Benjamin Daniels - Further Confessions of a GP

Hannah was now 42, and as each month passed her dream of motherhood slipped further and further from her grasp. There is plenty of talk in the media about career women putting their jobs first only to find that they have left it too late to have a baby. This wasn’t the case with Hannah. She would have happily started a family in her 20s, but she had quite simply never met the right guy. When she reached 37, Hannah decided against risking her chance of motherhood by waiting for Mr Right, and chose instead to embark on fertility treatments as a single woman. Our initial consultations were about the pros and cons of using an anonymous donor versus using the sperm of a generous gay friend. At first she battled to get funding for IVF on the NHS but failed, and so instead used all her savings to have cycles of fertility treatment privately. With each cycle came the drugs and the injections, followed by the hope and then, finally, in Hannah’s case, the overwhelming disappointment.

My job throughout all of this was simply to support her. I helped out practically by occasionally organising blood tests and letters to explain time off work, but mostly I was another shoulder to cry on when all the hope turned to despair. Hannah was putting her entire life on hold in order to have a baby. She stopped going out or having holidays. She spent every penny on fertility treatment. She turned down a promotion at work, because she didn’t want the stress of more responsibility affecting her chance to conceive. She even turned down a few nice blokes who asked her out, knowing that trying to get pregnant via donor sperm while in the early stages of a new relationship was just too weird.

Hannah was aware of how much the IVF was taking over her life. She had told me that she just wanted to know she had tried everything she could to get pregnant and if it hadn’t happened by the time she hit 40, she would take a deep breath and move on with her life.

However, when her 40th birthday came and went, she couldn’t quite let go. ‘I’m still having periods, Dr Daniels, and I feel healthy!’ she explained to me. ‘I couldn’t live with myself if I hadn’t tried everything I could to conceive.’

At the age of 41, after eight unsuccessful cycles, she had spent a total of £40,000. Her credit cards were maxed out and her flat had been remortgaged twice. She had borrowed money from her sister and mum. Finally, she came in to tell me that she had given up.

‘It’s a relief really, Doctor. It took so much out of me physically and emotionally. Even if I had the money I’m not sure I could put myself through another cycle. I’ve decided to adopt. There are children who need mothers and it seems selfish and stupid to be desperately trying to make a new baby when there are plenty of babies in the world who need a mother.’

The adoption process isn’t easy either, but at least it was a positive move rather than the continual pain of IVF. We went through the forms together and I completed the questions relating to her health. Up until the IVF, Hannah had been completely healthy, but during the last round of treatment they had found a cyst on her ovary that needed further investigation. Before I could complete the adoption paperwork, she needed to have her cyst investigated. I referred her to a gynaecology consultant and the news came back that it was ovarian cancer.

At first glance it might seem as though the IVF had saved her, as it was a scan during the IVF procedure that had picked up the mass on the ovary before she had any symptoms. In reality, it was highly likely that her fertility treatment had caused the cancer. The medication prescribed to stimulate the ovaries at least doubles the risk of ovarian cancer. So, after finally thinking that she was over all the unpleasant medical procedures that had plagued her during her fertility treatments, Hannah would now have to go through a whole lot more, this time to try to save her own life rather than create a new one.

A year later, battered and exhausted, Hannah came back to see me, having finally been given the all-clear by the cancer doctors; the ovarian tumour had gone. She now wanted to get back on track with the adoption agency.

It was at this point that I had to break the awful news to her that now that she was a ‘cancer survivor’, they were unlikely to place a child with her for adoption. The risk of the cancer returning was still quite high and as a single mother if this did happen a child placed with her could become an orphan. I really didn’t think she’d be allowed to adopt a child now and I thought it best to be honest with her straight away.

Finally, Hannah’s grief erupted. The thought of adopting had been getting her through the horrors of her cancer treatment and now this door was closing on her too. She was absolutely devastated.

It was several months before I saw Hannah again. She literally bounced through my door like a Labrador puppy.

‘I’m pregnant,’ she beamed.

‘What?’

‘You heard me. I’m pregnant!’

‘How?’

‘Well, I’m not sure if you remember but my dad died a year ago and we finally got his affairs in order. I inherited some money and my sister agreed to go with me to a fertility clinic out in India. She donated an egg and well… voilà . I didn’t want to tell you that we were going, because I thought you might try to put me off.’

‘Well, I might have tried, but well, wow! Congratulations! How many weeks are you?’

‘I’ve just had my 12-week scan and everything looks fine. I didn’t really need to see you about anything in particular but I just wanted to come and let you know.’

‘I’m so pleased for you, Hannah, and I can’t wait to meet your new baby in the flesh in six months’ time!’

I could barely take the smile off my face for the rest of that day.

If anyone asks me the worst thing about being a doctor, my answer is always immediate: for me, it’s the constant fear of making a mistake. Every July a letter from the General Medical Council falls on my doormat. It is always a request to renew my annual subscription, but without fail, when I see who the letter is from, my heart races as I wonder if this could be the summons calling me to explain my incompetent actions to a courtroom full of grieving relatives and snarling journalists. It’s a fear that never goes away. It is something that every doctor has to learn to live with.

I was once three days into a holiday in Mexico when I woke up in a cold sweat, terrified that I had forgotten to do something for a particular patient sitting in a hospital ward 5,000 miles away. I couldn’t go back to sleep until I had called the ward to make sure the patient was okay. I was genuinely worried about that patient, but I can’t deny that there was a large helping of self-preservation in my fear. Making a mistake could cost me my job. Still, despite the general consensus that doctors are only in it for the money, we do care about our patients, and the idea that someone could come to harm because of my error is horrifying.

A surgeon knows that if he accidentally snips an artery when trying to remove a kidney the patient could die within seconds on the table in front of him. As a GP my mistakes are less acutely dramatic, but the potential consequences of my actions could be just as grave. Any headache could be a brain tumour, any feverish child could have meningitis and, as I discovered last year, any cough could be lung cancer.

Last April Ted came to see me with a bad knee. We had a chat about painkillers and I referred him to a physiotherapist. As he was leaving he asked me if there was anything I could do about his smoker’s cough. I suggested he gave up smoking, and he shrugged and walked out the door. Eight months later he was admitted to the emergency department with a collapsed lung due to lung cancer. When I looked back at the medical notes I made at that last appointment with me, I hung my head in shame. I wrote plenty about his knee pain and then at the very end it read: ‘ Cough. Smoker. Advised to stop smoking. ’ That was it: I hadn’t listened to his lungs, I hadn’t asked about weight loss or coughing up blood, and I didn’t request the chest X-ray that might have diagnosed his cancer earlier and saved his life. I even looked through the notes of some of the other patients I saw that afternoon. I spent nearly 30 minutes talking to a 20-year-old law student about her numerous self-diagnosed food intolerances, yet when Ted told me about his cough, I short-changed him with just a few seconds of my time.