What now? was her next question.
Again, this was a hard one to answer. Well get the palliative care nurses involved and will always make sure that youre never in pain or distress with the symptoms. You might remain stable and fairly well for some time
But basically Im 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 couldnt 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
Every couple of months or so the surgery shuts for an afternoon and we have some sort of educational session. Its 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 patients blood pressure if I was going to ruin his relationship because my drugs were inhibiting his erections.
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 patients blood pressure if I was going to ruin his relationship because my drugs were inhibiting his erections.
The first chance to demonstrate my newfound sensitivity came the very next day. Brian had come in for a review of his blood pressure medication. I know its wrong to pigeonhole, but I always felt like Brian looked like the perfect stereotype of a bus driver: mid-50s, with mutton-chop sideburns and an ever-expanding beer belly. His faded white shirt always had large yellow sweat patches in his armpits and was open at the neck to reveal a big gold chain that matched his sovereign rings. Brian was accompanied by his wife Deidre, and although they always came to see me together, I had the impression that their relationship was often strained. With my new approach, perhaps I could help?
Brian, some men find that beta-blocker medication like the one youre taking for your blood pressure can affect their ability to have erections. Do you ever find this to be a problem?
Well, funny you should say that, Doctor. Me and the wife here have been struggling to manage in the bedroom department for some time. When were alone together I just cant seem to get the little fella to stand to attention these days.
Wow, I think to myself. What a breakthrough. The nice sex therapist lady was right. We do need to talk more about sex with our patients. Perhaps I can make a real difference to Brian and Deidres relationship. Perhaps the sexual frustration is the reason why theyre always bickering.
Mind you, I do still get erections though, Doctor, Brian said, interrupting my thought process.
This young lass got on the bus last Tuesday. It was a right warm day if you remember and, cor blimey Dr Daniels, you should have seen her! Gorgeous she was. Legs this long and a little top that didnt leave much to the imagination if you catch my drift
Brian went on to explain in some detail each item of his young passengers clothing, and the relative part of her anatomy that was exposed as a result. Rock solid I was, Doctor. Could barely keep the bus on the road! I could see her in my rear-view mirror and I had wood from the stop outside Boots on the high road all the way to the leisure centre past South Street. Thats five stops, and I got caught at the lights just before the bridge. I really dont think its the blood pressure tablets that are the problem, Doctor. I think it might be Deidre. Shes not the woman she was. Just doesnt really do it for me any more.
Deidre had been sitting quietly up until now, but I could sense her rising fury. Dont you worry, Dr Daniels, erection or no erection, Brian doesnt do a great deal for me either these days. In fact, he never really did. Even when we were young I always had a lot more fun on my own, if you know what I mean.
Brian and Deidre went on to describe each others inadequacies in the bedroom department in some detail. To make things even more awkward, they didnt speak directly to each other but instead spoke to me as if the other wasnt present. I sank as deeply as I possibly could into my chair and cursed myself for turning what could have been a nice simple consultation into something so toe-curlingly awkward that I wished the ground would swallow me up. I tried to think of some useful interjections, but I was well out of my depth with this one, so instead I sat excruciatingly silent until Brian and Deidre decided that I had heard enough and left.
My brief attempt at viewing my patients as sexual beings was well and truly over.
Maggie II
Maggie had come back to see me after seeing the cancer specialist again.
He was very nice, but he soon discharged me when I decided that I wasnt going to have any chemotherapy.
How are you coping?
Everyone keeps telling me how brave I am. They tell me Im a fighter and that Im strong. Im fucking dying and they just talk to me about staying positive. The problem is, Dr Daniels, Im not that brave or strong or positive. Right now Im scared. In fact, Im thoroughly terrified. Its as if Im not allowed to admit it to anyone because I have to be so godforsaking brave the whole bloody time.
Its okay. Youre allowed to be scared.
How about fucking terrified?
Yup, that too.
Im all right when people are around or when Im busy, but when everyone else is out and Im alone in the house, I cant stop myself from wondering about the end. How will it be? Will I be in pain? Will it be next week or still months away? Will I stop breathing first or will it be my heart that stops? Will I already be in a coma or will I feel myself dying? I need to have some power over this. Sometimes I wish I could piss off to Switzerland and end it all now. I just want to wrestle back control over this whole sodding thing.
Regardless of the person with the cancer, the same clichés seem to recur time and time again. One of which is sufferers of the disease being universally thought of as brave. The public image is of brave cancer sufferers heroically running marathons while defiantly sporting their chemotherapy-induced baldness. Its as if the brave label arrives the moment you are diagnosed with cancer and youre not allowed to be anything else. Reality TV personality Jade Goody morphed from being a national hate figure to being some sort of serene martyr the moment she was given her cancer diagnosis. In fact, such was the furore when she died that some people were calling for cervical cancer to be renamed Jade Goody disease. I thought I was going to have to start telling people that their smear revealed some abnormal Jade Goody cells on their cervix or that the Goody had spread to their liver. Jesus, as if breaking bad news isnt hard enough already!
It wasnt that Maggie was any less brave than anyone else. She was having a thoroughly normal reaction to the knowledge that she was going to die. We hadnt really known each other well before her diagnosis, but she seemed to have acquired an immense trust in me since I spotted that she had cancer. To be fair, it wasnt some sort of clever diagnosis worthy of House, but she clearly appreciated me sending her straight into hospital that first afternoon. There was no cure, but we were going to do everything we could to keep her comfortable. Theres another classic cancer cliché that Maggie hates.
Communication skills
Once a year our surgery sends out hundreds of anonymous patient satisfaction questionnaires. It always makes me feel a little under scrutiny, but overall I cant dismiss the potential value of finding out what my patients really think about me. Some of the questions are about general matters, such as telephone access and how long it takes to get an appointment. Others are more directly targeted towards the patients interactions with the doctor, and contributors are specifically invited to comment on the experience of their most recent consultation.
When the collated results are emailed to me, I eagerly read them through. Being a good doctor isnt just about being popular, but I cant pretend that I wouldnt feel thoroughly demoralised if all my patients reported in their questionnaires that they hated me!
This year, the first question asked whether the doctor helped them feel at ease. Phew, 85 per cent of my patients felt I had done this. The second question was whether the patient felt that their concerns had been listened to: 83 per cent scored me highly on this one. A further 88 per cent of the respondents were impressed with my ability to communicate with them. It was a relief that I was scoring well, but I was only reaching the average scores that most GPs achieve on these standardised surveys. Despite the regular pounding we get in the media, overall satisfaction in GP services remains consistently high.
The final question asked if the patients felt that their last consultation had helped lead to an improvement in their physical or mental health. On this I scored 40 per cent. Ouch! That meant for the majority of my patients, although they were put at ease, had their concerns listened to and were well communicated with, their actual health was no better off after seeing me than it was before.
This might seem like an epic failure, but actually it is a very accurate description of what a doctor does. The famous French writer Voltaire said that the art of medicine consists in amusing the patient while nature cures the disease. I would add that nature sometimes makes them worse too, but ultimately our role is often to offer a distraction while time and the miraculous natural healing abilities of the human body work their magic. Some of my patients are very aware of the limits of my therapeutic abilities, but others seem to feel that I should be performing miracles. Regardless of their expectations of my curative powers, every patient expects me to be nice to them.