Warning: A Doctor Rants

Vaccines had a bad press a few years ago, but things have changed, or so I thought. That’s why I was surprised when this week a university student refused the freshers’ dose of meningitis C vaccineFreeImages.com/Antonio Jiménez AlonsoI was even more surprised when he told me that his father, a doctor in another European country, was against vaccination.

What would you have done?  

University students are at higher risk of meningitis. One in four 15-19 year olds carries meningococcal bacteria in the back of the throat, as opposed to one in 10 of the general UK population. And, if you haven’t been a fresher for a while, imagine all that mingling with hundreds of other young people, often in crowded conditions.  

There’s lots of useful info on meningitis, and on vaccines.  Alas, I only know sites for fluent English speakers, and the lad in front of me wasn’t one of them.

I jokingly told him I wanted words with his dad. But in reality that was never going to happen. In general practice there’s barely time for a long discussion with a patient, let alone with family. Photo by Jean Scheijen FreeImages.com/Jean ScheijenConsultation rates with GPs have gone up in the last 20 years to around eight consultations per person a year. Along with that, patient expectations have risen. No bad thing in itself, but it requires more time.

Many areas are bulging with an influx of new patients. London has a particularly mobile population but it’s not the only place where there are migrants, refugees, or simply new housing. Some arrivals speak little English, so interpreters are needed, and the consultation takes twice as long as a result.

The pattern of work has shifted. As hospitals shed more care onto general practice, and send patients home sooner, GPs inevitably must do more. Around 90% of medical care now takes place in surgeries, by GPs, nurses and other members of the health team.

National Health Service logo

The structure of health care has changed with the advent of clinical commissioning groups (CCGs). In my view, that work takes a lot of good GPs away from face-to-face patient care.

Professional development makes demands too. I have to keep up to date, and these days I also have to prove it via appraisal and revalidation. People believed something had to be done post-Shipman, so now we spend time counting lots of things that don’t count. I hope that changes, but meanwhile preparing for annual appraisal takes two hours a week.

Providing good medical care is now a real struggle. GPs are retiring, and a sizeable chunk of medics are leaving the country.

Australian and UK towels on the beach

There’s nobody to replace them.

Like many GPs, I teach medical students. That time too must come out of a busy week. But here’s what really worries me about teaching.  

In the last 10 years I’ve noticed that fewer students now want to be GPs. Yet not so long ago new doctors were falling over each other to join practices.

It’s no wonder that doctors in the UK are angry and fed up. New changes imposed by government are likely to make things worse. In many areas, NHS general practice can barely provide a decent service five days a week. How can it stretch to seven days?

I’m not against change. General practice changes all the time. That’s part of its attraction as a speciality. But the developments I’ve lived through now make it almost impossible to do the job properly.

doctor's bag

You may like to read: 

Numbers of NHS doctors registering to work overseas could reach unprecedented record in the Independent, September 21, 2015

A fictional GP reflects on What They Don’t Teach at Medical School

I muse on What Happens when You Become a Doctor.

Easy tweet: What’s wrong with general practice? http://wp.me/p3uiuG-15w A #doctor rants #NHS via @DrCarolCooper

What They Don’t Teach at Medical School

Today GP Geoff gets a new group of medical students to teach. The names may change from week to week, but there’s always at least one swot from Germany or the Far East, a home-grown rugger bugger who is too big for his chair, a student in a hijab, a gay man, a babe who fiddles constantly with her iPhone, and an argumentative leftie.

HP Rapaport Sprague stethoscope, circa 1981

Geoff is a character from my novel One Night at the Jacaranda.  I made him up, but, if you know much about medicine, he seems real enough.

Education is not a vessel to be filled, Geoff muses, but a fire to be lit.  He has forgotten who said, it, but he’s pretty sure the fire should stay lit for the whole of their careers. So the students need a dose of reality.

fire in the political belly

Geoff reflects on his fifteen years of practice. The reality is that patients wangle sick notes because they don’t like their work. They get prescriptions for things they could have bought from the chemist. Well, par for the course.

