And her hair is falling out.

I empathise with this sister and sort her some HRT sharpish. It has worked wonders for others. I think she really needs breathing space. 

Patient 3: The Millenial.

Guy is 32 and has just been released from a stint in prison for accessory to murder and for causing grevious bodily harm. He needs a referral to be assessed for ADHD (Attention deficit hyperactivity disorder).

He has done some internet researching and thinks this might explain his history of violence. 

He has found some wholistic care centre offering specialist natural remedies and would like to apply for funding to be referred to this service.

I am on my most agreeable behaviour and promise to look into all of this for him, whilst mentally composing the letter to follow: 

"Unfortunately, the bosses at the top have refused to pay for this exotic service but you are on the 18 month long waiting NHS version for adult ADHD assessment and here's the number for the people holding you back. Contact them every month to check your position in the queue. "

I was not prepared to get in his bad books and I have learnt not to argue with Millenials. They know everything. 

Patient 4: Gen Z.

Next up is a young man looking all fresh and tight in a crispy new shirt and tie with his skinny trousers, heralded by the scent of his perfume. He's got his phone in his hand and tells me about his new important job in Tech, by way of explanation for the very important call that he may need to take mid- consultation. 

He looks so young! I am impressed. I still have to remind myself that people born in 2001 are bona-fide adults. 

"So what it is, is.. my girlfriend sent me this Snapchat message saying she needs some space."

I wait for the punchline. He sits tapping his feet.

"The thing is, I'm not sure what she means by that and it's causing me a lot of anxiety. "

I ask  "Have you spoken to her about it. "

"Well we've chatted about general stuff.  But we've not hung out for a couple of weeks cos she's like busy with work and stuff. My mum said to see if she's okay but she's done this Tiktok video with her mates last weekend so I know she's alright. Must be her new job. She's just got a new job and it's been a bit stressful, I think."

Followed by more details about how they were both stressed with working long hours 9-5 through the week, and how his mum identified symptoms of anxiety in him as she suffers the same. 

He lets it all out and finally comes to a resolution that he will go and see her. All by himself! I was so proud of him, I almost gave him a sticker!

Bring on Generation Alpha! 

 😊

Getting Jiggy with it

History-taking is vital in medical practice. It translates a narrative using clinical knowledge acquired over many years of training in a systemic art form, to analyse symptoms and form a diagnosis. It is one essential skill that differentiates a doctor from a google search. 

A doctor knows what questions to ask next, taking the patient's full circumstance into perspective. 

Thanks to hot knowledge and the internet, I find a lot more people presenting with diagnoses rather than symptoms. This can be misleading for the doctor and they have to work backwards to prove or disprove the theory. 

Some patients, having analysed their symptoms online, will maintain a streamlined presentation of symptoms to lead a doctor towards the diagnosis they have decided. This can be detrimental. I will share some examples another time.

Today, it is my dearly beloved reception staff who have decided to make my job easier by diagnosing the patient at booking.

He is a 90 year old man. Booking notes: "Depression. Since his wife died recently, he has not been eating and is losing weight."

I set my mood and called for him on the buzzer. A spritely man swung the door open, did a little jig then waltzed unto the patient chair. 

I looked at the booking notes again to be sure I had the right patient as it seemed completely incongruous with the man sat in front of me. 

"Hello Mr. Jiggy. " I said with a smile, confirming his identity and wondering if I had actually misread his actions. Perhaps he was staggering drunk from drowning his grief, but no, he was collected and smelled fresh. 

"How are you?" I asked cautiously, stressing on the "are" to emphasize my concern for his wellbeing.

"Oh, I'm feeling Chucklarious." He said and then giggled at his own clever spontaneous joke. "Do you get it, chuckle, hilarious, chucklarious?"

I looked at the booking notes and back at him again.

"I'm so sorry to hear about your wife" I started 

"Aah," he said and waved his hand in the air dismissively. "That one, she was a bad woman. Terrible, terrible woman."

I sat back in my chair. Better let him take the lead on this one, I thought.

He then told me the sad story of how his late wife, who had been his second wife, had transferred all the money in their account, which was most of his life savings, to her son from a previous marriage just before she died. "Twenty years of my life wasted on that godforsaken woman." He said.

