I was a bit ratty this morning. Not looking forward to work.
But then I had a good set of patients in the morning.
The first phone call was someone who wanted a repeat prescription of her Hormone Replacement Therapy (menopause treatment). Before I asked her to book in for an annual blood pressure (BP) check at some point- she interrupted me and said, ‘before you ask me for a BP check, because you always do, I already have it’ and started laughing proudly that she’d beaten me to it. Made me chuckle. Playfulness is a necessary ingredient for life.
Then I saw Duncan a 22 year old who has come to see me once or twice a month for the last 8 months. Everyone around him keeps dying. He’s anxious- and he doesn’t like it and is struggling to make sense of it all. Fair. This time his dog died, about a month ago after I last saw him. I’m worried I might be next to be honest. Need to get him off our books, and just generally away from all living things…
He has finally started letting emotion out and cried for the first time recently. It feels good and like a relief. He’s re-connecting to his emotions. It’s common for traumatic incidents to cause people to dissociate. It’s a coping strategy but it doesn’t work very well long-term. He’s a good kid- reading a lot about trauma and how to grow as a person through all of it. He’s come a long way since I started seeing him last year. A lot less anxious. Wants to start working soon. He feels he is behind his peers but his peers haven’t been through what he has. And the work on himself he is doing will stand him in good stead in the long-term.
I met a lovely North African patient. One of those people who has a capacity to endure and be grateful and happy despite an immeasurable amount of pain and challenge. She has a rare condition called necrotising myositis. Her muscles are consistently being attacked by her immune system and breaking down. This leaves her with muscle pains, and weakness and puts her in a constant state of inflammation and tiredness. Despite this, she’s doing a PhD and working. One hard part about these kinds of rare conditions is that no-one around her will ever understand what it’s like because no-one knows what it is and visibly she looks OK.
‘I can imagine this takes a real toll on you and also imagine a lot of people really don’t understand the extent of what you’re going through so if you ever need any support e.g. a sick note or anything, let us know.’ She concedes not being understood is a hard truth she has had to accept. She is appreciative of being seen and understood. That is half the medicine- ensuring patients are seen, heard and understood.
The next patient is a head of year at a secondary state school. The system is broken, money is tight, her work schedule is overloaded and she constantly fire-fighting… and she is dealing with a narcissist who bullies her. She keeps getting cold sores, and is exhausted from the struggle of doing and managing beyond her capacity for so long. She wanted half-term holidays to enable her to do all the things on her to do list but instead her body has given in and shes got more cold sores and is just completely out of juice. She initially says she doesn’t want to talk about it as it’ll get her upset. I tell her she can if she wants as it might be good to get it all out… she talks and cries, and feels lighter. She doesn’t realise but what she really needs is a proper break and some space to process everything. We discuss strategies and boundaries. She’s not had a day off work in years. I give her 2 weeks off work after half-term and she’s completely overwhelmed with appreciation. Because she’s been seen and understood. She says ‘I want to hug you but I guess it’s unprofessional.’ I let her give me a hug.
It made me reflect on something I read recently on touch, and how it is incredibly beneficial for bonding hormones and even healing. It is a human need. And yet we are trained to believe it is unprofessional. Of course it’s not always appropriate, but it certainly shouldn’t be considered unprofessional.
My next patient has a multitude of problems. She’s obviously traumatised and comes out with a million problems that I can’t fix and takes up 20 minutes. Bless her. But I don’t feel like blessing her. After a list of random issues and nonsensical conversation, she starts talking to me about an incident she faced with the radiographer in the hospital two years ago and how she’d never been spoken to so rudely in her whole life… that’s my limit… ‘right, times up’ I interrupt her usher her out the door hastily.
As the day goes on and the interruptions continue, my patience wears thin. I see a lady with her husband and 2 children in the room, as the family have had scabies. They are concerned that despite 2 treatments they are still itching. The rash is not spreading anymore. My gut instinct is that it’s fine and the itch is residual and will get better with time. They’re not happy with that and ask more questions and ask me to look at the whole families residual rash despite only booking one consultation for her. Then she asks about some pains in her shoulders. I’m tired, I don’t have the energy for this so my answers become curt and body language is closed. They’re polite and say thank you and leave. I feel a bit guilty.
One of the front desk girls comes in and ask me to write a letter omitting a patient from court. She’s been called stand witness at a trial to give a character reference for her father before he murdered 2 members of the family. She can’t bear the thought of it and her mental health has deteriorated so she’s written in to ask if she can be given a letter of support to exempt her. I haven’t seen the patient and don’t know her at all… one of the temporary doctors has written about her worsening anxiety since being called to stand. Another doctor was asked if she would write the letter but she declined as she feels it’s legally delicate. There was a time when you would never write a letter like this when you don’t actually know the patient given the important legal consequences of such a decision. But the systems are under enormous pressure so you have to make allowances and just do what you feel is right. My risk tolerance is quite high. They call me Le Chiffre. I write the letter.
Mindful Medic 