They also suck you into their lives and dump their shit.  So you get involved when they tell you about their affairs that went wrong, the drugs they score on a Friday night, or how much they hate a sister or brother.

Or when they’re still driving even though they shouldn’t be.

FreeImages.com/Juan Miguel Rodriguez

Case in point: nice Mrs Thingy. Geoff is not too hot good on names, but he knows he advised her very clearly not to drive until her seizures were under control.

The snag is her three children. Geoff instantly forgets what she says her husband does, but he gets the gist. Mr Thingy has to get to Ealing Broadway station by 7am so he can’t do the school run.

“Can you walk them to school instead?” asks Geoff, ready to extol the benefits of blue skies, fresh air, exercise, autumn leaves, and the rest.

suburban street

“Doctor,” she says in a wheedling tone, “if I did that, it’d be a mile and half each way just for the boys. And Poppy is at a different school. There’s just no time. I’d run myself ragged, and that’s not good for my seizures.”

“Perhaps a neighbour can help?” suggests Geoff.

She gives a pitying look. “They’re all pensioners near us.”

“What about asking at the school? You may find a parent of a child in another class who lives near enough to you.”  Geoff is aware he’s running late now.

FreeImages.com/Vikki Hansen

“Well, I don’t know,” says Mrs Thingy.

“Why don’t you talk to the school secretary?” Geoff suggests. He may even need to involve Mr Thingy, find out if he can start work later during term-time. This is as far as one could possibly get from looking through the test results and reminding her about her smear. Geoff makes a mental note to do all this later.

Mrs T says nothing. She stares as if the GP is the baddie who makes up the laws.

Geoff continues, “If you have a seizure at the wheel… Well. It hardly bears thinking about.  Remember the Glasgow bin lorry crash last year? The driver blacked out at the wheel and killed six people.” 

“I know, I know.”  Her glance at the door shows she’d like to end the conversation as soon as possible.

Geoff leans back in the chair, which isn’t far as he has a cheaper model than his partners. “You realize, don’t you, that I’m obligated to contact the DVLA myself if you don’t.”  (For readers outside the UK, this is the Driver and Vehicle Licensing Agency.)

Her expression freezes.  “But I thought confidentiality…”

“Doesn’t extend to situations where the public is in danger.” He shakes his head slowly as he pulls a sympathetic face.

“Oh,” she says in a small voice. “Right.”

Geoff knows what he will discuss with his students today. Confidentiality.

And the knack patients have of sucking you into their lives.

***

Easy tweet: “What They Don’t Teach at Medical School http://wp.me/p3uiuG-14k via @DrCarolCooper” #medicine #students

What Happens When You Become a Doctor

Any day now and it’ll be the Killing Season, so-called. August 1 is the date when a fresh crop of newbie doctors arrives on hospital wards, bursting with enthusiasm and theoretical knowledge but woefully lacking in experience.

Jeremy's scalpel

In fact August is no longer worthy of that macabre tag. The month now begins with a sensible induction process for newly qualified doctors, with proper training in the tasks and procedures they’ll need to do in the coming months. Gone are the days of ‘See one, do one, teach one.’ The Killing Season is well and truly dead. Induction is a recent trend. I will never forget the utter panic on my first day as a doctor as I crept around in squeaky new shoes trying not to look like the rawest recruit. It was a Sunday—was there ever a more stupid day to start work?—and a patient had the misfortune of dying within 45 minutes of my arrival at the hospital. Now don’t jump to conclusions. I hadn’t even seen her before she died.

