Busy on call days with patients too numerous MPs who don’t know their glutes from their humerus He who a very long problem list brings These are a few of my least favourite things
Blood bottle shortages for venesection Those who are rude to the staff in reception Slurs that at GPs the gutter press slings These are a few of my least favourite things
White plastic aprons that make you feel sweaty Letters one gets of complaints that are petty The patient whose mo-bi-le phone always pings These are a few of my least favourite things
Visit requests at the end of a long day Calpol prescriptions for people who should pay Just one appointment for several siblings These are a few of my least favourite things
When the day’s done And the blood’s spun And I’m feeling glad I simply remember my least favourite things And then, very soon, I’m sad
Lies about lazy GPs in the papers Flatulent folk with their foul smelling vapours Songs that the anti-vaxxer often sings These are a few of my least favourite things
Long waiting times to be seen in outpatients Early requests for repeat stupefacients Fitted Mirenas with no sign of strings These are a few of my least favourite things
Sick note demands from those not ill a week Not even time in the day for a leak Headlines inflating a GP’s earnings These are a few of my least favourite things
Fifty plus phone calls to make of a morning CQC visits with too little warning Replacing silicone pessary rings These are a few of my least favourite things
When the week ends And I’m with friends And I’m feeling high I simply remember my least favourite things And then I begin to cry
After Oscar Hammerstein II and Richard Rodgers
For more song adaptations and woeful attempts at poetry, all with a GP flavour, please follow the links below:
In his essay ‘The Decay of Lying – An Observation’, Oscar Wilde has one of his characters say, ‘If something cannot be done to check, or at least to modify, our monstrous worship of facts, Art will become sterile and beauty will pass away from the land.’ I think Wilde has something to say to our current situation for unless something is done to check our monstrous worship of modern medicine, a world in which a patients clinical parameters are all too often elevated above the individual to whom those clinical parameters apply, our working lives will also become sterile and devoid of beauty.
That is, of course, if they haven’t already.
Life is more than merely attending to one’s health and yet, as we plough on through our working days with our heads permanently down and without us ever having a chance to look up, this is something that we all too often fail to appreciate. Whilst, as their enter end of life care, we might be pretty good at rationalising the medications that we have previously urged our patients to take, I wonder if we sometimes have delayed too long the lightening of the burden that we sometimes place on our patients to be healthy. Because medicine is a burden for many – and not just for our patients. It has become a burden for us too.
At the end of another extraordinary busy week, not only for me and the other doctors but for everyone in the practice, one in which we have once again been flooded with patients and their concerns, it’s no wonder that many of us feel that we are drowning. When, as now, many feel they are on the point of going under and are understandably concerned only about survival, it’s hard to appreciate beauty. As a result, as we try to cope with all the competing, seemingly urgent, demands made upon us, as we struggle to simply make it through the day, all the joy that we once drew from our working lives slowly drains away
Part of the problem though is of medicine’s own making. We have medicalised life too much by our insisting that what is in reality entirely normal is in fact dangerously abnormal and in need of medical attention. This is as true for what we would term marginally raised cholesterol levels as it is for the everyday unhappiness that characterises all our lives from time to time. No wonder we are inundated with requests for medical help when we have made far too much a medical matter, no wonder the lists of those we have to phone grow ever longer when we continue to urge everyone to ‘not hesitate to call if it gets any worse’, no wonder we have the worried well when we have told the well that they should worry.
It’s not only that there aren’t enough of us working in medicine, part of the problem is that medicine is trying to do more than it should. With our increasing obsession with data we are in danger of losing sight of the art of medicine and consequently we risk doing ourselves and our patients a disservice by causing concern where none was warranted. We need more medics but we also need less medicine, at least less of the unthinking algorithmic, protocol driven medicine that is increasingly encouraged. If only though we had the time to think!
Because the truth is that it really is possible to live a long and happy life with a cholesterol of 5.8. Indeed, it may be easier to do so than with a cholesterol of 4.7 when one has to worry whether that externally imposed target is being maintained by the medication one is taking, medication that, in addition to its side effects, daily declares to us as we are take it, that we are ill. This is not to say that we should never prescribe, but we must not imagine that what we tell our patients to do is more important than the real purpose of living. We will all have our views on what the real meaning of life is but I suspect we can all agree that it consists of more than swallowing a tablet of atorvastatin every day.
