Rather than springing up into life-saving action, I heaved myself out of my blissfully comfortable chair and ambled down to the waiting room. Over the last ten years that limitless enthusiasm had been gradually broken down and replaced with a defeated resignation. I took no satisfaction in this time getting my diagnosis spot on. Still waiting for that spontaneous pneumothorax to heroically cure, I was greeted instead by one of our local street drinkers in a drunken stupor in the childrens play area of the waiting room. Using the expertise I perfected during endless Friday and Saturday night shifts in the ER, I skilfully escorted the intoxicated man from the surgery back on to the street.
In a wave of sad nostalgia I wondered what that naïve 18-year-old me would think about what he had become. Would I have even bothered to have gone on to study medicine if I could have foreseen how so much of that initial hope and optimism would drain away? Not even out of my twenties yet, I began to wonder if being a doctor was anything close to the career I thought it was going to be. As I returned the drunk homeless man on to the street, I offered him an appointment to come back and see me the following morning when he was sober, explaining about organising an alcohol detox. Ill be there, Doc, he told me as he shoved the appointment card into his pocket. We both knew that hed miss that appointment, but at least we were mutually left with a faint glimmer of hope for something better.
Please dont imagine that this book is about me looking for sympathy or commiserations about my broken dreams, or assume that I have lost my empathy and respect for the people who expectantly seek my help or advice. I guess its just that the often grim reality of practising inner city medicine is not quite what I had expected it to be. I no longer dream of miracle cures and magic bullets and I have definitely given up waiting to dramatically re-inflate that collapsed lung. Instead, I acknowledge that my role is to listen and share the pains, concerns and sufferings of the people who sit before me. I offer the odd nugget of good advice and provide some support at times of need. Perhaps just occasionally I even make a small difference in someones life. The intention of this book is simply to give an honest but light-hearted insight into some of the joys, frustrations and absurdities of being an inner city doctor in modern Britain. I hope you enjoy it.
I have been doing this job for 3 years and I genuinely love it. I like the variety and getting to know my patients. I find it challenging and rewarding. Sometimes I even make a diagnosis and cure someone! Im currently working as a locum which means that I work in different parts of the country, covering other family doctors when they are away. I also still do some shifts as an ER doctor from time to time. Some of my posts have just been for one day, others have been for over a year and I get to see the good, bad and ugly side of doctors, patients and the British National Health Service. I love my job and think that it is one of the most interesting out there. I hope that after reading this book you might agree with me, or if not at least realise that it isnt just about seeing coughs and colds.
Mrs Peacock
Like parents, doctors are not supposed to have favourites but I have to admit to being rather fond of Mrs Peacock. She is well into her eighties and her memory has been deteriorating over the last few years. Most weeks she develops a medical problem and calls up the clinic requesting me to visit. When I arrive, the medical problem has been resolved or at least forgotten and I end up changing the fuse on the washing machine or helping her to find her address book, which we eventually locate in the fridge. As I tuck into a milky cup of tea and a stale coconut macaroon, I reflect that my medical skills probably arent being put to best use. I imagine the grumbling taxpayer wouldnt be too pleased to know that having forked out over $350,000 to put me through my medical school training, they are now paying my high wages in order for me to ineptly try to recall which coloured wire is earth in Mrs Peacocks ageing plug.
Mrs Peacock needs a bit of social support much more than she needs a doctor so when I return to the surgery I spend 30 minutes trying to get through to social services on the phone. When I finally get through, I am told that because of her dementia, Mrs Peacock needs a psychiatric assessment before they can offer any social assistance. The psychiatrist is off sick with depression and the waiting list to see the stand-in psychiatrist is three months. Im also reminded that Mrs Peacock will need to have had a long list of expensive tests to exclude a medical cause for her memory loss. Three months and many normal test results later, Mrs Peacock forgot to go to her appointment and had to return to the back of the queue.
Through no fault of her own, Mrs Peacock has cost the health service a small fortune. Her heart scan, blood tests and hospital appointments all cost money and we doctors dont come cheap, either. Mrs Peacock does have mild dementia but more importantly she is lonely. She needs someone to pop in for a cup of tea from time to time and remind her to feed her long-suffering cat. It would appear that this service is not on offer, so, in the meantime, Ill continue to visit from time to time. When the coconut macaroons become so inedible that even the hungry cat wont eat them, Ill think again about trying to get Mrs Peacock some more help.
