I cycle into work. It’s a rainy day. I’m going down a steep hill and brake hard behind a van that suddenly stops. I skid viciously and nearly fall off. I let go of the brakes and momentarily recover—only to realise I’m still hurtling towards a stationary van. I slam the brakes again, skid, and bobble around unflatteringly.
I stop an inch in front of the van.
Epic.
A puff of relief followed by a big grin across my face.
Tea, Rain and Managerial Puzzles
I arrive at work. Andy—the service manager—knocks on my door.
Andy: “Made a cup of tea for yourself, have you? Thanks!”
Me: “How many people are in this morning?”
Andy: “Six.”
Me: “So you want me to make six cups of tea this morning?”
Andy: “Yes, that would be nice.”
Me: “Right. Shall we block out my first patient appointment so I can do that instead? Anyway, are you OK?”
Andy: “Yes, thanks for doing all that paperwork last night. Mind you, it was in your tray so it’s your work.”
He laughs really hard.
Me: “Right. No problem. All OK otherwise?”
Andy: “Yes. It’s good that it’s raining. I like the sun, but the Earth and the plants need water. So the rain doesn’t bother me. And my plants that I just planted.”
Me: “Yes, it is. Good for the plants. Thanks Andy. Have a good day.”He, predictably, leaves me with a bewildered look on my face.
Andy is our service manager. Andy was the only manager until Jamie, the practice manager, arrived six months ago and stopped me from quitting a lot sooner.
Ideally, you want a manager who sorts things out and for whom nothing is too much trouble. Jamie is that. Andy is sweet—but definitely not that. If you ask Andy a question, you’ll get three back.
Jemma
Jemma, my first patient, has pelvic pain and abnormal bleeding. Her ultrasound shows adenomyosis—a condition where the womb lining grows into the muscle wall problematically. It often needs hormonal or surgical treatment.
We start with painkillers, and I refer her to Gynae. It’ll take months before she’s seen.
A Sticker Saves the Day
Gene, 3, comes in. Mum’s worried about croup. She’s lethargic and downbeat. Croup is a viral condition that can sometimes cause serious airway obstruction leading to a medical emergency.
The Westley Score helps assess severity. After examining her, the score is a reassuring zero. I give her a sticker. She bounces into life and suddenly becomes a chatterbox. She cracks me up.
Brian’s Bladder of Boredom
Brian, a new patient, came early for his appointment and has been waiting an hour. It can be a sign of boredom or loneliness.
After sorting the essentials, he tells me everything about his medical history. I notice my urge to end this consultation quickly, but remember how neglected our elderly are. I let him blather on for the remaining 7 minutes of his allocated time. Then he starts explaining how prostate operations work and I interrupt him and tell him:
“Right Brian, listen, time’s up—we’ll have to save your prostate tutorial for another time!” He bursts out laughing and takes the prompt promptly.
He’s still got his sense of humour—an excellent antidote to loneliness (which is an anagram of “one illness”– it sure is an illness).
MOIS Chemistry
We have a lunchtime meeting: Medicine Optimisation Incentive Scheme (MOIS). The aim is to improve prescribing habits.
Simon, our in-house pharmacist, and Katerina, leading the call, keep interrupting or disagreeing with each other. But sometimes they laugh together.
Confusing.
On our end, it’s me, Andy, and Nat (our other GP), on mute.
“Anyone else feel like there’s something going on between Simon and Katerina?
“Yep. there’s definitely something that needs to be released here.”
“Yep. I can’t quite figure out what the underlying emotion is.”
“Do you reckon they’re having an affair?”The rest of our call is made far more interesting with observations on Simon and Katerina’s love-hate relationship.
Ruby
Ruby, a tall, blonde 40-year-old, comes in with six months of back pain. At the end of the consultation, she coyly asks:
Ruby: “Would diazepam help?”
Here we go. Diazepam is a muscle relaxant and more significantly, mind relaxant with a lot of addictive properties and side effects.
Me: “Diazepam can help for acute back pain, not chronic pain so it’s not indicated.”
Ruby: “Yeah, but it feels sooo good.”
I chuckle.
Me: “I know it does. That’s the problem.”
Ruby: “Oh go on, Doctor.”
She slaps me on the arm. Unbelievable.
Me: “Not a chance, Ruby.” I smile. “Off you go.”
I’ve survived a skid, a MOIS love triangle, and a Ruby ambush. The rain has stopped. Andy’s plants are thriving. And so am I?
Mindful Medic 