HP Rapaport Sprague stethoscope, circa 1981

HP Rapaport Sprague stethoscope, circa 1981

Wet behind the ears, I had no idea of the procedure to follow. Even scarier was the realization that I had two whole wards full of people to keep alive as long as possible. I rushed round to say hello to them all and check they were still breathing. At the same time, I said goodbye to many things: sleep, leisurely weekends, sitting on the loo without being bleeped. In short, to normal life. iv nutrition

While a lot has changed since then, including working hours, some things haven’t, as I realized from a recent blog post by Salma Aslam (by which I mean Dr Salma Aslam) Transitional state: med student to doctor It all came back to me. When you graduate from medical school, you may get a number of different reactions. 1 “Well done, but don’t go round thinking you know it all.” Don’t worry, I didn’t. And still don’t. 2 “So what?” That’s what I got from a group of arts students sitting around in the bar. They acted like they couldn’t care less about my news, but they were probably envious. 3 “Can you have a look at my verruca?”

plantar warts

Count yourself lucky. It’s much worse to be subjected to the long saga, in multiple episodes, of their entire medical history. This is when you get envious of those jobless arts graduates. 4 “The only thing that works for my migraines/arthritis/autism is kinesiology/homeopathy/acupuncture.” The implication is that allopathic medicine does nothing. Well, I’ll keep an open mind about that, only not so open that my brain falls out.

tablets

5 “You should get a job as a medical adviser on Casualty or something.” Yeah, right. Like nobody else with more experience wants to do it. 6 Perhaps the weirdest reaction was from my mother, who insisted I should now call her Dr Cooper. Why? “Because my daughter is a doctor, it’s like I’m the doctor. You may congratulate me now.” Get used to all of it. It may be a while before you hear the most welcome response of all: Thanks, doc. I feel a lot better.”

medical bag

Easy tweet: What happens when you become a #doctor? http://wp.me/p3uiuG-12N via @DrCarolCooper #medicine

Six Lessons from the Eye Clinic

Today Sanjay takes his mother to her hospital appointment.

He’s a nice young man, a character from my novel One Night at the Jacaranda. Although I made Sanjay up, maybe you know someone like him?

He and his mother walk past a sign warning of the symptoms of Ebola.

Not surprising the font on the sign is massive. This is the eye clinic.

1138666_78954230 medical eye

The morning is a learning curve. They arrive at 9.30am to find there are over 40 patients there already.

Beta, I should have brought chair from home,” says Mrs Shah. Here comes Lesson One: in addition to bringing glasses (including bifocals), appointment letters, and any medication they are taking, in original containers, patients should bring something to sit on.

The only empty seat belongs to a man who’s just gone to the loo, which doesn’t flush, as he explains to all and sundry on returning to waiting-room.

A poster on the wall advises patients that clinic visits can take up to four hours. The notice on a board by the receptionist says the clinic is running 90 minutes late. Sanjay isn’t sure if this time should be added to the four hours, or whether it is already part of it. Nobody knows. Lesson Two: don’t ask stuff. Just accept it may take some time.

They stand in the corridor for a while.  A nurse emerges from somewhere and calls out, “Philip Nutmeg” or something similar. When Mr Nutmeg fails to respond, she says it again, looking meaningfully at Mrs Shah. Sanjay says helpfully, “She’s not Philip Nutmeg.”

The nurse glares at him.

Frame on eye chart

Eventually Sanjay’s mother is summoned into a little room to have her vision tested by another nurse, and to learn Lesson Three: computerised medical records do not necessarily contain any medical records. The entire hospital went computerised two months ago, this nurse says, but there are no clinical data on them. So Mrs Shah gets to recite her entire medical history. She looks over the nurse’s shoulder to make sure she writes everything down.

When they come out again, a cleaner in a hijab is here to deal with the loo. And Philip Nutmeg still hasn’t shown.

Lesson Four: nobody gives old people a seat, not even when they are rubbing their knee and looking around hopefully.  It shocks Sanjay that not one person has stood up for his poor old mother.  He considers ejecting someone forcibly, but then his mum isn’t as old or as poor as some of the others.

In the corridor there are two wheelchairs blocking doorways. In one, a woman with one leg. In the other, a man (or possibly a woman). This person has two legs, but Sanjay is not sure about the face because it’s covered with a blanket.