Tom Jones
The term presenting complaint is what we use when we describe what the patient comes in complaining about i.e. the patients words rather than our diagnosis. Normally as a doctor the presenting complaint will be back pain or earache or not sleeping. Elaine Tibbs presenting complaint was different. When I said, Hello Miss Tibbs. What can I help you with today? she said, Im having pornographic dreams about Tom Jones. Her words, not mine.
For the more common presenting complaints, most doctors will already have a check list of questions in their heads. For example, a female patient says, Ive got tummy pain and I say, Where, and for how long? and Have you got any vaginal discharge? When faced with the presenting complaint of pornographic dreams about a celebrity, I was left hopelessly speechless. When discussing Elaines sexual fantasies, I was very keen not to know where, for how long and if there had been any vaginal discharge. Unfortunately, I didnt get a chance to point this out to Elaine before every minuscule aspect of the dreams was described in surprisingly graphic detail.
I am rarely left speechless by a patients opening gambit, but as with Elaine, there are always a few that do leave me at a complete loss. My personal favourites are:
When I eat a lot of rice cakes, it makes my wee smell of rice cakes;
I masturbate 10 to 15 times per day what should I do?
I ate four Easter eggs this morning and now I feel sick;
My husband cant satisfy me sexually;
When I was in church this morning, I was overcome by the power of the Lord;
I think my vagina is haunted.
Elaine is a classic example of someone that we doctors see fairly regularly. She was odd and eccentric, but not quite mentally ill. She was slightly obsessive and delusional but not really harming herself or anyone else. Admittedly she didnt work, but she functioned reasonably well from day to day and didnt really have any insight into the fact that other people found her to be a tad unusual. Instead, Elaine generally saw most of the rest of the world as slightly peculiar and felt it was just her and, of course, her darling Tom Jones who were the only normal ones. Looking through her patient records, I noted that she did once see a psychiatrist a few years back. He diagnosed her as having some abnormal and obsessive personality traits but no active psychosis. This is psychiatry speak for slightly odd but basically harmless
When I eat a lot of rice cakes, it makes my wee smell of rice cakes;
I masturbate 10 to 15 times per day what should I do?
I ate four Easter eggs this morning and now I feel sick;
My husband cant satisfy me sexually;
When I was in church this morning, I was overcome by the power of the Lord;
I think my vagina is haunted.
Elaine is a classic example of someone that we doctors see fairly regularly. She was odd and eccentric, but not quite mentally ill. She was slightly obsessive and delusional but not really harming herself or anyone else. Admittedly she didnt work, but she functioned reasonably well from day to day and didnt really have any insight into the fact that other people found her to be a tad unusual. Instead, Elaine generally saw most of the rest of the world as slightly peculiar and felt it was just her and, of course, her darling Tom Jones who were the only normal ones. Looking through her patient records, I noted that she did once see a psychiatrist a few years back. He diagnosed her as having some abnormal and obsessive personality traits but no active psychosis. This is psychiatry speak for slightly odd but basically harmless
He does love me, you know, Doctor. If he met me, he would know it straight away. Were made for each other.
Isnt Tom Jones happily married and living in California?
No no no! He loves me, doctor. Elaine would have happily spent all afternoon telling me about her Tom Jones fantasies, but I felt that we needed to move things on. I used the classic doctor phrase that we pull out of the bag when we feel that were not getting very far. So Elaine, what are you hoping that Im going to do for you today?
Well, doctor, I need you to write Tom a letter. It would sound better coming from you. Hes a doctor as well. Well, not a real doctor, but Im sure hed be a wonderful doctor if he wanted to be. Hes very kind you know and oooh so gorgeous and anyway, Im sure if you just explained everything he would see sense, I know he would.
Basically, I was being asked to stalk Tom Jones on Elaines behalf. I could imagine the letter.
Dear Tom,
Please will you leave your wife, family and LA mansion and move into a run down 1 bedroom apartment with a slightly odd woman with straggly hair and a duffel coat that she has been wearing since 1983. It will make my life slightly easier as she wont keep coming to the surgery and annoying me with her graphic descriptions of your imaginary sex life.
