The Perfect Treatment

‘There’s every indication that he’s going to be all right,’ Dr Contini reassured her gently, while Abby looked at him surreptitiously with new eyes.

Yes, it was clear that he could be charming. She wondered momentarily what it would be like to be the object of that charm, that warmth and undivided attention. Perversely, uncharacteristically, she found herself longing for it—almost as though the incident with Will Ryles had jolted her out of a deep sleep, like Sleeping Beauty in the fairy-tale—then brought her face to face with the prince. Snap out of it, Abigail Gibson, she admonished herself once again. Get real!

‘Thank you for saying that,’ Mrs Ryles said tremulously, trying to inject some hope into her voice. ‘Here I am, going on about our affairs, but what about you, Blake? How’s Kaitlin? Any change there?’

‘No, nothing,’ Dr Contini said heavily.

‘Is there likely to be?’

‘I doubt it very much.’

As Abby made her way to Outpatients a little later, she puzzled over that last brief verbal exchange. It was evident that Dr Contini had known Dr Ryles and his wife for quite a long time.

She sighed, looking at her wristwatch and making an effort to shift her thoughts to the work ahead in the clinic. She was looking forward to it.

It was only too easy to become obsessional about the internal politics of a hospital, which were so closely connected to the broader political scene. It could sap one’s energy. Although it was of concern to her, as much as she knew that one had to get involved in some degree, she did not have time for that right now.

Who, she wondered, was Kaitlin? The question nagged at her persistently…as did the tone of Blake Contini’s voice when he had replied, ‘No, nothing.’

The voice had sounded dead, devoid of all emotion.

Dr Wharton’s clinic was well under way when she got to Outpatients. The young family practice doctors like herself were given new patients to see so that they could take detailed histories, do extensive physical examinations, order blood tests, urine tests, X-rays if necessary, and anything else that might be required before the consultant in charge—in this case Dr Wharton—saw each patient to confirm, or call into question, the preliminary diagnosis. This system saved the senior GPs a lot of time, as well as being a good training exercise for the young doctors, who were themselves MDs.

‘Morning, Sue’ Abby smiled at the receptionist sitting behind the desk off the main waiting room in the family practice unit. ‘Sorry I’m late. Anything interesting for me? I have to leave again for a while just before eleven o’clock to see a patient on 2 East, one of Dr Contini’s patients that I missed at the rounds. Is he—does he—Dr Contini, that is—have many patients here this morning?’

Although Abby felt her face flushing as she asked the question, and still feeling somewhat disturbed by all that had happened already that morning, it was good to be in the relative peace of the family practice clinic. Abby felt herself beginning to relax, her habitual confidence returning. This was her territory.

‘Hi, Dr Gibson.’ Sue, the young, efficient receptionist smiled back. ‘It’s going to be one of those days, I think. Lots of interesting cases for you to get your teeth into. Here’s your first.’ She handed over a folder that contained the patient’s basic statistics and initial complaint. ‘Dr Contini has a couple of patients to see. He told me he’d be available for any consultations here if anyone wanted him.’

‘That’s really great! Maybe I’ll take advantage of that offer, if Dr Wharton’s busy. Thanks.’ Abby took the folder, glancing at it to see the patient’s name and feeling an upsurge of anticipation at working in the same unit with Blake Contini, even though it was an anticipation tinged with remnants of irritation.

Dr Wharton would be there in the unit, plus two other family practice MDs in training like herself. At the moment there was no sign of them—no doubt they were already in the offices assigned to them, seeing patients.

‘Mr Barlow,’ she called out across the waiting room, ‘Gary Barlow.’

A thin man, wearing an old raincoat, got up from a chair, nodding to Abby. ‘This way, sir,’ she said. Leading the way, she proceeded to the small examination room which was to be her office for the duration of the clinic.

‘Take your coat off, Mr Barlow. Have a seat there next to the desk. I’m Dr Gibson. I’ll be seeing you first—taking a history, doing an examination—then Dr Wharton will see you.’

With the folder open on the desk in front of her, she read the chief complaint that this patient had. ‘Chronic bronchitis’ it read, followed by a question mark, then ‘Persistent chronic cough.’ That would have been written by Sue from the patient’s own description of what was wrong with him. Many of their patients came there without any reference letter from any other doctor; they simply telephoned the hospital, asking to see a GP. Many had never had a family doctor.

Mr Barlow, in his fifties, was thin and tired-looking, with a drooping face of loose skin that reminded Abby of a bloodhound. The top of his head was bald. In general, he did not look particularly healthy. He sounded slightly breathless from the simple effort of having walked from the waiting room and taken off his coat. He sat down heavily in the chair next to her desk. Abby took some history sheets from the pile on her desk to add to the file, prepared to do a fair amount of writing.

‘It says here that you have a chronic cough, Mr Barlow,’ she began, her pen poised above the paper, ‘Tell me when that first started, and any other symptoms associated with it.’

For the next few minutes she wrote busily while he talked. It seemed to her that he was trying to minimize the length of time he had had the cough, as well as his level of concern about it. He said he had had a cough for about a year, then it had got worse over the winter, showing no signs of going now that spring was here. He was the sort of man, she suspected, who would not go to a doctor for many years, then would only go finally when symptoms were such that he could not ignore them and his level of anxiety got to a point where he could not think of much else.

