Benjamin Daniels - Further Confessions of a GP

Over the years I have had all sorts of refreshments offered to me by patients during home visits – cups of milky tea and custard creams are the norm, although I have been offered more than one gin and tonic, and on one occasion an old Rastafarian gent tried very hard to persuade me to share with him the enormous spliff he was smoking. As a general rule, I always decline the food or drink (or marijuana) offered by patients, but I’m rather partial to shortbread and I hadn’t yet had a chance to grab my lunch.

I took a seat in the armchair and politely nibbled on my biscuit while Mrs Briggs began to explain why she had asked me to visit. I was making my best effort to listen intently, but I couldn’t help but be distracted by Sinbad. The dog had started sniffing intently around his owner’s lower legs. This in itself was only slightly disturbing, but he then started enthusiastically licking the hard crust of skin on the soles of her feet. He systematically licked the entirety of each foot in turn, even endeavouring to squeeze his tongue between each of her swollen toes. After completing this, Sinbad focused his attention on a particularly hard callus on her left heel. After softening it up with a particularly vigorous lick, he began gnawing at it as if it was a tasty bone. I couldn’t quite believe what I was seeing and initially wondered if Mrs Briggs was even aware of what was happening, but as Sinbad struggled to get a good vantage point on which to clamp his teeth, she purposely manoeuvred her foot to a more accommodating angle.

Mrs Briggs was talking away, but I had very little recollection of her words. All I could focus on was the relish with which her elderly Jack Russell was feasting on her dead skin. Surely this couldn’t be healthy for either dog or human? Yet, I got the impression from their mutual sense of ease that it was in fact something that they had both been enjoying for some years. After around 10 minutes, Sinbad appeared to have had his fill of foot, but, clearly on the lookout for some dessert, he jumped up on the sofa and began sniffing around the saucer of shortbread biscuits that was perched on an adjacent side table. With the same sort of concentrated deliberation he had shown his owner’s feet, he licked each shortbread finger on the plate from top to bottom and then chose one that he liked the look of and began chomping away messily.

Finally taking some notice of her dog’s inappropriate dining habits, Mrs Briggs shooed Sinbad away from the saucer of biscuits and then, without the merest hint of shame, held the saucer out in my direction and offered me another. It was at this point that the harsh reality hit home. I had no way of knowing if Sinbad had already given the shortbread fingers a good going over before my arrival. Even as a glass-half-full kind of guy, I still couldn’t get away from the fact that it was quite likely I had just eaten a biscuit laced with dog saliva and foot scale. My gag reflex began triggering uncontrollably and God knows how, but I kept myself together and managed to leave the premises before vomiting.

John wasn’t the easiest of patients. He rarely took my advice on anything but still enjoyed coming to see me now and again to get a few things off his chest. He drank too much and he worked too hard and his diet was pretty awful. He didn’t need me to point out that his health was suffering as a result, but like so many of us he seemed trapped in his bad habits. John reluctantly took pills for his high blood pressure, gout and raised cholesterol. He always had the aim of changing his lifestyle so he wouldn’t need the medicine any more, but despite gym membership fees leaving his bank account every month, he was much more likely to grab a bottle of wine and a takeaway curry after work than eat a salad and run 10 kilometres on a treadmill.

John was in his early 50s and was still bitter about the break-up of his marriage almost eight years earlier. He blamed his ex-wife and ‘that bloody bastard’ she ran off with, but he did admit that he had spent far too much time working on his career and too little effort working on his relationship. He had also confided in me that his marriage had never really recovered from the stillbirth of their son 20 years earlier. He always felt that he should have somehow been able to have prevented his son’s death and he explained that feelings of blame ate away at him. He had always shooed away my suggestion of counselling, instead choosing to throw himself further into work and drink.

I had seen John miserable and angry many times, but today he seemed genuinely depressed. This was the first time he was questioning the point of going on; he wanted me to keep this off his record, but he had actually begun to seriously think about suicide. I was really worried about him, and wanted him to get some help, but as usual John dismissed the idea. I thought at least he would let me sign him off work for a few weeks, but no – despite all his anger and bitterness towards his career and the detriment it had caused to his life, he couldn’t quite imagine living without it. He had a fierce loyalty to his job and over the years it had taken pre-cedence over every other component of his life. You would think that, given its hold over him, John would at least be passionate and enthusiastic about his career, but when I asked him about it, he told me that as each year passed he found it increasingly hard to take any sort of joy or satisfaction from a day at work.

Normally it’s me needing to hurry along a consultation due to poor time keeping, but on this occasion it was John who brought our consultation to a close. He needed to get back to work. I watched him from my window frantically rushing back to his car.

As he accelerated out of our car park, I could just picture him speeding recklessly the few miles across town, running past his secretary, turning on his computer and grabbing his stethoscope.

I hoped his first patient of the afternoon appreciated him and wasn’t too disgruntled about him starting his surgery 10 minutes late.

Doctors are human too, and much like many of our patients, we aren’t always great at looking after our physical and mental health. We live our lives in much the same way as anyone else, and although we should really have above-average skills when it comes to self-diagnosis, we will still succumb to the inevitable eventually and shuffle off this mortal coil. Interestingly though, although doctors live their lives much like everyone else, we often choose to end them differently.

We live in a time where drugs and technology allow doctors to cheat nature and keep patients alive for longer and longer. This is a fantastic achievement of modern science and every day I speak to happy, healthy people who would be dead without our medical input. This advancement does, however, have a cost. As I write this, Nelson Mandela is still alive in an intensive care unit in South Africa. The television cameras have been kept away, but any medic can imagine what sort of life someone in his situation would be living. He is likely to be asleep much of the time with most of his waking hours spent devoted to taking medications either orally or directly into his veins. The needles and blood tests will be constant, with the desperate attempts by the medics to keep his vital organs functioning. Food would be at best puréed and at worst fed through a tube. Toileting would be via a catheter and a nappy. It seems so sad that such a great man could be reduced to this.

When we doctors talk among ourselves we often promise that we won’t allow our own lives to be kept artificially prolonged in such a way. When machines and medication can keep your heart beating while nearly every other bodily faculty is failing, surely it is time for doctors to stop dragging out any last semblance of existence and let nature take its course?