The truth is that we will continue to find our jobs impossible to bear for as long as we insist on carrying the weight of demand that we have created.
Elsewhere in ‘The Decay of Lying’, Wilde famously made the claim that ‘Life imitates Art far more than Art imitates Life’. I’m still pondering whether or not I agree with Oscar on this, but what I do know is that the lives of our patients are mirrored in our professional lives. As our patients lives are a mix of the good and the bad, so too are our times at work. Our jobs will never be easy – did we really ever expect them to be – and as it is sometimes a struggle for our patients, so too will our jobs sometimes be a struggle too.
This is not to suggest that we should roll over and accept how impossible our jobs are becoming, far from it, but we do have to accept the inevitability that sometimes we too will experience times of particular difficulty. Even so, it is worth perhaps remembering that even in the toughest of times there will be, if we look out for them, moments to enjoy and beauty to be appreciated. This last week has been as tough as any I can remember but in it I have experienced the kindness of a colleague, the appreciation of a grateful patient, and the concern of the person that, as I rang them at 9pm, told me that I really ought to be going home. There have even been the odd occasions when, amidst the chaos, I have even enjoyed the satisfaction of having managed one or two genuine medical problems with perhaps a modicum of competence!
But it’s not just our work that is this mixture of pleasure and pain. As our patient lives mirror our work lives, so too do they mirror our personal lives. Ancient wisdom tells us that there is ‘a time to weep, and a time to laugh; a time to mourn, and a time to dance’. [Ecclesiastes 3:4]. We are, therefore, out of synch with reality if we think we should be happy all the time. It is normal to grieve the sadnesses that we all sometimes experience in this life.
Even so, as one of those Christian types, I am frequently comforted by those words written by the apostle Paul, with which he describes himself as somebody who is ‘sorrowful, yet always rejoicing’. [2 Corinthians 6:10]. For me this speaks to matters beyond this life but i think it also applies to the here and now.. It reminds me that even in the sad times that we all sometimes experience we can still know what it is to be happy. As for me, for example, I am currently looking forward to becoming a Grandad, my daughter being a little over 38 weeks into her first pregnancy. And this, despite there being other circumstances in my life that cause me to be sad, is something that, along with many other people and things, is a constant cause of great joy to me.
Although not always an easy one, the trick I think is to realise that, just as one can still experience sorrow when there are things that make us happy, one can also be happy when there are things that make us sad. We don’t have to wait until all the sadness in life is gone before we allow ourselves to be happy. We can take pleasure in those things that bring us joy even when there is much that causes us distress.
For me, as I start a welcome couple of weeks off and prepare for ‘grandfatherhood’ with a pipe, a pair of slippers and a packet of Werther’s Originals, I suspect I may find it easier to take pleasure in the coming days than some who may read this post. Even so, I hope that this weekend, irrespective of how hard your week has been, you too can find some happiness to enjoy.
It was early morning and Festive Road was quiet. Most of the residents were indoors reading the newspaper reports of how GPs were hiding behind locked doors and still refusing to see patients. Some others though, having found themselves put on hold after phoning for an emergency ambulance, were discovering that it wasn’t just primary care that was currently facing unprecedented demand.
At number 52 Mr Benn was sitting in his chair and thinking to himself how it seemed that some people had forgotten that the ‘S’ in NHS was for ‘service’ and not for ‘slave’, that the NHS was intended to be free at the point of need, rather than at the point of whim, and that healthcare can’t be simultaneously quick, cheap and good. ‘You can only have two of those three ideals at any one time’, he said to himself getting up from his chair. ‘But never mind that, what I need is to get away from all of this negativity’. And with that Mr Benn put on his black bowler hat, left his house and started to make his way to the special costume shop from which he knew adventures could start.
On the way he saw a man trying to lift a large box out of the back of his car. Though it was far too heavy for him to carry himself, the man refused to accept the help being offered by his friends who were standing nearby and who were being forced therefore to watch him as he struggled.
It wasn’t long before Mr Benn arrived at the costume shop. He went in and started looking at all the costumes, wondering which one to try on. He saw one costume hanging up that he’d not noticed before. It consisted simply of a cardigan and a tweed jacket complete with leather elbow pads.
‘Who wears a costume like that?’ Mr Benn thought to himself.
Just then, as if by magic, the shopkeeper appeared.
‘Good morning, sir’, said the shopkeeper.
‘Good morning’, said Mr Benn. ‘What uniform is this?’ he asked pointing to the costume he’d just been looking at.