"I should have known she was up to something when she asked me to marry her. That was a red flag!" He said "My first wife did the same and it did not end very well either."

The conversation went into his historical love life, complex family dynamics, his time in the war and so on. 

We talk about marriage proposal traditions. Me mostly uhm-ing and saying " well" to most of his opinions.

My head was still waiting to get to the bereavement and grief part where he was not eating and eventually, he did. 

"So you see, the problem is, I have not had to cook for myself in seventy years and don't know where to start now. My daughter (who lives in Australia) suggests I buy one of these air fryer things. What do you think doc, are they any good?"

We talk about air fryers.

"Well actually, what I would like is to meet a nice woman who can cook." I suggest simple air fryer recipes and options like Meals-on-wheels and home delivery food services. "well yeah, I guess," he says turning his head form one side to the other in contradictory movement. "But I'd prefer to meet a woman, they're other things you can do with a woman."

Err, okay. I'm not ageist, I concur but spare me the details please. 

We talk about various places he can go to find love. He has tried the pub, too many men there. He has tried the community centre but they mostly did things like knitting and line-dancing - too boring for him. He was considering going online but he didn't trust that. 

I agreed to refer him to the befriending service and see what other suggestions they may have. 

He was a charming pleasant man and my last patient for the day so I had allowed the conversation run longer than usual.

After a while, Mr Jiggy sits back in the chair and looks at me with a smile on his face.

"So," he says. "Do you know how to cook?" 

😊

Ps: Who is to argue that some Jollof rice is not a cure for Depression 😄🤯🤓

Truth or How dare you?

Some days at work leave me questioning my sanity. 

Today was one of those. 

Alpha

After checking the first patient's blood pressure, I tell her "Your blood pressure is raised again today, I'm afraid."

She replies "I don't know how you can just sit there and tell me my blood pressure is high. I know my own body and I know that its not. "

I stare at the electronic blood pressure machine, wondering why it was being so rude to this lovely lady until I realised she was talking to me! 

Me? What did I do?

"I'm not just telling you anything, I'm only reading what the machine says."

Sigh

Beta

"Doc, I need you to find another way to prove that I am pregnant. "

I had just informed the next patient that the second blood test and third urine pregnancy test confirmed that she was NOT pregnant. 

"But I am nearly due and if you don't refer me soon, I'll need to be induced and I don't want that. I am very sure I'm pregnant because I felt it when the embryo divided and became a foetus. I have been pregnant many times before so I definitely know!"

I managed to convince her to start taking her antipsychotic medication again and see me in 2 weeks to discuss this "pregnancy" further. 

Charlie

Young, curvy lady sitting in front of me. 

"I know I'm a man. I just need to get rid of these things on my chest and sort the other stuff..."

Hey, its 2023! 

Somebody, somewhere is trying to match her body with his mind, unlike patient beta unfortunately, where I'm trying to match her mind with her body.

But my job here today is to fix the depression probably caused by the testosterone which is forcing the body to match the mind whilst messing up the mind further....you get the drift.

Delta

By the next patient, I had completely resigned from logical thinking. We needed to work out his body mass index so I asked casually. 

"Do you know how tall you are?" 

He was a thirty year old man, standing at about eye-to-eye level with my 5ft and nearly 6 inches. 

"I'm 5ft 11" He said confidently, tilting his chin forward and spreading his arms apart, in attempt to somehow elongate himself .

I smile. "I don't think so. But let's see what this height chart says. "

He stands in the measuring position, against the Height chart on the wall and it reads 172cm (which converts to around 5ft 7" in old money).

"What does it say?" He asks, as I make a note of it.

I reply "It says 172cm which is about 5 ft 7 inches." Then quickly add "But that doesn't mean you are not 5ft 11."

Honestly, I don't know what is real or right any more. 😏

Cry Baby

As a lingering link to my first career love for Paediatrics, I do a regular baby clinic as part of the national child health programme.  The mothers bring in their babies around 6 -8 weeks old for a general examination and developmental assessment, a check up for themselves and for baby vaccinations.

It is a sensitive time for most mothers, especially first time mothers who may be sleep-deprived, hormonal, and grappling with the realisation that this squirming, pooping, guzzling, yet fragile creature is now their full responsibility.

I have a lot of sympathy for the process.

