Benjamin Daniels - Further Confessions of a GP

On reflection I decided that Donald deserved more encouragement for his decision: ‘I think it’s really great that you are willing to donate your body to medical science, Donald. Well done you. Are you on the organ donor list too? Wouldn’t it be amazing to have one of your organs live on in someone else’s body and keep them alive when you are no more.’

‘Yeah, I thought about that, Dr Daniels, but I’ve had to say no on that one.’

‘Oh, why’s that?’

‘Well, what if my organ went on to help someone who I didn’t agree with?’

‘What do you mean?’

‘Well, what if part of my body was given to a terrorist or a suicide bomber or something? I wouldn’t want that.’

‘I think a blown-up suicide bomber would probably need a little more than one of your kidneys to keep them alive, Donald.’

‘Well, yeah, but you know what I mean. What I’m saying is that I would want some sort of clause on my donor card to say that my organ wouldn’t go to a religious extremist or a paedophile or someone like that.’

‘Isn’t being an organ donor about just helping someone else regardless of who they are? It’s about giving a complete stranger the gift of life. A stranger to you – but for someone else, a beloved father or daughter or wife. Through your generosity, you could extend someone else’s life for potentially decades to come.’

Donald paused.

‘I can sort of see what you’re saying, Dr Daniels, but I just couldn’t die peacefully knowing that one of my organs could live on in a Manchester United fan.’

‘It’s this gastric band. It’s not working. Something has to be done, Doctor!’

I’d never met Donna, the woman sitting in front of me, before, but I recognised her. Every morning I pop into the local Tesco Express near my surgery to grab a sandwich for lunch. Normally this task is carried out in a foggy blur of early-morning grogginess; I rarely notice my fellow shoppers. However, today had been an exception. And now, the patient facing me in my office, I realised, had been in front of me in the check-out queue that morning. She had caught my attention because she’d bought herself an entire chocolate cheesecake for breakfast and proceeded to tuck into it even before she’d left the shop. Please don’t think that I am some sort of evangelical health-food fanatic; chocolate, cheese and cake are three of my favourite things. A chocolate cheesecake is a thing of great splendour, something in which I have indulged on many occasions, but this was 7.45 on a Monday morning. Who eats a chocolate cheesecake for breakfast?

‘What’s been going on then?’ I asked Donna.

‘Well, when I eat, I always feel sick. I think there’s something wrong with the gastric band. I’m not even losing weight.’

Even without a gastric band I think that eating an entire chocolate cheesecake for breakfast would have made me feel a tad nauseous. Thanks to a bariatric operation, my patient had a band restricting her stomach to only a quarter of the normal capacity. If today’s breakfast was representative, of course she was going to feel sick after meals.

‘Who put the band in?’

‘The NHS wouldn’t do it so I had to go private, but I can’t afford to go to see them again. It cost me a bloody fortune to do it in the first place. What a waste of money.’

Looking through the notes I could see that Donna had come in many times over the last few years requesting help with weight loss. A previous GP had referred her to have a gastric band fitted on the NHS, but the request had been rejected because she didn’t fulfil the criteria: patients need to have spent at least two years trying to lose weight through exercise and diet programmes. Clearly not prepared to wait, Donna had found the money to get the op done privately.

I’m not against the idea of weight-loss surgery being performed on the NHS. Ideally we would all be slim and healthy due to vigorous diets and abundant exercise, but the reality is not that straightforward. Many people simply can’t manage to control what they eat and so end up overweight. When the weight starts getting to dangerous levels, a gastric band can completely turn someone’s life around. Some might argue that the cost of the procedure should never be fronted by the taxpayer, but successful gastric band operations can often cure expensive diseases such as diabetes and high blood pressure, returning to health and work people who were previously facing a future of illness and disability. The potential savings to the taxpayer are enormous.

Most patients who have a bypass operation simply can’t manage big meals any more. They feel full and sick if they eat too much, and soon learn to lessen their portion sizes. But I guess Donna was finding that old habits die hard.

‘Donna, I don’t think you need to see a surgeon. The gastric band is doing what it’s supposed to do.’

‘But this band makes me feel sick all the time.’

‘No, you will feel sick if you try to eat as much as you did before the operation.’

‘But I never really ate much anyway and now I eat even less.’

Donna looked suitably insincere – so much so that I didn’t feel I needed to mention that I had witnessed her choice of breakfast that morning.

‘Let’s make a deal. I want you to promise that you’ll make a massive effort to eat much smaller portions of food for the next two weeks. If you can do that but find you are still feeling sick I’ll refer you to the surgeons on the NHS.’

Donna nodded with what I took to be genuine earnestness, and, sure enough, she didn’t return. I’m hoping that next time I see her, the nausea will have gone and along with it some of the weight.

I like doing antenatal checks; it is one of the few times during my day that a patient isn’t coming to see me because they are unwell. The process of measuring pregnant tummies, listening to foetal heartbeats and having chats about baby preparations is a lovely part of my job. Karen’s appointments had been no exception. She was very excited about the arrival of her first child. The pregnancy had been normal and her antenatal appointments with me had been unremarkable.

I only got wind that something had gone wrong when I received a letter from the hospital. Karen’s waters had broken a few weeks early, and her baby had then started to show signs of distress during the later stages of labour. The hospital team had initially tried to use forceps to get her baby out and then went on to perform an emergency caesarean section. They discovered the umbilical cord was wrapped around his neck. When he was finally delivered, the baby didn’t start breathing. The paediatric team tried to resuscitate him with oxygen, and when he still didn’t breathe he was put on a ventilator and rushed to the neonatal intensive care unit.

It was touch and go for several days, during which Karen barely left his cot side. Her baby son Wesley had been starved of oxygen for too long during the birth, and it had caused some damage to the brain. Ironically, by a mechanism I don’t fully understand, the oxygen that was then given during the resuscitation period to keep him alive went on to cause further brain damage. The brain scans confirmed that quite extensive damage to Wesley’s brain had occurred, but the neonatal specialists explained that only time would tell how severely disabled he really was.

It was several months before I met Wesley for the first time. He had been kept in the special care baby unit for 12 weeks and there were all sorts of ongoing problems. For Wesley to leave hospital he needed to have a mobile oxygen supply and also a special feeding tube that went into his stomach via his nose. I popped in to see how they were getting on on my way home one evening. ‘He’s gorgeous,’ I said, as I peered down at Wesley in his specially modified cot. If I’m completely honest, he wasn’t gorgeous. He was odd looking with a large forehead and bulging eyes. He could sometimes focus on light in the way that a baby a few days old might, but he wasn’t smiling or showing the sort of interest in the world that a normal three-month-old would.