‘Why don’t you try it on and see for yourself?’ the shopkeeper replied. ‘But’ he added, ‘you’ll be needing these accessories’. And he passed Mr Benn a flimsy plastic apron, a surgical face mask and a pair of blue latex gloves.
Mr Benn took the costume into the fitting room and, once inside, he quickly changed. He looked at himself in the mirror and then walked through the door that he knew could lead to an adventure.
On the other side Mr Benn found himself outside a GP surgery. There was a long line of people queuing to enter the building. Mr Benn noticed that the doors were unlocked and that there was no electrified concertina wire fence surrounding the building. Neither was there a sniper gunning down anybody who approached the practice seeking to gain entrance.
Mr Benn made his way past the people, the vast majority of whom were waiting patiently to be dealt with. At the front of the queue, however, a man was shouting at the receptionist and complaining that GPs were lazy, work shy cowards who were overpaid and ought therefore to be ashamed of themselves. He insisted that he knew all this was true as he’d read about it in the paper that morning. When he finally finished shouting, the receptionist calmly explained that, if he’d just like to wait outside for a few minutes, the GP would call him on his mobile and see him for the appointment that had been agreed the previous evening when he’d rung in about his medical concerns.
Inside the building Mr Benn made his way through to the waiting room where a few chairs were appropriately spaced to allow social distancing. On one was sat a frail elderly man. He rose unsteadily to his feet when a smiling young doctor came out of her consulting room and called his name. As she did so, the doctor noticed Mr Benn.
‘Hello’, she said, ‘Are you the locum? It’s so good to see you. We’re snowed under here today as we’re short on doctors, what with one partner self isolating and working from home and another on long term sick leave due to some personal difficulties. Pop yourself in that room over there. All the passwords you’ll need should be in an envelope that you’ll find on the desk. If you need anything, give me a shout’
Mr Benn made his way to the room the doctor had been pointing to as she’d been speaking and within a few minutes, Mr Benn was sat gazing at a computer screen on which a long list of patient names was growing ever longer. As he picked up the phone to make the first call, Mr Benn looked at the clock and noticed that it was only just gone eight o’clock in the morning. The working day had begun. All morning Mr Benn consulted patients either on the telephone or, whenever necessary, face to face. When he had finally completed the morning’s work it was gone half past one.
Having spent the whole morning in his consulting room, Mr Benn felt the need to stretch his legs so he decided to tour the building and see what else was going on. Reception was still busy dealing with a huge numbers of telephone calls and one of the office staff was checking how many blood bottles were left in the building so as to determine whether or not there would be enough for the blood tests that were booked to take place over the coming weeks. The practice nurse was squeezing in an extra leg ulcer dressing at the end of her morning clinic and the HCA was seeing a patient for whom a doctor had requested an urgent ECG.
Upstairs, as if her day was’t busy enough already, the practice manager was now having to have an urgent discussion with the CCG regarding the growing crises over the impending collapse of a neighbouring practice and the admin team were rebooking all the flu clinic appointments that they had spent hours arranging the week before as they had just been informed that the vaccines would be arriving two weeks later than had previously been promised. Back downstairs most of the doctors were still in their rooms either still consulting or working through the mountain of results, letters and reports that still had to be dealt with.
In the final room that Mr Benn came to a doctor was slowly rocking in his chair with his head in his hands. He looked close to tears. Mr Benn stepped into the room and closed the door behind him. The nameplate on the door read Dr Mungo.
‘Are you OK?’ Mr Benn asked. ‘How’s your morning been?’
‘Not the greatest’, the doctor replied. ‘But then, there haven’t been many days that have been all that great recently. One wonders how long it can carry on like this with just too much being asked of us. And I wonder too how long I can carry on. Sometimes I feel like a cardboard cutout of myself, going through the motions like a two dimensional character in a poorly animated children’s cartoon from the late 1960’s or early 1970’s!’
‘Nobody can do it all’, said Mr Benn. ‘And there’s no shame in being asked for more than you’ve got and only being able to give all that you have. Is there anything I can do to lighten your load? I’d be happy to help’.
Dr Mungo asked if Mr Benn would mind doing a home visit and Mr Benn said he’d be glad to and so, within a few minutes, he was heading off to see a man in late middle age who was suffering from a neurodegenerative disease. His wife, Mary, had phoned that morning as she was becoming increasingly concerned about his frame of mind.