There’s also an old man pushing out some zeds and a younger man who reeks of alcohol. It is 10.45am.

Sanjay notices a woman with a pinched face and a jute bag bearing the name of a firm of solicitors. The doctors will love that, thinks Sanjay.

One of the doctors appears now to find out what’s wrong with the man with the blanket on his head. He insists there’s nothing wrong, but the light hurts his eyes.

Lesson Five, thinks Sanjay: bring dark glasses to the eye clinic because the lights can become unbearable once you’ve got dilating drops in your eyes. Now the man in the wheelchair is mighty pissed off because the doctor has asked him not to cover his head with the blanket. “It scares us, you see. We think something‘s wrong.”

Sanjay’s not so sure. He reckons you could die in the clinic and not be noticed.

The crowd eventually thins out and they get somewhere to sit.  Sanjay’s stomach is rumbling, and so is his mum’s. Lesson Six: bring something to eat.

989041_50471101 baguette

By the time they’ve been there three and three-quarter hours, Sanjay’s mother has had her visual fields tested and her corneal thickness measured, and her pupils look as wide as a dead cat’s. She’s also gone into the inner sanctum, where the consultant sits at a desk in front of a large cutaway diagram of an eye. This is worrying. Shouldn’t the doctor know what eyes looks like by now?

The medical verdict is not too bad. Mrs Shah’s eye pressure is fine today, and her cataracts don’t need doing yet.

Unlike a patient leaning on the front desk. There’s only one receptionist left, and this patient is pleading with her to expedite his cataract surgery because it’s very urgent. Unfortunately, the receptionist tells him he’s only on the routine waiting list.

By the time Sanjay and his mother leave, there’s just one man left in the waiting-room. Maybe it’s Philip Nutmeg.

1221586_15421511 nice eye

Ham and Eggs with Mr Turner

It was lovely to sit down for two and a half hours with my mobile turned off. On the minus side, I had to put up with caricatures that would have done Harry Enfield and Chums proud. In the lead role is an on-form Timothy Spall doing his best-ever impression of Timothy Spall’s rendition of Timothy Spall.

His gurning is magnificent, his grunts fit for a piggery at feeding time. It all helps establish JMW Turner’s origins: his father was a barber and his mother a lunatic (as it was termed in Victorian times). The artist’s inarticulacy is well portrayed, but I didn’t see the need to over-egg the pudding, turning him and his housekeeper into Wayne and Waynetta Slob

There is also much gasping, groaning, staggering and falling about, all of which sharpens the contrast between Turner and his colleagues at the Royal Academy (filmed at Wentworth Woodhouse near Rotherham, South Yorkshire). There we have John Carew, David Roberts, John Constable, John Singer Sargent, Sir John Soane and others. The more Turner grunts, the more they twirl, ponder, recoil, ponce about and generally over-act.

Then Mike Leigh takes the piss out of the Ruskin family who come across as unbearably pseud.

I can't show you a Turner. Go to the Tate Britain.

I can’t show you a Turner here. Go to the Tate Britain.

The film Mr Turner goes to huge lengths (or, as the Daily Mail puts it, ‘amazing tricks’) to make the film authentic in every detail. Doctors did house calls in those days, though I’m not sure how Leigh induces Dr Price to come to London all the way from Margate for a simple home visit, especially since, in the film, Margate has quietly slipped west to Cornwall.

Still, the stethoscope is spot on as the simple tube invented by Frenchman René Laënnec His name is pronounced ‘Le Neck’ though this isn’t where doctors wore it at the time. The binaural model used today only came into production in 1851, the year Turner died. 

