Further Confessions of a GP

It was 4 a.m. and I had just given myself a little hit of coffee and chocolate in an attempt to help drag myself through those last few painful hours of an A&E night shift. The caffeine was giving me palpitations and an odd buzzing sensation, but not successfully eradicating the overwhelming hazy blur of exhaustion. It had only been an hour since I had necked two cans of Red Bull, but I just needed one more coffee to help me muster the energy to see my next patient.

Despite having one wrist handcuffed to a prison officer and the other hand chained to the metal frame of the trolley, Kenny was, metaphorically, bouncing off the ceiling. The prison officer’s grey and expressionless face was in stark contrast to his prisoner’s, whose beaming grin and intense shining eyes were almost mesmerising. It was apparent that the drugs market within our local prison could provide stimulants considerably stronger than my vending-machine coffee and out-of-date Twix bar.

Kenny reached out his cuffed hand, but I paused. There is something about someone being handcuffed that makes me automatically think he must be horrendously dangerous. If I took his hand would he somehow be able to slip out of his cuffs and take me hostage? Being taken hostage by a drug-crazed prisoner is a scenario I would handle particularly badly. Looking Kenny up and down, I realised that my sleep deprivation was making me paranoid. Kenny really didn’t look very dangerous. He was scruffy and scrawny, but his missing teeth didn’t inhibit his childlike smile. I reached out my hand and he gave me a warm and enthusiastic handshake.

‘I’m Kenny, but all my friends call me Crackhead Kenny.’

‘I’m Dr Ben, but all my friends call me Big Nose Benny.’

I instantly regretted the informality of my response, but I often find myself slightly less reserved during the early hours of the morning. It’s as if patient-doctor etiquette has a vaguely different set of rules at night. Either that or I simply become increasingly inappropriate the more sleep deprived I become.

‘I reckon my nickname trumps yours,’ Kenny declared triumphantly.

‘I suppose, but you’ll have to change yours when you stop taking crack. I’ll always have a big nose.’

‘True,’ he nodded. ‘But I reckon I’ll always be Crackhead Kenny,’ he added ruefully

I wanted to ask Kenny why he was in prison, but it was none of my business really, so instead I stuck with the more conventional question of why he was in hospital.

‘Well, I fell over and these clowns are covering their arses, so they wanted me in here for a check over.’

I looked over to the prison officer for some sort of response but his face remained expressionless. I wondered exactly what it would take to prise any sort of emotion out of him.

I started scanning Kenny’s medical record and noticed with some surprise his date of birth.

‘We’ve got exactly the same birthday.’

Kenny looked at me oddly.

‘We were both born on 6 March 1977.’

‘We’re time twins!’ Kenny shouted enthusiastically.

‘Yes, we are,’ I replied smiling, unable not to be caught up in Kenny’s infectious drug-induced gusto.

‘I tell you another thing we’ve got in common, Dr Ben. As a boy I always dreamed of being a doctor. I wanted to do something good with my life. I really wanted to help people and make them better. I also liked the idea of driving a nice car and flirting with lots of sexy nurses.’ He gave me a wink. ‘Although I think I might have left it a little late now,’ he added ruefully.

‘It’s never too late to flirt with the nurses, Kenny, but I’d give our charge nurse Barry a wide birth. He’s a grumpy old bugger.’

‘Yeah, I spotted him on my way in. Perhaps a career in medicine isn’t for me after all.’

Maybe it was just too much emotion caused by lack of sleep, but I couldn’t help but feel a connection with Kenny. Sharing a date of birth is fairly insignificant really, in the big scheme of things, but at four in the morning during our peculiar substance-enhanced encounter, it seemed to hold some meaning.

I imagined us both as small babies, beginning our lives on that same day. We would have started off similarly enough as two equally innocent infant boys, new and full of potential. Our first steps and first words would have coincided and at some point during our childhoods we both decided that we wanted to be doctors. What had ebbed away at Kenny’s potential while mine was being steadfastly encouraged?

After giving Kenny a quick check over, I wandered out to the nurses’ station where Barry the charge nurse was slumped in his chair looking unshakably miserable. I told him about the connection I’d made with my time twin and reflected on why and how our lives had taken such different paths.

‘He’s just a smack head who happens to share your birthday. Stop being a sentimental twat and get some work done. Most importantly, get him discharged before he comes down off whatever he’s taken and starts kicking off.’