When he arrived at the house Mary was waiting for him on the doorstep. She ushered Mr Benn upstairs adding the words ‘You’ll find Midge in the front bedroom’. A cachectic looking man who appeared much older than his years was laid on the bed. He was reluctant to make eye contact and more reluctant still to speak. Mr Benn sat on the edge of the bed and looked around the room. The contents revealed that the occupant had a keen interest in cricket and Mr Benn noticed a photograph of the man he’d come to see batting for the local village team. It had clearly been taken in happier times. Mr Benn allowed the silence to remain for a minute or two before asking in a quiet voice ‘What’s up?’
The man looked at Mr Benn and began to speak.
‘It’s just that I’m such a burden to everyone. And especially to my wife. I can’t do anything for myself now that I’m so weak and so she has to do everything for me. It’s ruining her life. She’d be better off if I was no longer around. I just wish I was dead’.
Mr Benn wasn’t sure what to say and so, for a short time, he said nothing. But then he gently spoke to the man
‘I’m saddened to hear how difficult your life is at the moment. It must be so very hard for you. I don’t know why this is happening to you and it’s hard for me to know quite what to say. But can I say simply this? You’re not a burden. Just now you need to be carried, but a burden is something that is unwilling borne. Your illness is a burden – but you are not. Though she would no doubt rather that things were different, though your condition is no doubt something that causes her great sadness, it’s clear that Mary loves you. And so, though your condition weighs you both down, she is glad to help carry the load. You are not a burden because she carries you gladly, and a burden gladly carried is not really a burden at all. Please try and take some comfort that you’ve somebody who cares for you as she does. You really are so well loved by her’
Mr Benn paused for a few seconds before adding. ‘And, for what it’s worth, I care about you as well.’
After a few more minutes of silence, Mr Benn stood up. He didn’t know if he’d been of any help but, as he turned to leave, he saw Mary standing at the bedroom door. She smiled at him and whispered ‘Thank you’ as he passed her. Mr Benn, started down the stairs but, as he did so, he glanced behind him and noticed that Mary had entered the bedroom and she and Midge were embracing. And that made Mr Benn smile too.
He arrived back at the surgery just in time to start a busy afternoon consisting of still more phone calls and numerous face to face consultations. Eventually, shortly before 7pm, the work for the day was complete.
Just then a man appeared, sporting a moustache, a pair of circular framed glasses and a purple fez.
‘Excuse me Doctor’, he said ‘Would you mind seeing just one last patient? Given his symptoms, you’ll need to see him in the isolation room’.
Mr Benn followed the man along a corridor until they reached the room situated at its end. The man opened the door and Mr Benn stepped though it. As he had expected, Mr Benn found himself back in the fitting room of the costume shop. He took one last look at himself in the mirror before changing back into his own clothes. In the shop he returned the costume to the shopkeeper before starting the walk home to Festive Road.
As he approached number 52, Mr Benn noticed that the man he’d seen that morning was now being helped by his friends to carry the heavy box into his house. And as he passed a group of people who were chatting happily to one another Mr Benn was able to overhear the topic of their conversation. It was about how much they all appreciated the efforts of those working at the local health centre. It seemed that not everybody believed what they had been reading in the papers.
As he reached his front door Mr Benn thought about the days events. He’d enjoyed spending some time with Midge and Mary and hoped he’d been at least a little help to them. He didn’t want to ever forget that there would always be some things that were genuinely worth doing.
He reached into his pocket for his house key but found there instead an old cigarette card. On it was a picture of a cricketer and Mr Benn recognised it as Midge as he had been in his younger days.
‘How on Earth did that get there?’ Mr Benn said to himself. ‘I guess I’ll never know, but I’ll keep it just the same. It’s just what I need to remember’.
Other story posts:
To read ‘Jeeves and the Hormone Deficiency’, click here
In recent weeks the media has been full of reports of desperate suffering. So quickly does one story follow on from its predecessor, it is all too easy to forget the events which shocked us just a few weeks ago. Just as the shootings in Plymouth were superseded by events in Haiti and Afghanistan, so these too will one day fade into our collective subconscious as some new tragedy comes to the fore and takes its brief turn on centre stage.
