Benjamin Daniels - Further Confessions of a GP

I didn’t initially recognise Kenny when he came to see me. It had been a few months since he’d been a patient I’d seen high as a kite and handcuffed to a prison officer in A&E. We were now in the very different context of my GP surgery on a drizzly Monday afternoon. Kenny seemed very different too. His face looked greyer and older in the daylight, and although he tried to manage a smile, without the aid of his narcotic buzz he had lost his infectious grin.

‘I wanted to come and see you ’cos you was nice to me that time when we met in the casualty department.’

‘Oh, how did you know I worked here?’

‘Well, since I’ve been out, I’ve been back to A&E a few times. I was asking after you and that big Scottish male nurse told me you worked here as a GP, so here I am.’

I tried to muster a smile, but I could tell that having Kenny as a regular patient was going to be hard work. I could just imagine Barry the charge nurse thinking it hilarious to direct Kenny to me.

‘How long have you been out of prison?’

‘Nearly a month now. I’m staying at a friend’s, but I’m going to get myself sorted out this time. No more smack for me, Dr Ben. I’m going clean for good this time.’

‘Great, so are you involved with the drug and alcohol team? Are they doing a rehab programme with you?’

‘No, Doctor. They’re all useless there. I won’t ’ave nothing to do with them. You’re the only doctor I trust. That’s why I’m here. I want you to help me.’

I like being told that I’m a good doctor and even though I knew that Kenny was after something, I couldn’t help but feel flattered by his compliments however loaded they might have been. I’m sure one of the reasons that I wanted to be a doctor was some sort of unhealthy need to be liked. Many medics are, like me, constantly searching to be appreciated, and some patients can’t help but try to manipulate that flaw at times. When I first started as a GP, my trainer told me that wanting to be loved by everyone is an admirable trait in a Labrador or a prostitute, but it doesn’t make for a good doctor. I had a feeling that Kenny was going to prove this to be true.

‘I really want to make it work this time, Dr Ben. If I can just get off the crack I can get myself a place to live and a job and most importantly back in touch with my little girl. She needs her dad.’

Kenny looked up at a scribbled picture on my wall that my eldest had drawn for me.

‘If you’ve got kids, Dr Ben, you’ll understand how important it is that I stay off the crack right now.’

‘Absolutely,’ I said, still waiting for the but…

‘But I just need something to get me off the crack. Just to settle me down a bit and stop me losing it. Not much… Just a few Diazzies and some Temazzies and Zoppies. In prison they gave me Pregabbies, so I could do with a few of those.’

Patients who take meds for their weak bladder or high blood pressure tend not to have pet names for their tablets. When someone affectionately shortens the names of their medications, it always worries me. Diazzies are diazepam, temazzies are temazepam and zoppies are zopiclone. The meds that Kenny were asking for are all addictive and can cause a sort of spaced-out stupor when abused. Pregabbies are pregabalin, which are a type of painkiller, but they can be crushed up and injected to cause a high.

‘Kenny, what’s the point of coming off one drug and replacing it with another? If you really want me to help you and you want to clean up, we need to work out a programme of getting you off all drugs. It’s the only way.’

Kenny had been working hard to pull on my heartstrings, but as soon as it seemed that I might not prescribe him what he wanted, his lip started to curl and his voice was on the rise: ‘But I came to see you ’cos I thought you were gonna help me.’ He scowled at me.

‘Come on, Kenny, we both know that there is no point in me prescribing new addictive drugs to take up the job of the old addictive drugs. You need a proper supervised detox as an inpatient.’

‘But I want to come off the crack today. There’s a wait for detox, so that’s why I need a little something now, just to get me off the really bad stuff.’

I really wanted to believe that Kenny was serious about giving up his habit for good, but I knew from painful previous experience that many addicts either misuse their prescription drugs or simply sell them to get enough money for the harder stuff.

‘I won’t do it, Kenny. The drug and alcohol team have a walk-in service that’s open this afternoon. You could go round there right now and see them.’

‘I can’t believe you are refusing to help me. If you don’t prescribe nothing for me I’ll be back to using crack tonight. I could be dead in a month. You’ll have to live with that on your conscience.’

‘You don’t have to go back to using crack, Kenny. That’s a decision that you still have control over. If you really want to change your life around you can—’

I didn’t manage to finish my last sentence as Kenny was already out the door and gone.

Lee was here for an army medical examination and looked very nervous. He was tall, but looked more like an oversized 15-year-old than an adult. The prospect of him becoming a soldier seemed ridiculous.

‘Are you gonna have to stick your finger up my arse?’ he stammered.

‘What? No, Lee. Why would I need to do that?’

‘’Cos my mates told me you ’ad to have that done before you could get in the army.’

‘They were winding you up, Lee. Although I can’t vouch for what they do to you at military training college.’

Lee broke out into a broad smile, clearly very relieved by the fact that my finger and his anus would be remaining unacquainted.

‘So you’re terrified of the prospect of having a rectal exam from a doctor, but not scared of being blown up by a Taliban bomb in Afghanistan?’

‘I’ll be all right, sir.’

‘I’m not your teacher, Lee; you don’t have to call me sir.’

‘Oh right, yeah, sorry, Doctor.’

It felt like child abuse agreeing to let this 18-year-old boy go to war. My job was just to fill in a form declaring any previous medical history that the army might want to know about. Nobody really cared about my opinion on the war and the effect it might have on this poor boy.

‘Lee, are you sure you want to join the army?’

‘Yes, sir, I want to serve my country,’ he said proudly.

‘But do you really know what could happen out there. Do you even know what they’re fighting about?’

‘It’s about 9/11 and what Osama bin Laden did and that… and my mum says that joining the army will keep me out of trouble.’

That seemed a fairly stark reflection of life in modern Britain. Lee’s mum clearly felt that going to Afghanistan would get him into less ‘trouble’ than letting him stay here and hang out on the local council estate.

I started scanning through his notes hoping to find some sort of ailment that might be picked up on by the army doctors who would review my report. A few childhood illnesses and some more recent weekend A&E visits were all that I could see. The previous month Lee had fractured his fifth metacarpal, a hand injury that is almost always caused by punching someone. The other injury four months earlier was a ‘periorbital haematoma’ (a black eye), again, most likely resulting from fighting.

Maybe Lee’s mum was right. Maybe the army would be the best thing for him. He is from a really rough part of town and he has minimal education, and no skills or qualifications, not to mention that there really aren’t many jobs going at the moment. His brother has been in a lot of trouble with the law and perhaps the army would stop Lee heading in the same direction.