Charades

Consultation in General practice can sometimes feel like a game of Charades. The doctor trying to guess why the patient has actually come whilst the patient throws cues but never divulges the actual fact.

Even highly suggestive questions like: "Why have you come here today?" or "How can I help you?" can prove futile. 

This couple seemed to enjoy playing this game with me. Usually individually but today they had come as a double act.

They were a very pleasant Chinese couple in their late fifties, who obviously had no faith in western medicine. 

Today, Mrs Xu (fake name obviously) asked me to check her blood pressure....again. I noticed we had checked it more often than usual over the previous 6 month period. 

It is normal, as usual. 

Mr. Xu's blood pressure was a bit raised as usual so I ask if he had taken his blood pressure medication. I knew the answer coming. No.

"No good for me. Maybe I have 2.5mg, instead of 5mg?" He hasn't actually tried taking it. He proceeds to show me blood pressure readings done on their home monitor within the same range. 

Mrs Xu is also monitoring hers, as a control in their experiment, I suspect.

"Ah, yes. But we no like this a medicine. We have new one from China. Very good medicine"

We have had exactly the same conversation at least four times in the past 6 months. We talk about her varicose veins and hot flushes, his low vitamin D, eczema and raised cholesterol.

He collects the prescription for the lower dose but emphasises very pleasantly, that they will not be taking any prescribed medication. 

We have small chat about China, they recommend parts to visit and they present me with another tin of authentic Chinese tea.

They are very grateful.

For what? I do not know. 

Like Lazarus

I first decided to keep some sort of journal of my experiences at work, mostly to remind myself that these things actually happened and I had not just imagined them.

I preferred to remember the more light hearted, less serious episodes. 

Every now and again though, I recall some utterly bizzare but actually serious experiences. Like this one from many years ago:

I was freshly qualified, doing my mandatory housemanship year at Lagos University Teaching Hospital.

On this particular day, I was on duty in the emergency department, alongside a fellow house officer (As we were called in the first year following graduation).

Two days earlier, a lady had been rushed in unconscious following a hit-and-run car accident. The person who brought her in had no information about her identity.

Unfortunately, this was not a healthcare system where one was at liberty to save lives at any cost. Somebody had to be paying.

She remained unconscious in the Emergency department until she very sadly died from internal bleeding. Alone, on an examination couch in a busy department, unidentified.

About half an hour after she died, a group of people turned up to the department as her family.

It fell to my colleague to speak to them as he had been the last doctor in attendance. The more senior doctors were attending a trauma.

I saw them gather around him in the room and thought to myself how brave he must be to be able to break that kind of news, and right next to her body.

I carried on with my work.

A few minutes later, I heard mumbling and chanting, coming out of that room, rising above the usual ambient noise.

I looked through the glass door out of curiosity.

The family held hands in a circle around her, praying and singing. In the middle of the circle was Dr. Mycolleague. His hands were pointed over her and he was repeating in a commanding voice: "Rise up! Get up now!"

It was a most bizarre experience. I am a Christian and I am a doctor but this was next level.

I ran to get the consultant on duty.

As it turned out, it was the first time a patient  had died in front of my colleague. He had been struggling to process the experience when the family arrived. This had triggered a mental breakdown, with hysteria and confusion, and he reverted to some sort of Christ-the-healer mode. He did have underlying mental health problems.

I can only imagine the overwhelming sense of guilt, failure and helplessness he must have felt.

He was suspended for a time, whilst getting the help and support he needed.

It was a very hard way to learn the importance of separating sentiments at work especially when dealing with cases that may resonate with personal experiences.

We are humans first.
Every doctor is some other doctor's patient. 

A pig in a poke

I have come across various social media photos and posts revealing adverts so preposterous that one often doubts the authenticity of them.

I had not actually conceived the thought of the possibility that there might just be somebody out there who was reading these kind of posts with thoughtful intent to patronize them.

That was until that fateful morning when Mr. Hook (let us call him that), walked into my consulting room. He was in his mid-fifties, of average height and build. There was some discordance between his casual dress style and attitude, and the seriousness of his voice.

"I've come in for my prescription doc, and for a bit of medical advice"

I quickly scan through his regular medication records to check that they were all relevant and appropriate.  Some medicine combinations in his prescriptions suggest to me that he possibly had a recent heart attack.

8 months ago, he confirmed. This had given him a wake-up call to pursue a healthy lifestyle.

"I've stopped smoking, cut down hours in my stressful job, I am eating only healthy stuff..."

"Brilliant! Well done. "

"In fact, that's the other thing I wanted to talk about ."

He brings out an empty medicines box, with a bold label ARTERY CLEANSER.

"It's a fantastic drug," he tells me. "I found it on the internet and want to check that it's okay to take with the rest of my medication".

I look at the box. It has bright colours, instructions to take one daily and an impressive list of potentially curable conditions. It also has an expiry date. Nothing else.

No manufacturers address, no attached leaflet, no ingredients, no scientific information.

"What does it contain?" I ask.

"I thought you could tell me. It says it's a wonderful drug and can cure most of my problems, it's exactly what I need."