But despite the newsworthiness of such dreadful events, most suffering goes by unnoticed. To all but those caught up in it, most suffering is unexceptional, with life continuing mundanely on for those unaffected by those events of which they are unaware. W.H. Auden had it right when he wrote in his poem ‘Musée des Beaux Arts’,
‘About suffering they were never wrong, The Old masters: how well they understood It’s human position; how it takes place While someone else is eating or opening a window or just walking dully along…
They never forgot That even the dreadful martyrdom must run its course Anyhow in a corner, some untidy spot Where the dogs go on with their doggy life and the torturer’s horse Scratches its innocent behind on a tree.’
A few weeks ago a practice in the town where I work collapsed resulting in those that had been registered there being allocated to the remaining local practices. Our practice list size increased overnight by about 10% as 1700 individuals joined us bringing with them the stories of their lives, many of which inevitably included great hardship. I was struck by how totally unaware I was of the genuine suffering that was occurring in the town where I have worked these past 25 years despite the fact that, on some occasions at least, that suffering would have been playing out in households neighbouring those I myself was visiting on a regular basis.
I wondered how it must feel to experience grief whilst all too conscious that few others shared it with you. For, despite it being ignored by an indifferent world, those who feel the pain of suffering experience it as something worthy of everyone’s attention. To the grieving individual, nothing remains the same and for the world to continue on, unchanged and unmoved, must surely only add to their sense of disorientation.
Auden’s poem ‘Funeral Blues’, is in stark contrast to his ‘Musée des Beaux Arts’. In it he has his bereaved narrator demanding that everyone should stop what they are doing and, having been made aware of his loss, join him in his mourning. Furthermore, given what has happened, he considers the whole of the created order no longer serving any useful purpose.
‘Stop all the clocks, cut off the telephone, Prevent the dog from barking with a juicy bone, Silence the pianos and with muffled drum Bring out the coffin, let the mourners come.
Let aeroplanes circle moaning overhead Scribbling on the sky the message ‘He is Dead’. Put crepe bows round the white necks of the public doves, Let the traffic policemen wear black cotton gloves.
He was my North, my South, my East and West, My working week and my Sunday rest, My noon, my midnight, my talk, my song; I thought that love would last forever: I was wrong.
The stars are not wanted now; put out every one, Pack up the moon and dismantle the sun, Pour away the ocean and sweep up the wood; For nothing now can ever come to any good.’
It’s a beautiful poem capturing the intensity of the grief that accompanies the loss that for the most part goes by unnoticed by an uncaring world.
In reality, of course, nobody has the capacity to become emotionally involved with all the suffering that is all too prevalent in what is frequently a very sad world. As George Eliot wrote in her novel ‘Middlemarch’
‘That element of tragedy which lies in the very fact of frequency, has not yet wrought itself into the coarse emotion of mankind; and perhaps our frames could hardly bear much of it. If we had a keen vision and feeling of all ordinary human life, it would be like hearing the grass grow… and we should die of that roar which lies on the other side of silence.’
Nobody should expect the whole world to experience so intensely the sadness that they themselves feel, but we should not be surprised perhaps when there are some who seek to share their sadness with us and thereby give it a significance more in keeping with that which they feel it deserves. Though the pain that is often brought to us is frequently the result of something we can do nothing about, to acknowledge the sadness of others is nonetheless hugely valuable.
And perhaps that is part of why our job is currently so difficult. With so many struggling and, seemingly, doing so alone, perhaps there is a need for some to have their struggles noticed by somebody other than themselves. If, rather than pretending that we have the answer to their problems and offering platitudes that suggest that things aren’t as bad as they seem, we are able instead to be human enough to perhaps share a little of their sadness, then we will have done something that is immensely worthwhile.
It will not of course be easy, not least because the whispers of our own individual struggles, in a job that too few appreciate is itself increasingly difficult, are themselves seldom heard. Even so, in a world where once many lead lives of what Thoreau described as only quiet desperation, we would do well to at least hear what has now become their sometimes silent but nonetheless deafening distress.
[With thanks to Frank Skinner whose Poetry Podcast on W.H. Auden got me thinking along the above lines.]
When I first posted this elsewhere I was asked how one can ensure that being with those who share their experiences of pain, loss, and grief don’t wear us ever so slightly down each time we meet with them. I suspect that the answer to that is that we can’t but that our being worn down a little, rather than ultimately doing us any harm actually makes us more than we were before. My reasons for thinking this are quite complex and are theologically underpinned. For anyone who might be interested They are touched on in some of the related pieces which are linked to below.
