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!