HP Rapaport Sprague stethoscope, circa 1981

HP Rapaport Sprague stethoscope, circa 1981

I liked Turner’s last mistress Mrs Booth (played by Dorothy Atkinson) who bears more than a passing resemblance to my ex-husband’s new wife. And Marion Bailey is a superb depiction of loyal housekeeper Hannah Danby, not least for the evolution of her psoriasis. First we see her scratching her neck, but later her scaly skin turns rampant. As the years pass, she becomes increasingly stooped and rigid, probably from psoriatic arthropathy which affects some 10% of people with psoriasis.

Turner’s eccentricity and talent come across well, as does the progression of his style of painting. Many of the images are genuinely beautiful. But the acting? More ham than a Bavarian market.

This is just my opinion. In no way does it represent the views of my husband (who thought we had booked to see Teenage Mutant Ninja Turtles), let alone the rest of the movie world. I’m sure everyone else will absolutely love the film to bits, darling.

Some of my Favourite People are Books (part two)

It’s usual for a list of great novels to include

  • an inscrutable foreign masterpiece from the present-day
  • one Jane Austen title (choice depends on intellectual criteria, such as which film hero was most fanciable)
  • an angst novel (Philip Roth often fits the bill)
  • To Kill a Mockingbird
  • Catch-22
  • and *drum roll* Anna Karenina.

bookshelf

Maybe you’re waiting with bated breath for Rosamund Bartlett’s new translation? Her Anna Karenina, due to be published in August, is already ranked about two millionth on Amazon (how does that happen? Tolstoy pulling rank again?).

Sorry to disappoint, but my choice of Russian blockbuster is by Boris Pasternak. When I first read it, I was neither a medic nor a writer, whereas Yuri Zhivago was both.

It snowed and snowed, the whole world over,

Snow swept the world from end to end.

A candle burned on the table;

A candle burned.

I loved Doctor Zhivago for its action, its setting, its characters, its lyricism (and Omar Sharif). I even studied Russian and tried to write poetry. Then I figured out the real lesson: to avoid becoming as self-absorbed as Pasternak’s hero. Also, not to turn into a bloke, especially not one with a frosted tache and a balalaika.

Dr Zhivago

Catch-22 may not be on this list, but I treasure another novel that gave rise to a very current phrase. Yes, the past is a foreign country in L P Hartley’s The Go-Between. Twelve-year old Leo figures out the facts of life. He also figures he’s being used.

“Well,” he said, “let’s make a bargain. I’ll tell you all about spooning, but on one condition.”

I knew what he was going to say, but for form’s sake I asked: “What is it?”

“That you’ll go on being our postman.”

While the lad was naïve by today’s standards, the book is still fresh for 1953 and nicely captures Leo’s post-traumatic stress. By comparison The Shrimp and the Anemone is rather dull. Which is to say that I don’t recall any spooning.

My choice of modern foreign masterpiece is the perfectly scrutable The Yacoubian Building. If you haven’t read it, it’s a lively ensemble novel peopled by a doorman, his family, a gay newspaper editor, Islamists, and the other motley inhabitants of the building on Suleiman Basha Street. Here’s a passage about the womanizing aristo Zaki Bey.

From Lady Kamla (she of the inexorable appetite) he learned how to start and when to desist and how to ask for the most abandoned sexual positions in extremely refined French. Zaki Bey has also slept with women of all classes – oriental dancers, foreigners, society ladies and the wives of the eminent and distinguished, university and secondary school students, even fallen women, peasant women, and housemaids. Every one had her special flavor, and he would often laughingly compare the bedding of Lady Kamla with its rules of protocol and that of the beggar woman he picked up one night when drunk in his Buick and took back to his apartment in Baehler Passage, and who he discovered, when he went into the bathroom with her to wash her body himself, to be so poor that she made her underwear out of empty cement sacks. *

The story may seem a bit ‘told’ for some, but that’s probably the nature of Arabic literature. The book has special resonance for me as I’ve lived in Cairo, although Al-Aswany doesn’t describe anything as atmospheric as my first terrifying day at school when I screamed so much that I threw up onto the teacher’s shoes.