As I finished writing up his notes, the prison officer walked Kenny out of the department to his waiting van. ‘My carriage awaits!’ he exclaimed giving me a regal wave with his non-cuffed hand. ‘See ya later, Big Nose Benny.’

‘Nice meeting you, Crackhead Kenny.’

Maggie I (#u305ef69c-c570-58ae-a7fc-8c02eeb06cd6)

‘It’s my leg, Doctor. It doesn’t really do what I want it to do. It’s as if it’s not really part of me any more.’ Maggie tried to crack a smile but I could see she was really scared.

‘Right, let’s have a look then.’

Maggie was quite right. Her left leg wasn’t doing what it was supposed to be doing. She could sort of move it, but her coordination was shot and she had resorted to walking with a stick.

‘I’m walking like an old lady, but I’m only 56. It just came on over the weekend and it’s getting worse.’

Maggie was clearly looking for some reassurance, but the truth was that I was worried too.

‘We need to get this looked into,’ I said, stating the obvious.

I’d met Maggie a few times, but usually only when she was accompanying her husband for his blood pressure appointments.

‘Any medical problems in the past?’ I asked as I scanned through her notes.

‘No, I’m fit as a flea. Well, I had breast cancer in 2003, but that’s long gone. It can’t be anything to do with that.’

I looked up from my computer screen and she held my gaze. I was trying to find words that might be both reassuring and honest, but before I could even open my mouth, Maggie was crying.

‘The breast cancer’s all gone,’ she blubbed, trying to convince herself more than convince me. ‘They discharged me from the clinic five years ago.’

‘It may well be nothing to do with the breast cancer, but let’s just get some tests done.’

Maggie clearly needed to see a specialist and have a scan. She didn’t really need to be admitted to hospital that morning, but then it wasn’t appropriate to make her wait two weeks for an outpatient appointment either. When stuck with this sort of quandary, I generally default to the ‘What would I want if it was me?’ option. This turned the decision into a bit of a no-brainer and I phoned the medical consultant on call who agreed that she should go straight up to the hospital.

Sometimes it’s really satisfying to get a diagnosis right, but I took no pleasure in having my suspicions confirmed this time. Maggie’s leg symptoms were due to her breast cancer returning. It had already spread extensively and it was lesions in the brain that were causing her leg symptoms. After being told the result of the scan she was discharged with some steroids.

Maggie had still been in a state of shock when they’d given her the diagnosis in hospital, so she made an appointment with me to go over a few things. First of all she wanted to know how the cancer had lain dormant for all those years before coming back. I would like to have been able to answer that question, but the truth was I just didn’t know. It wasn’t something she’d done wrong; it was just one of those awful facts about cancer. Sometimes we think we have beaten it, yet somehow this horrible disease has a dirty habit of reappearing. Maggie hadn’t even noticed a breast lump, but by the time she had her scan there were cancerous lesions in her liver, bones and brain. The cancer specialist offered her some chemotherapy that might temporarily shrink the tumours, but he made it very clear that he could offer her no cure.

‘What now?’ was her next question.

Again, this was a hard one to answer. ‘We’ll get the palliative care nurses involved and will always make sure that you’re never in pain or distress with the symptoms. You might remain stable and fairly well for some time …’

‘But basically I’m going to die.’

I thought about trying to counter that remark with something upbeat and positive, but in reality Maggie was right. She was going to die and I couldn’t say anything that would change that fact. I stayed quiet, handed her a tissue and put my hand on her hand. We sat in silence for a few moments while she sobbed. After she left, I made myself a quick cup of tea, splashed some cold water on my face and pulled myself together enough to see my next patient.

Brian and Deidre (#u305ef69c-c570-58ae-a7fc-8c02eeb06cd6)

Every couple of months or so the surgery shuts for an afternoon and we have some sort of educational session. It’s an attempt to keep us up to date and make us better doctors. The most recent education afternoon was on the topic of sexual health. A lady with a colourful silk scarf and ethnic sandals was talking to us about the importance of sexual identity.

‘How often do you see your patients as sexual beings?’ she asked. ‘How often do you consider how the medications you prescribe might affect the sexuality of your patients?’ I had to admit that the answer to both of these questions was ‘never’. I knew that some medications could affect libido and erections, but I tended to avoid discussing it with patients if I could. This was all going to change from now on, though, I decided. The sex therapist lady was right. There was no point lowering a patient’s blood pressure if I was going to ruin his relationship because my drugs were inhibiting his erections.