My next patient spent the first few minutes explaining just how precious this baby was due to the difficult period around the delivery, unlike her previous experience. 

I was genuinely attentive to her detailed description of the colours and consistency of his nappy contents and all his feeding and burping routines. 

After the introductory chat, she placed her half asleep baby on the couch for examination.

I started by checking the baby's head control which is done by gently lifting the baby up by the arms.

As I started to lift the baby up, he startled awake and started crying- like a baby.

I tried to settle him by rubbing on his tummy for a few seconds, no luck. From the corner of my eyes I could see the mothers countenance changing. 

"Maybe you should give him a cuddle." I said calmly, gesturing for her to pick him up which she did, but the crying did not immediately cease. 

It was a normal baby cry, not a shrill where I would start to think that there was something irritating his brain but his mother had gradually started turning red and her eyes getting larger.

"What is wrong doctor? Why is he crying?"

I thought about the question for a second and stopped myself from saying "You tell me, you're the mum,".... for all the times people say to me "You tell me, you're the doctor."

The next thing I knew, the mother exclaimed "You have dislocated his shoulder!"

By now her eyes had widened and seemed to take over her forehead. She was starring straight into my face and huffing and puffing, as if trying to intimidate me.

Really?! I thought, puzzled, my mind quickly racing across all possible causes of hypermobility whilst trying to figure out how the mother arrived at this diagnosis. 

I have heard about mothers who have inflicted injury on their baby unintentionally, but for fear of being perceived as neglectful or having the social services invading their lives as safeguarding risks, concort a story to explain the injuries and absolve them of any guilt.

Was this woman possibly trying to blame me for something she had done to her child?! I wondered. 

By now her whole body was shaking and she was pacing back and forth which, in my opinion, was making the baby cry even more. 

"Look," I said " Why don't we just settle down and I can have a look at his arm and check him over? It is very unlikely that his shoulder would dislocate from such a simple manoeuvre." 

I sat at the edge of the couch in attempt to restore calm and control of the rapidly escalating situation.

"Call an ambulance!" She demanded "You should not be sitting, you should be getting an ambulance. You have dislocated my baby's shoulder!! See he's not moving it!"

She was holding him tightly across her chest, both of his arms enveloped within hers. I wondered how he was expected to move his arms.

"Can I examine him?" I asked. "If there's something wrong I can refer him to be checked by the paediatricians." 

She looked at me in shock/horror, as if I had said something like "Well, he's broken now, pass him over so I can throw him in the bin."

By now, the baby seemed to have tired of crying and just wanted to go back to sleep.

She clutched him tighter and burst out of the room shouting "Ambulance, get an ambulance "

She ran to the waiting room, banging on the reception screen screaming "Get me an ambulance, the doctor has dislocated my baby's shoulder!"

I made a quick call to the hospital paediatrician on call to refer him for further checks and then went out to meet her in the waiting room. 

By this time a few of the reception and other staff had gathered around her.

"I have asked the paediatricians to have a look at him, so you can take him to the emergency room to be seen." I said. 

"I have already called ambulance myself " She said with indignation, holding her mobile to her ears and saying (to baby's dad apparently) "Come quickly, the doctor has dislocated his shoulder we need to go to A&E!"

She looked at me and said "I cannot carry a baby with a broken arm to the hospital, I need an ambulance!"

(So apparently the arm was broken now. Things were getting worse 😕!)

The father appeared very quickly, making me more convinced that they were staging this whole performance to cover up something they already knew.

She repeated her recurrent claim to him and he charged at me saying "I cannot believe this. I cannot bloody believe this. We brought our baby to be looked after and now you have broken her arm. Useless! Bloody hell!"

"How could you? How many times have you dislocated babies' shoulder? Can you not do an Xray and fix it? Are you not a trained doctor? And so on...

Not sure which of them would be willing to rationalise at this point, I stated to both. "You would probably be waiting over an hour, likely longer for an ambulance. " (The sad reality of the overstretched NHS). "You are probably better taking him to the hospital yourselves. They will be expecting him."

They turned to each other and started arguing.  By this time the baby in question was sound asleep. 

I thought I saw a brief smile pass his lips, perhaps it was just wind.

They refused to re-enter my consulting room to remove their car seat and other belongings.

They sat arguing in the waiting room until they were the only ones left there, then they got in their car and took their baby to the hospital. 

