Further Confessions of a GP. Benjamin Daniels

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СКАЧАТЬ not one of those sorts of men, Dr Daniels. He doesn’t really like to talk about his feelings. I’m sure he’d just clam up.’

      ‘Funnily enough, my wife might say the same about me, Maggie, but here we are talking about some quite intimate, personal things. Sometimes you just have to try and see what happens.’

      ‘I’ll give it a go over the weekend and give you a ring on Monday to let you know how it goes.’

       Maggie IV

      ‘Hello, I’m here to see Maggie.’

      ‘Come on in, Doctor. She’s just having a facial done, but go on through as the make-up girl is just finishing up.’

      It seemed odd to think of Maggie having a facial. I always considered her a robust Yorkshire lass and had never associated her with beauty regimes. As I entered the room, Maggie was getting the last of her blusher applied. I’m no expert on such matters, but it looked a bit overdone to me. Her cheeks were excessively rosy and her lips a dazzling ruby red. The young girl applying it looked up and gave me a smile. ‘The family are coming to visit soon so we want her to look nice, don’t we?’ She added those final dabs of blusher with genuine pride, although I did rather wonder if there might be good reason why she only applied make-up to the deceased rather than to the living.

      Despite the make-up girl’s best efforts, Maggie still had the yellow tinge all corpses seem to have. I’d come to complete the paperwork, and as the last doctor to see her alive I was supposed to do a final examination of her body. Maggie had been at the undertakers since Saturday afternoon and it was now Monday morning. If my examination revealed anything other than a diagnosis of death, something had gone very, very wrong.

      I nodded at the undertaker to confirm that it was definitely Maggie lying on the metal trolley in front of me. I left my stethoscope in my bag, but stuck on some gloves and had a prod between her ribs on the left side of her chest to make sure she didn’t have a pacemaker fitted. I knew Maggie’s medical history well enough to know she didn’t have one, but I checked just in case. We are always told that cremating a body with a pacemaker still inside can blow up the crematorium. I imagine this is in fact a bit of an exaggeration and it’s more likely that the grieving relatives don’t really want to find the remnants of charred batteries while spreading the deceased’s ashes over her favourite rose bushes in the back garden.

      I did mention to the undertaker that Maggie had had a silicone breast implant following her mastectomy some years before. There is no risk that the implants will blow up the crematorium, but they do leave a damaging sticky goo on the walls of the incinerator. Nowadays, most undertakers will remove them, which was an idea that tickled Maggie when she was alive. She told me she had suggested to her husband that he put her implant on the mantelpiece next to the urn containing her ashes, but apparently he hadn’t found it funny.

      I was going to miss Maggie. She had an amazing spirit that shone through and she always made me smile however gloomy our discussions. For all the amazing medical breakthroughs of modern years, once she received her diagnosis, all we ended up offering her were steroids and morphine. Both are cheap old-fashioned drugs that we’ve been using for decades. In their defence, the morphine gave her a pain-free death and the steroids probably gave her an extra couple of weeks. Maggie had promised me that she would try to open up to her husband, talk about her feelings and say goodbye to him. In the end, her condition deteriorated very quickly and just two days after she made me that promise she was gone.

      For those last few weeks I was Maggie’s confidant. I was someone outside the family to whom she could talk and on whom she could rely when she was in genuine need. It isn’t something ever taught at medical school. It can’t be measured or turned into a government target, but for those six weeks Maggie was my most important patient and although I was unable to cure her or prevent her death, nothing could make me feel more like a doctor than giving her my time.

      When I’d heard the news of her death, I’d phoned her husband Tony to offer my condolences. I’d suggested that once the funeral was dealt with, he might want to pop in and have a chat. He didn’t take me up on the offer, but a couple of weeks later he did leave an envelope for me at the reception. It was a photograph of Maggie looking young and carefree. Her head was tilted back and she was laughing at something. It really did capture her spirit beautifully. On the back it just said, ‘Thank you for everything you’ve done for us, love Maggie and Tony.’

       Can’t be too careful

      Tracey’s entrance was never quiet. Buggy, shopping and three boisterous children piled into my room in a swirl of chaos.

      ‘’Allo again, Doc,’ Tracey chirped cheerily. ‘You must be sick of the sight of us, eh?’

      ‘Not at all,’ I fibbed back. ‘So what brings you in today?’

      ‘Well, it’s all of us really,’ and with that Tracey listed various transient minor ailments that seemed to be causing her and her brood great concern.

      ‘This one’s the worst,’ she said, pointing at her son Bradley who was jumping most energetically off my couch. ‘He’s really poorly. Not himself at all. He’s right off colour, he is. We was up the ’ospital all Saturday with him. ’Ad to call an ambulance and everything, but after nearly four hours waiting around in A&E they just said he had a virus and sent us home with paracetamol.’

      Tracey spends a lot of time requesting medical attention. It seems that however many times either I or the other doctors offer reassurance, she needs more and will seek out medical help at the drop of a hat. I don’t begrudge Tracey her frequent attendances. Well, if I’m honest, at the time I often do, but in the cold light of day I can accept that she is trying to be the best mum she can be. She worries about her children like all parents do, and she doesn’t have the means to alleviate this anxiety without a trip to the doctor. For the last few years, I haven’t really paid much heed to Tracey’s frequent visits, but her name had now cropped up on our list of patients who attend A&E too frequently.

      As we all know, the NHS has no spare money and one of the directives for saving funds is to persuade our patients to stop going to the hospital so often. For each attendance at the emergency department around £70 is charged to the NHS, and that cost doesn’t change much whether the treatment is simply some gentle reassurance, as in the case of Tracey, or if 10 doctors wrestle to save your life after getting knocked down by a bus. Our GP surgery gets paid £65 a year to look after Tracey however many times she comes in. The simple logic is, therefore, that for minor ailments it is much cheaper for Tracey to see us at the GP surgery than for her to go to A&E. It also frees up time for the emergency doctors to see patients needing genuine emergency care! That is why my bosses were telling me to make an ‘action plan’ with Tracey in an attempt to prevent her from visiting the hospital so often.

      After painstakingly reassuring Tracey that she and her children were going to survive the morning, I decided there was no time like the present and I was going to make the ‘action plan’ with her this very visit. We discussed all sorts of options to reduce her hospital attendances. I started by suggesting that she phoned the surgery rather than dial 999.

      ‘But sometimes I ain’t got no credit on my phone,’ she replied.

      ‘You could also take a taxi to the surgery rather than keep calling ambulances to go to A&E.’

      ‘Taxi! How can I afford a bloody taxi?’

      Finally, СКАЧАТЬ