To read ‘General Practice – a sweet sorrow’, click here
To read ‘Covid 19 – could it mean we really did have the experience but missed the meaning’, an updated version of ‘T.S. Eliot, Jesus and the paradox of the Christian life’, click here
Are GP dreams so hard to beat? Every patient that I ever meet I long to see them, see them face to face Cos as a GP I’m ideally placed
I’m gonna consult, gonna use techniques Get GP kicks right through the week
To understand them, my heart it yearns All your ideas and your concerns And I feel a deep frustration ‘Till I know your expectations
I’m gonna listen, gonna let you speak Get GP kicks right through the week, all right
When the CQC inspector calls Everybody briefly keeps the rules And so from him at his insistence I’m glad to keep my social distance
For a rating, one of good, I’ll seek Get GP kicks right through the week
With too much work and too little time And with criticism on the climb I’ll see the patients that I really should And try to see in that there’s something good
And though the future, though the future’s bleak Get GP kicks right through the week, all right
And though the future, though the future’s bleak Get GP kicks right through the week, all right
Sitting at my desk and feeling low Sometimes I’d like to quit Work into the time won’t fit Too much to do Working the whole day through On call days and Mondays always get me down
What I did I used to find worthwhile Could always have done more Now it just feels a chore Get the job done Now it’s no longer fun On call days and Mondays always get me down
Sadly, every week it seems it ends up much the same Demands constantly made on me Sadly, now the job’s like this, it’s really such a shame It’s not how it ever should be
What I feel I’ve never felt before No need to talk it out We know what it’s all about Its all a mess Criticism in the press On call days and Mondays always get me down
Sadly, now the job’s like this, it’s really such a shame It’s not how it ever should be
What I feel I’ve never felt before No need to talk it out We know what it’s all about Its all a mess Criticism in the press On call days and Mondays always get me down
Its all a mess Criticism in the press On call days and Mondays always get me down
Do you remember? Seeing all your patients face to face Do you remember? Working at a manageable pace Do you remember? Operations happening when planned Do you remember? Plentiful blood bottles close to hand
By the way, how did it all go wrong? Please excuse me, it never should have gone so wrong So sorry, it never should have gone so wrong But it went wrong
GPs, will the day come when we’re sorry When GPs we can’t ever again for you send We just can’t go on still thinking That’s it’s time for your natural end GPs, oh we never thought we’d miss you And GPs we can not simply always pretend That by asking of you more and more It won’t come to a bitter end
Do you remember? Needing not to wear those bright blue gloves Do you remember? Work was then still one of your great loves Do you remember? Being trusted to do what was right Do you remember? When your GP future was still bright
By the way, how did it all go wrong? Please excuse me, it never should have gone so wrong So sorry, it never should have gone so wrong But it went wrong
GPs, we just want to say we’re sorry But GPs now we can’t get through on the phone We hear how now you’re far too busy And you’re late every day getting home GPs, we’ll now try to write a thank you GPs, it’s so important to us, now you’re gone Maybe it can say that you were right And can say just how we were wrong
~~~
Blood bottles red dilly dilly Blood bottles blue When they are gone dilly dilly What will we do? A penny for your thoughts my dear A penny for your thoughts my dear I’ve no clue for you love I’ve no clue for you love
This stand alone story is now Part 8 of the the “Dr Scrooge Chronicles’. The first seven parts can be found here
Dr Scrooge was tired. All the time tired. He was more tired than a myxoedematous narcoleptic with sleep apnoea who’d just completed a week of nights. He was tired of Covid, he was tired of work, and increasingly he was tired of life.
It was just gone eight and he was alone in the practice catching up on paperwork at the end of a long day on call. Only it wasn’t the end as he was still left with a home visit to do. And to make matters worse he was supposed to be gathering with Dr Cratchit and a few other friends that evening to celebrate a friends eightieth birthday. ‘Looks like I’m going to be late for another social event’ he sighed to himself as he picked up his bag and the printout of the patient’s details that had been bought to him, along with a consolatory custard cream by the receptionist just before she’d left an hour or so previously.
As he left the building it was beginning to rain and the last light of the day was beginning to fade. Scrooge got into his car and drove out of the car park at the back of the surgery premises and began to make his way to the nursing home where the patient he was visiting lived. The staff there had insisted the man be seen on account of him just not seeming himself and Scrooge had been too worn down by the busyness of the day to do anything but agree to the visit even though he’d felt there would be little point in visiting somebody who he couldn’t help thinking, from his cursory scanning of the notes, was just a demented old man who’s life meant nothing now that all he did all day was sit in a chair.