The next day I received the hospital discharge letter saying that the baby was well on arrival and was discharged home without needing any tests. My suspicions were wrong, the poor woman.😏

In another place, another time and another culture, some people would have insinuated that this was an "ogbanje" baby. (A reincarnated baby with an evil agenda.)

Here and now, he was just another cute, cheeky little monkey. 👻👶

⁵⁵

Other People's Problems

Lifelong Learner Lesson No 4375: 

What do people really expect when they talk to you about their problems?

Some people want advice or solution

Others need to verbalise their thoughts to help them make their own decision.

Some people need to share the burden to make it feel lighter.

Others want to transfer the burden to someone whom they know to take on the burden of others.

Some people are on a data gathering exercise, researching the listener as a subject, even after they have already come to a solution themselves. (What would s/he have done instead?)

Others need a second or third or fourth opinion and perspective in order to make the 'perfect' decision.

Some people simply need a reason to have a conversation with you. 

Others need a broadcasting platform to make sure the message gets to the right target

Some people just want a witness to their suffering. They are okay to remain victims of their plight as long as others are aware how much they are suffering. 

As the listener, before diving into redeemer mode, first decipher whether the issue raised is actually a problem. 

Are they just narrating their experience to you that they are not really worried about? Not every moan is a problem. 

Sometimes its even just an opportunistic humble brag.

"My husband/daughter is always flying from one country to another" may not mean that she is unhappy about it. She might be letting you know how well they are doing with their new important status as CEO etc.

"These gym clothes/trainers wear out so quickly" =Look how much I am keeping fit.

There is no problem!

Most people go on to make their own decision in the end, and whether you deem it right or ridiculous, it must be accepted as their decision as long as they have mental capacity.

This can be difficult to accept and can sometimes feel like a slap in the face of the potential fixer, erasing their saviour halo.

I am more aware of this dynamic in the course of my work where it is easier to dismiss after documentation of a patient's capacity.

I realise how much it comes into play in every day connections between friends, siblings, parents and children especially as the children grow older, and spouses.

I am learning to check myself, figure out my role and sometimes even ask directly what the other person really wants. 

As for my own reasons for sharing my own problems, all or none of the above may or may not apply. 

Go figure!🤓😛😉😜

For better, For worse...

Once upon a time, being wise was an accomplishment coincident with grey hairs of age and years of lived experiences, a library collection of classics, or scars that told tales of battles or wartime hardships. 

Nowadays all you need is internet access with a decent data package, a randomly selected audience and voila! - you have the wisdom of King Solomon and the poetic flair of Maya Angelou!

I have also come to learn that if you have certain letters before your name and suffix titles suggesting educational supremacy, people expect some unrealistic levels of wisdom that transcends age or experience. 

Which is why this couple, with a combined age of more than 150 years, were sitting in my office today. 

In a free healthcare system, it was not unusual to be the listening ear for marital woes but these ones seemed different. 

They had been married for fifty years! 5-0! 

On their wedding day, I was still one of thousands of eggs and could easily have ended up as a bit of blood on a sanitary towel. 

Who was I to be giving them marriage advice?!

I had learned from past experience that my role here was to nod and hum and listen. 

                                 ******* 

I remembered a couple I had seen a few months earlier. 

The lady was fed up and frustrated with her husband's general bad behaviour. He stayed out late, drank too much alcohol and had become so boldly disrespectful to her that he now brought prostitutes home! She was filing for a divorce and wanted a letter detailing the effect on her mental health. He was there to seek help to prove to her that he was ready to change. 

The story sounded strangely familiar. 

Scrolling through her medical records, I found exactly the same consultation I'd had with her five years before! It was so identical that I could have just copied and pasted it.

I realised that my role was not to try to salvage their marriage, like I had assumed the first time around but just to write the "He said, She said" letter and wish them well.

                           **************

Today I was planning to do the same with this elderly animated couple who kept dragging me into their quarrel. 

"He keeps saying he's going to change but he never will. He says he feels like shooting me. Doctor please can you tell him that he should not speak to me like that!"

"She keeps nagging me. *Gavin do this, Gavin do that. Gavin don't climb there, Gavin don't sit here. How will you feel if you were me? I think I am going to change my name and just ignore her. "

"Every time he is with me my blood pressure goes sky high. You can check it now and see. I should have left him a long time ago." 

