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)