I apologize. I have never heard of it before and there is no information for me to go by.

Quite frankly, I am still trying to wrap my head round the mechanism by which one tablet can:
Cure Haemorrhoids, Cause weight loss, Boost libido and sex life, Cure tiredness, Supply oxygen to all your vital organs, Remove all pain and swelling, Repair all your veins and arteries, Strengthen your heart muscles, Improve memory, Banish cellulite.....

Perhaps I was being too scientific about the whole thing and my lack of wider intelligence must have shown on my face.

He looks disappointed. "Maybe you can research it and then give me a call later" he says.

I have to be honest. "I wouldn't advise you to take a tablet with unknown content, especially given your medical history and other medication, it does not sound very genuine to me." (And I am not interested in researching this obvious pig in a poke)

"That's just because you don't know about it. Here's the website." He writes it down for me.

I am too exhausted to argue so agree to look it up......AND I ACTUALLY DO! Over my small pot of olives during lunchtime at my desk, I type in the website details.

Same big colourful logo. There's a picture of a man wearing glasses and a white lab coat, and even longer list of the wonders of the tablet. 100% Guarantee.  Even bigger and brighter, there's a payment instruction.
Click here to BUY NOW! Only £59.99 for 15 tablets.
That's it.

Nothing about what it contains or how it works.

I give Mr Hook a call and tell him not to buy this tablet. He sounds a bit annoyed and says

"Well I'll just make an appointment with Dr. MyRetiringColleague to discuss it then, he has more experience"

I make a note of our conversation in his records, praying briefly that he is being sold a Multivitamin tablet as a worst-case scenario.

It's amazing how gullible people can be when trying to cling on to hopeful solutions.

It is even more amazing how many people are readily waiting to prey on vulnerability.

I go back to my olives.

Shine your eyes, mate!

Mother knows best

I had the privilege of reading her recent notes in the time it took her to come through the door. I could see that she had seen another doctor three days earlier with a fungal rash. She was eighteen years old.

Mum was in tow. She pulled the extra chair in the room to make a third angle so I got the hint. This was going to be a three-way conversation.

" You don't mind if I sit in, do you?" She asks, rheotorically.

"That's up to Allie" (Let's call her Allie), I look directly at my patient. She looked very timid but she was legally an adult so I asked "Would you like your mum to wait outside for a minute?"

I have found that to be a much better way of phrasing the question as it appears to alleviate the responsibility from the patient. Any shrug, hesitance or vague response is taken as a Yes.

"Oh no she doesn't mind, do you Allie?" Without much choice, Allie obliges her.

The problem was that the rash was still present after three days of using this cream.

"I can see that the other doctor asked you to use this cream for two weeks and then come back for a review"

"Well she was just worried that it would become very serious like mine did" Mum said. "I had exactly the same rash and I ended up in intensive care and this is exactly how it started"

 Getting a bit concerned that we might be missing something serious, I went over the details again.

"How did your rash start?" I ask Allie.

"It started as a small rash under my right bust over a week ago but it spread and became itchy"

"That's exactly what happened to me! I just woke up and my face was swollen. The doctor gave me something but it didn't work just like hers. He gave me some hay fever tablets but I ended up in intensive care and nearly died"

Allie looks a bit nervous now. Mum goes on to give full details of her experience with a severe allergic reaction.

"I think what you had was a different kind of rash" I say to mum. I turned to Allie. "Since you started using the cream, do you think it is still getting worse?"

"It's less itchy but still red." She said.

"It's very itchy and spreading to her face like mine did." Her mum said.

I take a look at her face but cannot find any rash. "Did you say it spread to your face?" I ask Allie.

"My face was swollen, I had to get an ambulance and they gave me some injections and I ended up in the intensive care unit"....Mum.

"Not really, no." Allie says.

I proceed to examine the rash and explain to her that it was clearly a sweat rash. It needed to be kept cool and aerated and allowed time to heal with the cream given. I quickly address Mum's rash history, highlighting the difference between her rash, caused by a severe allergic reaction, and Allie's rash, usually associated with fungal infection.

"Fungal infection? Oh yes! It runs in our family. She must have inherited it from my sister."

They are thankful as they leave. Mum promising to call an ambulance if it got worse and ask her other sister to get checked out.

I despair.

Life lesson 401

I recently got promoted to the next level in this School of Life business. So far it's been favourable to me and I am extremely grateful to God. I will not even pretend to suddenly be wise but I have learnt a few lessons along the way:

A smile is a powerful weapon...even in texts 😃.

It's okay not to want it all.

Do not form an impression of anyone based on someone else's opinion.

Listen to hear and to understand, not to reply.

You have no control over other people's emotions. One person will adore you for the same thing another will despise you for.

Enjoy the company of the very young and the elderly. They are less attached to the stresses around the world and help you to detach too.

Respect the cleaning lady, the waiter, the cab driver.

You can respect other people's cultures, opinions and beliefs even if you don't share them.

It is hard to trust people who never express any opinion. Silence is not always golden.

Do your best. After this, there is nothing more you can do.

Pick your battles. Some are just not worth showing up to.

Do not take good health for granted. You are going to need your body for your whole life. Look after it!