"I am not sleeping because of her nagging. I even hear her voice in my sleep." 

"He doesn't allow me to rest. Anytime he sees me resting he starts digging or drilling or vacuuming. Making noise!" 

"Doc, it is not as bad as you think. Our son thinks she's a good cook. I agree." 

"It is very very bad doctor. He keeps saying he feels like killing me! I feel like killing him too. And yes  I am a good cook, and cleaner and everything else." 

.... and on and on and on for what felt like the entire 50 years of their marriage. 

Finally, I decided to intervene to show some relevance. 

"So when was the last time you remember being happy together?"

Blank stares. 

"How did this all start?" I enquired further. 

She looked at me and said "It all started from something that his mother ate when she was pregnant with him ...."

Somehow I was expecting an explosion of laughter but quickly had to restructure my emerging outburst into some kind of contorted look of curiosity when I caught the dead serious look on her face. 

I pondered. 

Maybe I would have been better placed if I had signed up for one of those 7 day online Life Coach certification courses. 

Apparently, one can acquire the skills to solve other people's problems in just 7 days and make some good money in the process, solving their own financial problems along the way - or so the adverts claimed. 

Alas with my nineteen years of medical practice and all the prefix and suffix titles embracing my name, I was only able to prescribe them sleeping tablets. "

" So what are you going to do now?" I asked. 

"Nothing." They both replied. "We'll just have to carry on." 

I sent a referral to the safeguarding team to visit them and home and make sure they don't kill each other. 

For better, For worse......

 

Police & Thief

 

I have never fancied myself an actress.

My day-to-day job though extremely busy and interesting, will not make a good action movie. 

Well, unless you count the time I had to duck from a patient throwing a bottle of Vimto at me or slamming the door so hard that the door broke. 

One day however, the opportunity for a lead villain action role nearly came my way. 

I got a random call from someone who identified himself as Police Constable, or Sergeant something.

"Are you Dr...?"

"Yes?"

"Please could you give me your current location I need to serve you a letter."

I nearly laughed. As far as I was concerned it was a hoax call from a very novice fraudster. 

I mean, in all the movies I have watched the police find the baddie. They don't call to ask them to identify their location. 

For a split second I considered that they might be calling to present an award of good service to my community. Who was I kidding😄😄?

It was a bad line and got cut off. Another evidence of fraud, I thought. 

The next day, I got a call from one of our receptionists at our branch surgery a few minutes drive away. 

Her tone was a harsh whisper with a sense of panic.

"Doctor, Three policemen have just come into the surgery asking for you. I have sent them over, they will be there soon."🚔

I made my way to the reception ready to receive them, but more to minimise arousing the curiosity of the other staff and patients in the waiting room. 

Sure enough they arrived within minutes. 

One stood guard at the door whilst the other two approached me. One huge guy and another slightly smaller, tougher looking one. Very "Bad Boys"

I looked at them with intrigue and admiration, walking gallantly in their uniforms complete with stab vests and handcuffs. 

This was the most dangerously exciting thing that had ever happened to me in my life!

I wondered how I could savour the moment. I hadn't thought to bring a syringe with a long needle as a weapon to surrender. Perhaps I could suddenly turn around and start running. Or smash the window and try to jump out of it.  Or dive on the floor and roll between their legs....

"Are you Dr.....?" The huge guy jolted me to reality. 

"Yes, I am."

He then proceeded to read me a summon.

"You have been summoned by her majesty's....to attend the inquest .....death of.......contempt of court......thousand pound fine.... ..Do you understand?"

"Yes, I do." I said and he handed me a summons letter and a pen to sign something. 

Why was I so calm about it, you may want to know. 

Well, the night before, after the hoax-like call, I got another phonecall from the Coroners court ( The court which investigates unexpected or suspicious deaths) and had been given details about the case. I had reviewed it and was pretty confident that I had no involvement and nothing to answer for. 

I felt obliged to apologise for wasting their time  but they had no idea about the details. Their job was to deliver the summon. 

I looked at reception staff who were pretending to be busy with their work whilst obviously peeping and listening,  to try and get an idea of what crimes kept me busy in my spare time. 

