IT is 7.45 in the evening and I have been doctoring all day. Forty-three consultations, 430 decisions, four or five thousand nuances, eye-muscle alterations and mutual misunderstandings have left me emotionally drained and so exhausted that it is a considerable mental effort to remember quite how to double-lock the surgery door. But don’t pity me. I get paid – quite well by my patients’ standards. Pity the patients instead.
There was the batty woman who ‘has always suffered with her legs’. A forklift truck driver with asthmatic attacks to whom I explained three times the action of sodium chromoglycate in stabilizing mast cells – until we both agreed I should give up the effort and he should keep taking the pills. There was Mrs J, making light of the fact that her devoted husband, as well as herself, now has cancer, asking with genuine feeling about my family, and insisting on giving me $2 ‘for the holidays’ which she could ill afford but I could ill refuse. A man with a brain tumour who hasn’t told his wife and who keeps this agonizing secret with me and his hospital doctors. An ex-services amputee who clanks his tin leg against the chair, and a widow still in tears (‘we’d been together since the General Strike’).
And so it goes on. Wax in the security guard’s left ear, a nasty childhood eczema; several sore throats and coughs; two of which are selected for the five-star anti-smoking tirade; one of whom tellingly replies that he will give up his cigarettes the moment someone stops the pollution from lorry exhaust fumes that blackens the air of local streets.
Why haven’t I got the time or energy to refuse an old dear the sleeping pills which one of my colleagues commenced, on a strictly temporary basis, 15 years ago? Am I really making anyone happier, except perhaps the drug companies whose overpriced, crudely advertised (‘Narcoxyn 500 Has the Power’) – and occasionally unsafe – products I have been prescribing all day? I once heard a consultant colleague, who meant it as a compliment, describe general practitioners as ‘specialists in highly skilled reassurance’. I would much prefer to be a highly skilled specialist in making patients angry: because these so-called medical symptoms have causes – and cures – far beyond my sphere of medicine. We’re not trained in the installation of handrails or the delivery of meals on wheels. That’s somebody else’s business – despite the fact that any major improvements in health have been because of political and social reform rather than ‘medical breakthrough’.
Today – against my better judgement – I referred for specialist investigation a bus conductress with a run of ‘funny tummys’. I wrote her a comprehensive referral letter and she was carefully and competently examined by a specialist physician who, in turn, wrote a comprehensive and illuminating letter back to me explaining he too could find nothing specific and suggesting she might wish to try bran on her breakfast cereal. Were we maintaining a show of professionalism to mystify our patient or simply justifying the existence of the technology at the specialist’s teaching hospital? Or did the bus conductress simply want a little time off to postpone facing yet another new brain-bending fares scheme?
Probably my time was better spent visiting a recently bereaved wife whose husband’s ghastly death is still vivid in both our minds. And I would certainly do better if I were to bully the housing authorities to forbid a neighbour breeding pigeons next door to a diabetic man with life-threatening asthma, than I would by increasing his broncho-dilator dosages still further.
But then again, just as one has almost talked one’s own profession out of existence, along comes a good, old-fashioned emergency, calling for high-tech hospital medicine and some very fancy clinical management – but fast.
It came this morning with the unpredictability which is so typical of general practice. It should have been an easy visit: just another case of chickenpox. Some common-sense advice, a bottle of calamine, maybe a squint in the ears, and you can usually be out of the door again in a couple of minutes. This time I was greeted by two kids running barefoot down the length of the council-house corridor – naked but for grubby towels, and covered from the soles of their feet to the roots of their mouths with weeping scabs. Inside, their baby sister lay face down on the carpet like a discarded doll, with a burning fever, rigid neck stiffness, swollen eyelids shut tight over her eyes and with skin almost obliterated with pox craters.
Trying, while on the phone, to make light conversation, I asked where Dad was. He was, his wife explained, on remand in Brixton Prison on a charge of attempted murder. Oh, and since he had suffered brain damage in a road accident he was now so deranged that he literally tore his cell apart if not visited every day by his wife. So would I be able to arrange for her to speak calmingly to him over the phone before she accompanied her daughter in the ambulance?
A bad day; we all have them.
It only becomes a futile day when I get home and try to unwind in front of the TV set which is celebrating, yet again, that profitless and very expensive adventure in the South Atlantic.1
I doubt if I have ‘saved’ more than half a dozen lives in my life or, to be perfectly honest, prolonged or greatly improved the quality of more than a very few. Yet instead of tackling housing and working conditions, our society has instead perfected weapons which can blow a cruiser full of teenage conscripts out of the water, which publicly gloats over those boys’ deaths and which boasts its ability to blow the entire world into a desert of radioactive dust. What price then the stabilizing effect of sodium chromoglycate on mast cells?
Perhaps I should have the courage of a colleague who recently – and with a certain icy logic – gave up her medical career to work full time for nuclear disarmament: perhaps the single most fruitful measure of preventative medicine that modern society could take?
Obviously this is not my conclusion. I remain more convinced now than I was ten years ago, as a rather naive young hospital doctor, that if we are to have a society genuinely enjoying good health – rather than a medical sector snuffling after the causes of sickness like a baffled bloodhound – we need fundamental changes in the way our society is owned, ordered and organized.
Healthcare according to need rather than wealth is not just a good moral principle. It has been shown to work. And to be more efficient and effective than the commercial medical sector in North America. This is ground which must be held against governments who make no secret of their wish to return to the old two-tier medical care of charity and minimal medicine for the majority with a lucrative private sector providing VIP care to those who can foot the bills.
But if I ever get complacent about what can be achieved by medical measures alone, I need only go as far as I did this lunchtime: to the local supermarket. There I will almost certainly know half a dozen shoppers and will be able to see the trolleys quaking with pop and sugar, cheap cosmetics and ciggies: not because my patients are bad people. But because those products are cheap and filling and quick and keep the kiddies quiet. And it’s then, not in the consulting room, that I renew my practical and intellectual commitment to social change.
In this respect it is conventional to think of doctors like Ernesto ‘Che’ Guevara, Norman Bethune and Josuah Home. But I have more affection for those flaming words of Sylvia Pankhurst (whose mother-and-baby clinic – a converted pub called The Mothers Arms – was only a stone’s throw away from where I practise today) to the judge sentencing her, once again, to jail for sedition: ‘I have sat up with the babies all night and tried to make them better. But this is the wrong system and it cannot be made better. And I would give my life to see it overthrown.’