Nathan and I became trapped in a folie à deux, in which he came to see me for reassurance and I encouraged his behaviour by offering him a test that gave him a brief respite from his fears when the result come back as normal. Round and round we went, but I decided it was going to stop today.
Nathan, you dont need an HIV test because you dont have HIV. Youre a healthy 17-year-old lad and you need to stop worrying about your health.
I reckon Id just stop worrying if you gave me an HIV test.
Im going to refer you to a therapist. To address your excessive health concerns. You need help to find ways to stop worrying about your health so much.
Nathan looked at me blankly and then quietly left my room. He didnt ever go to see the therapist I referred him to, but instead went and got an HIV test from the walk-in sexual health clinic. I guess that I ultimately failed in my plan to break the cycle, but on a more positive note Nathan does seem to be coming in to see me less frequently. Perhaps hes better at dealing with his health phobias. Or perhaps hes just given up on me and is sitting at home terrified that he is about to die from the latest of his perceived ailments.
Nathan looked at me blankly and then quietly left my room. He didnt ever go to see the therapist I referred him to, but instead went and got an HIV test from the walk-in sexual health clinic. I guess that I ultimately failed in my plan to break the cycle, but on a more positive note Nathan does seem to be coming in to see me less frequently. Perhaps hes better at dealing with his health phobias. Or perhaps hes just given up on me and is sitting at home terrified that he is about to die from the latest of his perceived ailments.
Army medical II
It was a year after I had completed the army medical for Lee. He still looked like a young boy, but something had changed in him.
Im due to go back for my second tour in Helmand, Dr Daniels, but I dont want to go. Can you write something to say I cant go back?
I guess I can try. Was it really bad out there?
It was terrible. All my friends back here keep asking me is if I killed anyone. I dont even think I ever saw a Taliban to shoot at, let alone kill. All I saw on patrol were kids and women and old people, but every step youre wondering if a sniper is going to get you. Every time you see a kid you wonder if theyre going to blow themselves up. They look at you like youre scum and the women shout at us in their language and spit at us. Being in the vehicles was even worse. Imagine being in a vehicle that gets blown up by an IED [improvised explosive device] and catches fire. You either stay inside and burn or you try to get out and a sniper shoots you.
He went on: My mates think it sounds exciting, but I was scared the whole time even though most of the time nothing happens at all. Even during down time I couldnt relax. All the worrying made me ill. My bowels were all over the place and I barely slept. Some of the other guys in the battalion took the piss out of me, but I know they were scared as well. I just cant go back there. Since Ive been back Im just angry all the time. Please dont make me go back.
Lee, I can try writing something, but ultimately its the army doctors who get to decide, not me.
I wrote a long letter stating that I believed Lee had post-traumatic stress disorder. They might dismiss it outright given that Lee hadnt really even seen much action, but he did have all the symptoms. He couldnt sleep, was having flashbacks and experiencing continually high levels of anxiety.
Lee was worried that I would think him a coward, but the thought didnt cross my mind. Ive never been in the situation where my levels of bravery have been tested. Who knows how Id cope in the environment of frontline Afghanistan, never being able to close your eyes and go to sleep without a little part of your brain knowing that a rocket could come flying through the window or a Taliban disguised as a police officer could shoot you while you slept. Why some people cope in that situation and others dont, Im not sure, but Lee was my patient and he wasnt faring well. My letter concluded with the statement that I thought Lee was not safe for frontline duties and could be a danger to himself and his battalion. I hoped the army might believe me and give Lee a medical discharge.
Lee didnt have to wait to find out if the army would discharge him on medical grounds. He got into a fight with some local lads in the town centre and his punch put a 16-year-old boy in intensive care. He is on remand and looking at a likely one-year stretch in prison. I havent seen him since, but his mums optimism about him going into the army to keep him out of trouble seems a sad irony now.
Betty Ferrari
I was working in A&E again. As I arrived for my shift my heart sank as I spotted the queue of ambulances sat at the entrance. Each paramedic crew was patiently waiting to offload their patient into a department that was already completely full. Barry was in charge today, and he was looking very flustered as he tried to move trolleys in and out of cubicles in a gallant attempt to make space when there was none. The phones were all ringing at once and it felt like a scene from a disaster movie.