‘And do you smoke, Mr Barlow?’ Abby looked up.

‘Yes,’ he said.

‘For how many years have you smoked?’ she asked, keeping her voice neutral with no hint of judgement. ‘And how many cigarettes a day?’

‘Well…’ he said, thinking back, ‘I reckon I had my first cigarette when I was about fifteen. Now I smoke about forty a day, give or take a few.’

My God! Abby thought, keeping her face impassive as she wrote again. It was difficult to imagine getting through that many in one day, yet some people, she knew, got through more than that. ‘For how many years have you smoked forty a day?’ she asked, looking at him and watching his pale, watery eyes go blank as he stared across the room, trying to remember back that long.

‘Oh…’ He hesitated. ‘I suppose it must be at least ten years…about that.’

She wrote down the statistics. ‘When did you last have a chest X-ray?’ she said.

‘A chest X-ray?’ He looked surprised. ‘I’ve never had one.’

It never ceased to amaze Abby that many people who smoked heavily could tune out all the publicity and the statistics that were everyday knowledge about smoking and lung cancer. It was as though by some mental gyration they could dissociate it all from themselves, almost as though for health purposes they lived on another plane. That ability, if one could call it that, was very common, of course…and not just with smoking and lung cancer. It certainly applied also to hepatitis and AIDS, particularly among the population taking street drugs.

Maybe she shouldn’t be surprised, really, as nicotine was a powerful drug of addiction, although it was frequently not thought of as such. It produced a craving from which it was not easy to break free. Again, she was careful not to inject any hint of judgement in her tone. Sometimes patients would get up and leave if there was any hint of negative judgement about their behavior, past and present.

‘When did you last see a doctor?’

He hesitated, calculating. ‘Not for a long time. Never needed to,’ he asserted, with a hint of defiance. ‘Must have been about ten years ago, I guess. Had a tooth abscess. Had to have it pulled out. The guy gave me a quick once-over, then sent me to a dentist.’

‘I see,’ Abby said, writing that down. ‘Any other health problems?’

‘Nope,’ he said.

‘What about your general health? Your appetite?’ For the next little while she questioned him about the present, then went on to his medical history, starting from as early in his life as he could remember. Apparently he was one of those men who took his bodily functioning, his health, entirely for granted, having only a very rudimentary knowledge of the anatomy and physiology of the human body.

Abby filled in a requisition form for a chest X-ray, to be done that day in the hospital. If she didn’t get it done now he might never come back, especially if he got scared—any more scared than he was now. She did not want to give him a hint that he might have lung cancer, the possible diagnosis that was uppermost in her mind. He could also have chronic emphysema, a lung disease brought on by repeated chest infections, as well as by smoking. This disease also affected the heart.

She also filled in requisition forms for some basic blood work, to be done in the hospital labs. Chronic smokers were often anemic, as well as suffering from various vitamin deficiencies, as they were frequently poorly nourished. Smoking tended to dull the appetite and become a substitute for food.

‘I want you to have a routine chest X-ray this morning, Mr Barlow,’ she said, ‘as soon as we’ve finished seeing you here. I’ll call them to fit you in right away.’ There was no way she was going to let him get out of the hospital without one. ‘And I want to have some blood tests done as well, then we’ll see you here two weeks from now with the results.’

‘Ok,’ he said, a certain bravado in his voice. ‘Have I got bronchitis?’

‘I’ll be better able to answer that question maybe when I’ve examined you,’ she said, ‘which I’m going to do right now. I want to listen to your chest, take your blood pressure, and so on. I’d rather wait for the chest X-ray before saying anything definite.’

The lungs did not expand well. Abby listened to the breath sounds in those lungs as she placed her stethoscope here and there on her patient’s chest when he was lying on the examination couch a few minutes later. It was probable that he did have a chronic lung disease, bronchitis or emphysema, which did not rule out cancer as well. There was also the possibility of tuberculosis, which was increasing in prevalence these days.

When she had done a very thorough examination, she lifted the telephone to tell the receptionist that she was ready for Dr Wharton to see her patient.

‘He’s just gone in with one of the other young doctors,’ Sue informed her. ‘Dr Contini might be free between his cases. Would you like him?’

‘Oh…um…yes, if that’s all right with Dr Wharton.’ Abby felt herself to be a little flustered, not a state to which she was accustomed. Indeed, she prided herself on her sang froid.

‘Dr Wharton’s in full agreement,’ Sue said chirpily, giving Abby the impression that the receptionist was coming under the influence of the new head of medicine. ‘He’s running late, and Dr Contini wants to learn the ropes here.’

While waiting for Dr Contini, Abby called the X-ray department to make an appointment for Gary Barlow, stressing that she needed it done that morning, soon. As a chest X-ray could be done very quickly, they gave her a time which would coincide with the end of Mr Barlow’s appointment in Outpatients. Considering that he might leave the hospital without the X-ray she resolved to escort him to the X-ray department herself.