.....We live, We learn x

What's his is mine.

One common sign of drama is tears.

She had not been seated 2 seconds before they started to flow. Heavily, between sobs.

Depression excluded.

Experience has taught me that patients who are depressed rarely burst out crying in that manner before speaking. Especially when they had been happily chatting with a member of reception staff one minute before. (Yes, we notice these things).

I was in an unfamiliar room and looked round for tissues. There was none to be found. Good.

"I'm sorry, I haven't got any tissues. What's the matter?"

The tears stop quickly. She had made her point that this was very serious....and I had no tissues.

"I am not sure how you can help me" sob, sob. "My husband is hiding money from me!"

I am listening now, my mind is sympathetic. I am trying to recall all the local Domestic Violence and Women support group contact details. I am thinking Financial abuse here, planning my assessment questions.

"I mean, don't get me wrong, he is a nice husband and dad, he gives me all the money I need and I have access to our joint account. He does not monitor my spending or anything like that."

Okay..... Scratch the financial abuse line of thought.

It turns out her husband is spending some of his own money on things he likes, without telling her. She stopped working to have children, had two children, the younger was nine years old. Her husband had encouraged her to return to work a couple of years ago but she is not prepared to do so.

She is not suspicious that he is having an affair or accumulating debt. She just wants him to tell her how he spends his extra money.

My time is ticking away so I am trying to medicalise this whole doctors appointment business.
I start asking questions to explore depression, anxiety, delusions....all negative.

"I know you are not a marriage counsellor" she says

You do?!!, I do not say.

"But I asked him to go to marriage counselling with me but he won't because he does not see any problem with our marriage. I mean, there isn't any problem in our marriage really. It's just this issue bothering me"

She goes on to give more background to the marriage, children, etc. I look at my watch. Time's up. Now I am running late.

"Is there anything I can do to help, medically?"

"I am not sure really, can you suggest a marriage counsellor. I have found some but they are a bit too far for me."(20 minute drive)

"Might be a good idea to try and convince your husband to go with you first." I suggest. "I'm afraid I haven't got much more time left, you can arrange a review appointment if it becomes a problem for you as we discussed"

"Ok, thank you doctor. Please can you just look in my ears, I think I have wax...."

Millenial-itis

The young man slumped into the chair.

I reminded myself to smile and take a deep breath as my impatience started bubbling to the surface.

We were already 4 minutes into his 10 minute appointment. The first couple of minutes had been spent waiting for him to arrive after repeatedly calling his name over the public address system. His name would have appeared on the screen in the waiting room telling him what room to attend.

After waiting nearly 2 minutes, I had gone out to call him.

Sometimes people have popped into the loo or have mobility problems or a huge pram so can take a while getting to the office.

Not this guy. He was sitting right there, headphones over his ears watching something on his mobile.

That was when my irritation set in.

"How can I help today?" I managed a courteous face.

The history came out.

He was a third year university student and needed a letter to explain his absence from at least sixty percent of  lectures over the course of the year.
He wanted to defer his end of year exam or apply to repeat the year.

Still hoping I was of relevance to the story, I asked him the reason.

"I couldn't get myself out of bed so early in the morning cos I stay awake till around three or four am".

"And why do you stay up so late?"

"Dunno, just playing on the X-box and on my phone and stuff. But the lady at the office said if I could get a letter saying it was like my mental health and stuff,  it would help."

He went on to explain that he did manage to keep going to his evening job because he needed the money.

"But I'm not like "depressed" or "suicidal " or anything. My mum actually took me to the counsellor the other day but they said I need a doctor's note."

I sank back into my chair and sighed.

We had a brief chat.

In the most firm but polite way, I asked him to go and discuss his problems and priorities with his university liaison person.

He had given away his game consoles which was a good start. I wished him well.

He wasn't the first, and certainly not the last person with that problem. In fact,  it is a growing epidemic.
And until it was given an actual medical term, I spent the next few moments trying to figure out what to put down as the diagnosis.

I couldn't find "Millenialitis"

#Yolo

As I lay soaking in a hot bath a few minutes ago, I reminisced on the events of the week gone by. One particular conversation struck my mind. It went thus:
Me: "Hi I'm here to see Mr. Watsisname*"
Man: "Oh please come in, I'll just get him out of the freezer"
(I had gone to a funeral home to view the body of a deceased man who was to be cremated)

Reflecting on that statement, I realise that at the end of our transient journey here on earth, our bodies are no different from sausages and milk.....kept in the fridge for a short time until finally disposed.

We spend so much of our lives trying to "maintain" this body sometimes forgetting to look after the part of us that will live for eternity- our souls.
May our daily pursuits not overshadow our main purpose. Amen

I shall now proceed to devour my hot bowl of Isi-ewu with a chilled glass of Malta Guinness. It's 10:30 at night and I can hear someone saying calories but who cares. #YOLO

Friendship

As we grow older, friendships evolve, wax and wane, come and go.
Sometimes by choice, sometimes not.
We love, we learn. We loose, we learn. 
Each time, we grow.
The important thing is to leave clean, to live clean.
Life is too short to carry grief and grudges.