At times like this, each new patient being brought in feels like an extra mouth to feed when there is already not enough food to go round. The doctors and nurses collectively groan as they witness each new admission being wheeled in. The poor patient sitting on the ambulance trolley needs help, time and care, but this can often be lost when the staff are in such a flap simply trying to manage the impossible task of fitting 50 patients into a department with 30 beds.
Theres a bed crisis, one of the nurses mouthed to me as if to try to explain the madness that I was walking into. There was a time when a bed crisis was considered to be a rare, traumatic event, but now we just seemed to run on the assumption that there was always a bed crisis, which makes the phrase meaningless.
Fortunately for me, I wasnt responsible for managing the bed issue. I was simply there as a foot soldier. My job was to see and treat the patients as effectively and efficiently as I could. I blanked out the noise and chaos and picked up the medical notes of the next patient to be seen. To my surprise it was a patient I knew very well and, if Im honest, was probably my favourite patient at my practice. One of the odd perks of being both a GP and an occasional A&E doctor is that I sometimes meet my primary care regulars when they have an emergency and end up in casualty.
Betty was a great character, well known to all the staff at my practice. She had a loud cackling laugh and called everyone darling. She made sure to buy the practice a bottle of sherry every Christmas and would flirt outrageously with any man aged between 16 and 100. Betty had worked the boards as a cabaret performer for years and I loved visiting her flat and seeing the old black-and-white photos of her from the late 1940s looking glamorous. Her stage persona was Betty Ferrari, which sounds like the name of a drag act now, but back in the late 40s, she assures me, it was alluring and exotic. I was married to the stage and I was monogamous! That was her way of telling me that she never settled down or had children. With no family, Betty was lonely. I visited as often as I could. If we had medical students attached to the surgery I would bring them to meet her. I told them she had an interesting medical history but the real reason for the visit was because she loved the company and revelled in performing a few of the old numbers for a new audience. Unfortunately, these days her bad lungs mean she rarely finishes a song without being interrupted by a coughing fit.
Back in those original photos the cause of her current suffering could be clearly seen. In each picture she was holding a cigarette holder with the cigarette itself shrouding her in a swathe of smoke.
We used to think we were so sophisticated, Betty told me, and I loved the sexy husky voice the smoke gave me.
You could still give up, I often told her.
Too late now, darling, she would reply with her husky laugh.
It was no real surprise that Betty was here in hospital. She had been in and out of the emergency department seven times in the last six months. Each admission was for the same complaint. Her lungs just couldnt get enough oxygen into her blood stream. On each occasion she was admitted for a few weeks, given oxygen, steroids and antibiotics and then sent home. She had all sorts of inhalers, but despite everyones best efforts, an infection would cause her lungs to deteriorate again and she would be back in hospital. We couldnt give her oxygen in her flat as she still smoked and so the risk of her accidentally igniting the oxygen supply and blowing herself up was too high.
Betty was sitting up on the trolley leaning forwards. She was struggling to breathe and had an oxygen mask tight round her face. She was in a hospital gown that covered her front but was left open at the back displaying her ribs and shoulder blades protruding through tired pale skin. Betty was so short of breath that she couldnt really answer my questions. She had been sitting in this cubicle for the last two hours waiting for a doctor to come and see her. As the mayhem increased around her, Bettys breathing had become steadily worse. All alone, unable to shout or call for help, she was simply focusing all her attention on trying to get enough air into her lungs to stay alive. When I walked in I saw the recognition on her face. She tried to tell me something but the effort was too much and instead she gently shook her head and grasped my hand.
Betty had been short of breath ever since Id known her, but I had never seen her look this bad. Watching someone unable to breathe is horrendous. How it must feel for the poor sufferer I cant imagine and I was finding it difficult to watch Betty suffer so terribly in front of my eyes.
The department was chaotic, but Betty was sick and needed expert help. I started her on a BiPAP, a machine that helps the patient to breathe more easily, and called the doctors from intensive care. Betty was too sick to go to a ward. She needed to go to intensive care where they had all the equipment and expertise to get to grips with her breathing and possibly even put her on a ventilation machine. The specialist intensive care doctor clip-clopped into the department in her high heels. She was South African and looked impossibly young and elegant. Tall and slim, with perfect hair and make-up, she was a stark contrast to us dishevelled A&E staff wearing faded scrubs and grubby trainers. I carefully told her Bettys history and observations.