I was hoping for someone to make eye contact so that I could get them to take a photo of me and Starsky and Hutch. No chance.

In the end I got dismissed from the case and never even got to attend court!

That was enough action for me. I'll stick to the other movie genres: Some Historical fiction, some Drama and some Mystery -trying to piece together information from symptoms and investigations to make a diagnosis. 

Thank you very much. 

Death & Taxes

They say the only things we can be certain about in life are death and taxes. Always certain but somehow unexpected when it comes. 

Every now and again my job has me reflecting on these two, mostly the former. 

I find it intriguing how some people are very organised and matter-of-fact about both whilst others find ways to procrastinate or skirt around them until they become inevitable. 

One of the most memorable final moments I have witnessed at work wasn't even my patient. 

I was in my consulting room staring out of the window one afternoon having a housekeeping moment between patients when I noticed a man standing on the edge of the rooftop of a multistorey car park across the road. 

I assumed there was some building work going on and looked closer to see if he had a harness, assuming that there must be some health and safety equipment or barriers to allow him stand so close to the edge.

I looked down to the ground where I noticed a small group of people gathering and looking up at him. Before I could process what I was witnessing, I saw him throw himself down. 

A few of us rushed out of the health centre to the scene. An ambulance arrived in record time but it was too late. 

For a long while, I kept pondering on the incident. It was shocking and upsetting. 

What were his thoughts in those final moments. Confusion? Anger? Frustration? Depression?  Was he now at peace? 

These days I mostly work from a ground floor office overlooking the playground of a preschool nursery. The sights and sound are more pleasant. 

I often try to interprete the look in eyes of the dying. 

At a recent home visit to a dying man in his eighties, I saw Fear. He held my hand and cried telling me how scared he was of dying. I asked if he had a faith as I find that people often draw strength from their faith when all else, despite all medical intelligence, has failed. 

His wife, who had been interrupting the whole conversation, shouted from the corner. "He doesn't believe in all that. He's an athei..."

""SHUT UP!" He shouted back at her with what little strength he had left. Then turning to me, eyes still filled with tears, hands still shaking,  he said. "I am a Christian, I believe in Jesus and the church of England. "

"I hope that you can find some comfort in your faith." I said as I left him and his still bewildered wife shortly after.

In another patient's eyes I saw Courage, which I found particularly chilling as she was just shy of thirty years old, dying from cancer.

"I have to be strong for everyone around me. " She said. "My mum is also in a hospice in her last days. I just don't want to go before her."

In another patient, I saw complete Resignation. 

He was a man in his seventies with a lung condition for which he was predicted six to nine months to live, three years before. 

I saw him late one Friday evening. His whole family had gathered with lit candles and the priest had come to give him the final rites and communion. 

After assessing him, I had to gently break the news to the family that he was not actually dying yet, just badly constipated. I prescribed some laxatives and said I would give him a call the following week. His wife looked at me in horror. 

When I did ring him the following Tuesday, his cheerful wife informed me that he was out helping his brother move house.

I was relieved, and for a while shifted my attention from death to taxes. 

It was late January my tax bill was due. I looked at it again and turned away in annoyance/denial. I had until 23:59 on the 31st to pay it. It will have to wait until 23:45.

(Photo is the view from the window)

Ministry of medicine

They say Medicine and Ministry are two of the top three oldest professions, alongside prostitution.

There are many similarities between a doctor and a priest. Both are lifelong callings rather than careers, such that the roles of "Father" and "Doctor" continue in some form even after retirement. 

People want both present at the beginning and end of life, as some sort of connection between earthly life and the afterlife. 

People expect miracles from both.

People tell both things they will not tell anyone else. 

As a doctor, it is usually some hidden addiction  (to fudgecake or porn or gambling or alcohol or cocaine or cheese), some very dark and disturbing thoughts, where they really think caught that genital warts or simply that they need a sick note even though they are well as they have run out of annual leave entitlement at work.

They know that you have taken an oath to keep their secret, secret.

(We may tell you the story of the secret but never in a way that you can identify the person).

I recently had a consultation to discuss blood results with a patient who has had tests for complaints of feeling tired.

"Last weekend, it was my son's birthday. My house was full of guests and I just went up to my room to lie down. I couldn't even go back down until all the guests had left..."

