Benjamin Daniels - Further Confessions of a GP

Thankfully, despite these poor performers often being the headline grabbers, there are thousands of nurses with the same compassion and dedication Sian has. Her Olympic moment for me was won when she missed her daughter’s 10th birthday in order to sit with a grieving relative. She won’t be offered an OBE or a lucrative sponsorship deal, but in my opinion she is just as deserving of a gold medal.

It was absolutely pouring with rain, but it was our wedding anniversary and we had promised ourselves a rare midweek night out. After we’d made a mad dash from the car to the local Indian restaurant, a waiter opened the door for us and showed us to our table. As we took off our sodden coats, we watched as the drains on the street outside overflowed and an impressive stream of surface water ran down the road. We were the only ones who had ventured out on such a wretched evening.

‘Miserable out there, isn’t it? Like a bloody flood,’ I commented to the waiter as he came to take our drinks order.

‘No, sir. This isn’t a flood. I am from Bangladesh and we have real floods there. Many people die.’

‘Oh, well, yes, of course. Erm… I just sort of meant it as a turn of phrase.’

As if I didn’t feel humbled enough, the waiter continued, ‘Every day I am thankful to live in this paradise here in the UK.’

Looking out at the dark grey empty high street with the rain bucketing down, it was hard to try to picture this as paradise. There were no golden beaches or palm trees, but I knew what the waiter meant. Simply living in the UK makes us among the luckiest people on the planet. Regardless of the constant talk of economic downturns and double-dip recessions, we still live in a time and place in which the vast majority of us have food, shelter and safety almost guaranteed. I must admit that I felt slightly taken aback by the waiter’s comments, but I can understand how it might feel to listen to English people complaining about the weather as they leave unwanted food on their plates and then return to their warm dry houses.

During a short stint working in Africa, I witnessed some dreadful things, which put my life into perspective. On the day I returned home I promised myself never to take anything for granted ever again. Under no circumstances would I complain or moan or whinge, and I would absolutely never ever say ‘I’m starving.’ Of course, I broke my promise and I do all of those things. Sometimes it requires a little reminder like this that really I shouldn’t.

At work there are days when the majority of what I see is unhappiness. In the context of the ‘paradise’ our waiter saw in our homeland, it does seem a little obtuse. Of course, unhappiness and depression are complicated, and just because we don’t live in a war zone, or suffer famine or natural disaster, it doesn’t mean that there aren’t some fairly horrendous things happening within my patients’ lives that cause them great distress. Some patients tell me they feel guilty for how low they feel because they know objectively how lucky they are. Depression is a disease and for some of my patients it is a matter of trying to adjust brain chemicals or using therapy to deal with past traumas. But for people like me, who sometimes just get a bit grumpy about the minor inconveniences of life, I wonder if simply watching the news and gaining a bit of perspective might be more in order.

Often when my patients ask me for my advice it is with the expectation that I will be able to give them a quick Yes or No answer. I frequently disappoint them; the great majority of decisions made in general practice are a shade of grey as opposed to black and white.

For example, one patient might ask me if she should take a cholesterol-lowering drug, or another might ask me whether he should have an operation on his knee. The patient hopes I’ll simply say yay or nay, but in both cases I’ll actually drone on endlessly about the pros and cons. I’ll recite boring facts, such as risk statistics, drug side effects and surgical complications. Eventually, after imparting my wisdom, I’ll turn the question back to the patient and explain that it is their body and their decision.

However, just occasionally, I do have the very satisfying opportunity to respond to an enquiry with a definitive answer.

One such question is: ‘Am I going to die, Doctor?’ This is one of the rare questions to which I can be 100 per cent sure of giving the correct answer: ‘Yes, you are definitely going to die. We are all going to die.’ I appreciate that the patient is usually asking whether they are going to die in the immediate future, but the reality is that as soon as we try adding that sort of clarity to the answer, we start moving back into that very unsatisfactory grey area again.

‘Is there a bug going around, Doctor?’ is perhaps the only other question I am commonly asked that I can always answer yes to. Unfortunately there is always a bug going around. It’s how bugs roll. If they stopped going around they’d die out, which sounds appealing, but according to microbiologists would result in disaster. I’ll take their word on that.

A less common question asked by a patient recently was whether it was okay for him to have sex with his partner via her colostomy. Now, I really don’t consider myself to be particularly prudish – patients tell me about all sorts of slightly alternative sexual behaviours and I rarely raise an eyebrow. Even if I wouldn’t necessarily choose to partake in all of the said activities, anything that takes place between two consenting adults in the privacy of their own home is okay with me. Not colostomy sex, though. That’s a straightforward no.

I don’t think it will be a great surprise to any of you to hear that a reasonably high number of the patients who come in to see me leave my room without receiving a definite or immediate diagnosis from me. The great advantage I have in general practice is that time is by and large on my side. The patient in front of me is usually not severely unwell. They may well be in discomfort, worried and upset, but they are very rarely just about to expire before my eyes. This means that there is a bit more time for me to work out what is causing the aching legs, funny rash or tiredness that my poor patient might be suffering from.

However, working in the emergency department, time is often at more of a premium.

When the paramedics brought in David, barely conscious and with slow breathing, I really needed to work out quite quickly what was going on. I couldn’t rouse him enough for him to tell me anything, so I was left with the tricky task of trying to deduce the cause of his comatose state from hundreds of possible causes.

The best place to start was with the information that the paramedics already had at hand. They told me that David was 31 years old with no past medical history of note. He had been looking after his two-year-old daughter while his wife was working her shift as a nurse. He was absolutely fine when she left for work, but when she arrived home she found David lying unconscious on the sofa. Fortunately their daughter was unharmed and happily watching CBeebies, apparently unaware of her father’s poor health.

Why had a young, previously healthy man suddenly gone into a stupor? I started trying to work through some of the more common causes. I began with diabetes, but his blood sugar was normal. There were no signs of infection and no signs of a head injury that might have knocked him unconscious. His breathing was slow, but his lungs seemed clear. I was hedging my bets that something was going on in his brain and so was sure that the CT head scan I had just ordered was going to throw up some answers. Top of my list of suspicions was that an aneurysm in his brain had popped, causing a type of stroke. We managed to get the CT scan done pretty quickly, but to my surprise it came back completely normal.