Best wishes,
Dr Daniels
Stalking is defined as a constellation of behaviours in which an individual inflicts upon another repeated unwanted intrusions and communications. Elaine probably would have quite liked to have stalked Tom Jones, but I dont think she really had it in her. For Elaine, her problems with relating to everyday folk had resulted in her focusing all her energy on an imaginary relationship with a person whom she would never meet. I guess this was a good way to protect herself from the struggles and potential rejections of real-life relationships. Whatever the psychological explanation, Ill never be able to listen to Its Not Unusual in quite the same way again.
First day
I can still remember my first day as a doctor very clearly. It is something that I had been looking forward to since I first made the decision to study medicine eight years earlier. Now the actual day had finally come I was absolutely shitting myself and wondering if I wanted to be there at all. We spent most of the first day having induction-type talks. These consisted of a fire safety talk and an introduction from a medical lawyer on how best not to get sued. Not particularly confidence boosting.
As the induction day drew to a close, most of the other new doctors went to the pub. Not me though. I was doing my first on call on my first-ever night as a doctor. This may have been the short straw for some but, although frightened, I was excited and keen to get my first on call over with. This night would be the making of me, I thought to myself. By this time tomorrow, I would be feeling like an old pro and be regaling heroic stories of my lifesaving antics to my admiring colleagues in the pub. It was going to be like losing my virginity all over again. My brand-new shirt was ironed and although a couple of sizes too big, my white coat was starched and gleaming. I had a sensible haircut and a stethoscope round my neck. I looked at myself in the mirror astounded that I really was a doctor!
I picked up my pager at five that evening and sat there looking at it timidly. This small black box would come to be hated by me during my future years as a hospital doctor. This box would wake me from sleep and interrupt my meals. When completely overloaded with work and feeling like I couldnt cope, this small inconspicuous little box would bleep and tell me that I had another five urgent things to deal with. Of course I was unaware of all of this on that first innocent evening. Instead, I had a naïve excitement that I was finally considered important enough to have my own pager and that it might actually go off. I had been practicing how I should best answer it:
Hello, its Dr Daniels, vascular intern.
Thats right, my first job was as the junior in the vascular surgery team. I didnt really know what vascular surgery was, but I liked the sound of it. Perhaps I could drop the intern bit and just answer by saying: Hi. Dr Daniels, vascular surgeon. Hmm, that would sound much more impressive. I could just picture the attractive nurse swooning on the other end of the line.
To my surprise, at about ten minutes past five my pager did go off. I took a deep breath and answered the call: Hi. Dr Daniels, vascular surgeon. There was a sigh from the other end of the telephone. It was not a beautiful swooning nurse but was instead my consultant and new boss. You are not a vascular surgeon, you are my most junior and least useful helper monkey. Some poor bastard has popped his aorta and Im going to be in theatre all evening trying to fix him. I need you to order me a chicken chow mein, a sweet and sour pork and two egg fried rice. Have them delivered to theatre reception. The phone went dead. That was it. All those years of study and my first job as a doctor was to order a Chinese takeaway. Consultant surgeons have a wonderful way of ensuring that their junior doctors dont get above themselves.
Over the next hour my pager started going off increasingly frequently until it built up to what felt like a constant chorus of bleeps. Jobs that would take a few minutes for me to do now, took an hour back then because I was so new and inexperienced. I decided that the cocky doctor role didnt suit me so I went for the pathetic vulnerable new doctor approach. It worked and the nurses soon began to feel sorry for me. They offered to make me tea, showed me the secret biscuit cupboard and helped me find my feet. Just as I was beginning to gain a little confidence, my pager made a frightening sound. Instead of the normal slow, steady bleep there was a stream of quick staccato bleeps followed by the words Cardiac arrest Willow ward Cardiac arrest Willow ward. To my horror, that was the ward that my consultant covered. That meant that I should really be there. I started running. The adrenaline was pumping, my white coat was sailing behind me as I zipped past people in the corridor. I was important. It felt great! Suddenly, as I got closer to Willow ward, a terrifying thought dawned on me, Oh my God. What if Im the first doctor there!!!! Ive only ever resuscitated a rubber dummy in training exercises. Ive never had to do the real thing. To my left was the staff restroom. Doubts began to race through my head. Perhaps I could just nip in there and hide for a bit. I can reappear in a few minutes once the cavalry has arrived. It was tempting, but I bravely decided to keep on running and meet my fate.