Scrooge’s frustration increased still further as, barely having started out on his journey he was held up by traffic lights. The red light reflecting on the wet road seemed to goad him into thinking what he’d been considering for some little while. ‘Perhaps it really is now time for me to just stop’, he muttered to himself. ‘After all I could always make ends meet by exploiting the black market in blood sample bottles’.
The year had been a hard one. Though positive swab results of Covid tests continued to appear daily in his inbox, Scrooge hadn’t seen anyone ill with the disease for several months. Even so workload was higher than he’d ever known it to be and he no longer felt he was doing a good job. There just wasn’t the necessary time to give to patients. Earlier in the year he’d worked sessions at the local vaccination centre and had derived great pleasure from doing so, but now he found no satisfaction in rushing headlong through the seemingly endless list of patients that daily presented themselves to him only to later hear in the media how GPs were hiding away from their patients, supposedly behind locked doors. And it looked like it was all about to get a lot worse now that a neighbouring practice had collapsed and he and Bob had been forced to accept several hundred additional patients onto their practice list, including the man he was now on his way to see. With no additional staff to deal with what amounted to an overnight increase of 10% to the practice list, Scrooge wondered how he and all his clinical and non clinical colleagues would cope with the inevitable additional work. No wonder that even his excellent practice manager was now beginning to feel the strain.
It was the worst of times, it really was the worst of times.
As the car idled Scrooge realised that he had long since given up any hope of his turning out to be the hero of his own life and remembered instead something he’d once read about how everybody eventually experiences the defeat of their lives. Perhaps that was what he was now recognising to be the case for himself. His appraisal was coming up soon and, rather than discussing with his appraiser how he might look to improve over the coming year, Scrooge thought that perhaps it was time to get real and instead take the opportunity to discuss how he might best manage his now inevitable decline.
As the traffic lights changed Scrooge continued on his way and within ten minutes he was pulling up outside the nursing home. The rain continued to fall as he climbed out of the car and hurried to the front door. He pressed the doorbell and, as he waited to be let in, he donned the mask, ridiculous plastic apron and blue surgical gloves that purported to be PPE but only managed to make him look like some sinister Smurf with a burgeoning interest in basic butchery.
Eventually he was let in and led to a small room on the second floor of the old building that, over the years he had visited countless times. The room was a barren affair, sparsely furnished with the only decoration being a few framed verses of scripture urging the reader to remember that there was always reasons for hope in even the darkest of days. ‘If only’ thought Scrooge as he turned his eyes towards the frail elderly man he had come to see who sat hunched in a chair with his eyes closed and his mouth wide open. He saw and said nothing. Scrooge walked over to him and, crouching by his side, attempted to make conversation though, even as he did so, he knew there was little prospect of any meaningful communication. Scrooge examined the man but found no specific cause to account for his increasingly frail condition other than the all too apparent dementia that had brought him to the home some years previously. The man was clearly coming to the end of his life.
Stepping back outside of the room, Scrooge explained his findings to the young nurse who had been accompanying him. She passed him the patients treatment escalation plan on which was stated that hospital transfer should be considered in the event of his becoming unwell.
‘Shall I get his things together whilst you call the ambulance?’ the nurse asked. ‘How long do you think it will be?’
Scrooge’s heart sank. He’d been in this situation before, where what was written on the TEP form seemed inappropriate and, rather than helping to make decisions, only succeeded in making things harder. Surely admission wasn’t in the man’s best interests and yet to go against what was clearly written down made Scrooge feel uncomfortable.
The pair walked back along the carpeted corridors to the office where he recognised the familiar face of one of the senior members of the nursing staff who had worked at the home for as long as Scrooge could remember.
‘What do you think Clare?’ he asked her, ‘It can’t be right that we admit the poor chap can it?’
Clare looked up from the desk where she was sat. ‘All I can say’, she replied, ‘is that I’ve known Harry for a very long time, ever since he arrived here I forget how many years ago. And I’d be sad if he died in hospital’.
That was enough for Scrooge. Even so he thought he would try to speak to a member of the elderly man’s family, just to make sure they felt the same way that he did.
‘Do you know who his next of kin is?’ Scrooge asked Clare. ‘Is there anybody at all I can talk to’.