That would have been a normal statement - if we were not in a pandemic with lockdown rules forbidding household mixing!!😳 

I paused to see if she would realise what she had just confessed.

"I know we're not supposed to but he's a kid and it was his birthday!"

I decided to stay on the medical problem.

"Your blood results show that you have anaemia (low levels of iron in your blood) which is probably why you are so tired......et cetera..... 

...🙄For your penance, take some iron tablets everyday and pray that the police don't get an anonymous call reporting you.🙄"

My next patient is a young man who has called because he feels very stressed. He is so stressed that his mind now gets flashbacks to all the previous times in the past when he has felt mental stress....when a family member passed away and when another family member was very ill, nothing too colourful or out of the ordinary. 

He insists on me putting down in his records that he has had mental illness for years, in reference to these events 🤔. 

Specific requests to make notes in records usually warn me that there is legal stew brewing. 🧐

I am curious. These things happened years ago and have never been reported. Why now? His medical records are otherwise unremarkable.

"Well its this court just stressing me out." He says.  "They're going to send me to jail for fraud, and they don't even have strong evidence.

My lawyer says to get on record about my mental health and he can use that in his arguments."

I didn't ask, but he offered. He'd done it.🥸🧐😬

He spent the next few minutes confessing and arguing with himself about how the other two involved had escaped and how he knows he's not really mentally ill and just wishes the whole thing would go away. 

I listened, thinking what it must like to be a priest, trying to remember the words of absolution.

At the end, I almost say "May the good Lord accept your confession and grant you forgiveness. 

Go and sin no more."

😄😄

First, Know Thyself.

Its a tricky time to be a doctor in the "woke" world.

Between the internet and political correctness, there is little room for practice. 

Take for example, the day I was trying to get a trans woman in-transit to describe a rash on their penis when they were in denial of the fact that they have one, as it goes against "who they are"

They spent several minutes calling it fancy neutral names like thingy or whatsit, because the word penis is somehow offensive. 

When I realised what we were talking about, I asked permission to call it a penis, for the purpose of the consultation only, please. Thank you. 

Next, Grandma has booked an appointment to complain. She received an appointment following  a referral to the department of Elderly medicine for a combination of age-related issues.

"Elderly! How insulting! Do they even know me? I drive, I do yoga and pilates. I'm sorry but I am not going for that appointment."

I couldn't argue with her. She was only 85 years young. 👵

It was the second complaint in that week about referring to an octogenarian as old.🤔 I had obviously missed a memo.

Next, Girlie comes to see me with some issues "down there". I had a look after getting the gist.

"I think you have thrush."

She huffed.

"Well, I know my own body. I know it's definitely not thrush and when I checked my symptoms online it didn't say thrush." 

I don't argue, of course. What do I know? 

"Let's do some tests." I suggest. 

 The swab result came back confirming thrush. Every other infection excluded. 

"But can you just prescribe some antibiotics for bacterial infection? I know that that's what it is. I know my own body."

I'm scratching my head...."Er, no, but I can give you treatment for thrush, if you don't mind. "🙄😒

Next woke patient is not even the actual patient. It's a mum on behalf of her sixteen year old daughter. 

Mum has even booked a "starter appointment" first, to give me the heads up/low down...."Because daughter is in denial"

She tells me how beautiful her daughter is, showing me good'ol printed photos of beauty pageants her daughter had won and telling me about the beauty that runs in the family.

Sadly, she says, her daughter has now developed a mental illness -as people in the beauty industry do. 

"She keeps thinking she has acne because some of her friends at college have acne. I have researched it and it's actually a skin picking disorder.

We are seeing a private psychologist to help her work through it."

Princess comes in later with classic textbook Acne across her face. 

She seems sensible enough about it.

I give my diagnosis. Her mum is furious. 

"How can you just say it's Acne, you haven't even met her before. How do you know?" She says. 

🤔Where do I start? I thought. But I am becoming quite skilled at this professional answer thingy, so we have a little biology lesson. 

Mum reluctantly agrees to try treatment for Acne, after I remind her very subtly and politely, that her daughter is sixteen now so I really don't need her mum to agree with me.

Daughter is beaming triumphantly in the corner. 

Six weeks later, her acne is almost completely cleared and she's a beauty queen again!👸

No offence to the psychologist managing her Skin picking disorder.