‘There aren’t any children, Harry never married. But there is a younger brother who visits him regularly’. Clare flipped her way through Harry’s file and found the number and, passing it to Scrooge. added ‘Just press ‘9’ for an outside line’.
Scrooge picked up the phone and made the call. After a few rings it was answered and Scrooge introduced himself to somebody whose gentle elderly voice confirmed he was indeed Harry’s brother.
‘I’m sorry to bother you at this time in the evening’, Scrooge began, ‘but it’s about your brother. I’ve been called to see him and I’m afraid he’s not at all well.’
‘He’s not been well for a long time Doctor. It’s his age you see. That and the dementia. It’s been years since he was the man I once knew.’
Scrooge smiled to himself realising already that this conversation was not going to be as difficult as he had feared.
‘I understand’, Scrooge continued, ‘but Harry’s deteriorated rather a lot of late and if I’m honest I think he’s only likely to get worse over the next day or two. I thought you ought to know, just in case you wanted to pop over and see him. Unless of course you thought he ought to be admitted to hospital. The thing is I have a bit of paper here which suggests that some discussions were had previously and that it was felt then that, if he were he to become more unwell, Harry would want to be admitted. But I really don’t think the hospital would be able to do a great deal for Harry and I’m not sure that sending him in now would really be the best thing for your brother’.
‘Please don’t send him to hospital doctor – he wouldn’t want it. It’s like this you see. When you’re old, eventually it happens that the only thing you’re left with is your memories, and Harry, well he hasn’t even got those anymore. They’ll look after him well in the home. Leave him with those who know him best.’
The line went silent for a few seconds and then Harry’s brother spoke again, this time his voice wavering a little as he tried to control the tears.
‘Can I tell you something Doctor? You might look at Harry and think he’s just a demented old man, but I want you to know that that demented old man is still my hero. Always has been – always will be. When I was a boy he looked after me when there wasn’t anybody else who could. He was a good man. And he still is. Even now that his time has come’.
The two men chatted on a little longer before Scrooge eventually put down the phone. He relayed the nature of the conversation to Clare and it was agreed that Harry would stay where he was and the staff would continue to care for him just as they had for many years already. Scrooge updated the TEP form and, though he don’t imagine they’d be necessary, wrote up some ‘just in case’ medications before saying his goodbyes.
Back in his car Scrooge thought about what had just happened. He remembered those words on the wall of Harry’s room, words that his brother had said both he and Harry still believed. Maybe there was cause for hope in dark days after all, even at that moment of apparent defeat. And perhaps, as was the case with Harry, even in the years of one’s inevitable decline, you could remain someone of worth, someone who was still both loved and valued. Scrooge’s mind went back to those sessions he’d worked in the vaccination clinic when the frail and elderly had been wheeled in by those who still loved them irrespective of how dependent they had become on others. It had been a joy to give them their vaccinations, vaccinations that had seemed at the time to be nothing less than a shot of love.
And he thought too of something else he’d recently heard, something about how ‘shiny and new’ was all very well but that things with no past somehow lacked any soul. Perhaps that was true of people too. Although in physical terms Harry and his brother were both past their best, they undoubtedly had soul, their experiences of brokenness producing in them a depth that only age can bring, the wisdom of experience allowing them to accept others despite their imperfections.
*******
It was gone 10 by the time Scrooge arrived at the party and people were already beginning to make their way home. Dr Bob Cratchit was still there though. He was on a weeks leave and had clearly been taking full advantage of the fact by enjoying the liquid refreshment that had been freely on offer. He was a little worse for wear as he handed Scrooge a glass containing what little remained of the celebratory bottles of champagne that had been opened over the course of the evening.
‘What the dickens are you doing turning up so late?’ Cratchit asked Scrooge before adding in a more concerned tone of voice,‘Are you alright. Looks like it must have been a bad day for you today Ebenezer’ Cratchit felt the need to look out for the man who had once been his trainer but was now his senior partner at work.
‘Yes and no, Bob. Yes and no. The day was certainly busy, made busier still by a late visit request. But you know what? I wouldn’t have missed that visit for the world. And I’ll tell you something else. What with the influx of new patients, we’re going to need to try and recruit a new partner. But don’t get any ideas of you lording it over them as senior partner. I’m afraid you’re stuck with me for a little while longer yet.’
And with that Scrooge raised a half full, rather than half empty, glass of warm, flat champagne and drank to all that was good about General Practice.