For a tale that moves at breakneck speed and grips like a novice on a rearing stallion, look no further than Dick Francis. Low-brow? Maybe. Formulaic? Sometimes. But brilliant all the same, right from the off. This is from For Kicks.

The Earl of October drove into my life in a pale blue Holden that had seen better days, and danger and death tagged along for the ride.

I’m not the only fan of his opening style. Here’s what writer and blogger Emma Darwin has to say in Straight proof: what any of us can learn from Dick Francis.

Dick Francis

After brooding Russians, a traumatized adolescence, Egyptian neighbours and skulduggery in the stables, what could I possibly have left out? Chick-lit, that’s what. If you’ve read Me Before You by JoJo Moyes, you’ll know that Will has a life-changing motorbike crash.

“So, Patrick,” Will said, perhaps sensing my discomfort. “Louisa tells me you’re a personal trainer. What does that involve?”

I so wished he hadn’t asked. Patrick launched into his sales spiel, all about personal motivation and how a fit body made for a healthy mind. Then he segued into his training schedule for the Xtreme Viking – the temperature of the North Sea, the body fat ratios needed for marathon running, the best times in each discipline. I normally tuned out at this point, but all I could think of now, with Will beside me, was how inappropriate it was.

 What have all these books got in common?

A cracking story. Lots of conflict. Great dialogue. Wit, of course. I’m pretty sure there’s something else too, but it’s hard to analyse when you’re in awe so I’m damned if I know. Ask me again when I’ve got more of my own books onto other people’s shelves of favourites.

 

 *I had to correct the grammar in the English translation by Humphrey Davies. Sloppy editing, HarperCollins.

 

 

 

 

Hospital Tests: Has the Doctor Got it Right?

The department is in the bowels of the hospital. Appropriate, thinks Sanjay.

Sanjay is a character from my novel. I’ve let him out today for another hospital visit. There’ve been plenty of those in the last 18 months but today he’s got hope. He’s got hope the tests will be normal, and that he’ll be out of the door again before he loses the will to live.

As usual Sanjay passes the giant pebble on his way into the hospital. It is not a pebble so much as an expensive sculpture. Today it looks as if a dog has peed up against it.

UCL pebble

This hospital is one of the very few in the country that does this special ultrasound scan, a fact which pleased Sanjay’s mother. “See, beta? Now they know you are special.”

Not so Sanjay’s father, who took it as proof that bloody doctors don’t know what they are bloody doing and are just using his son as guinea pig.

One thing puzzles Sanjay: what is this scan exactly? He always asks questions but he’s rarely any the wiser. The doctors either reply something like “We’re going to take pictures of your squidgy bits” and give a smile that suggests he’s a couple of rungs below the village idiot.

Or else they give him a jargon-filled spiel, sometimes accompanied by a scribbled diagram on the nearest scrap of paper that comes to hand. surgeon's diagram

Once it said TOMATOES MILK WINE DRY-CLEANING on the back.

“Oh God, beta. Suppose they give you needles with this scan?” says his mum.

Sanjay shrugs. He doesn’t mind needles, but he’s not too fond of tubes up the behind. He had that once, when he’d passed some bright red blood. Luckily the test turned out normal.

He trusts the doctor who referred him for today’s scan. Just like he trusted the doctor who told him his colonoscopy was normal.

But what if the doctor had been wrong? And what if it wasn’t just the beetroot?

beetroot

Maybe the junior doctor had misread the result or had looked at someone else’s notes. Then Sanjay’s bowel cancer might go untreated, while someone else would get an abdomino-perineal resection that he didn’t need.

Abdomino-perineal resection: ‘complete surgical removal of the distal colon, rectum, and anal sphincter via simultaneous anterior abdominal and perineal incisions, resulting in a permanent colostomy’

a.k.a. ‘taking away some of your squidgy bits and popping your back passage onto your tummy’

Bummer.

Lots of people could be wrong a lot of the time, thinks Sanjay as he enters the revolving door. When you consider it, there are so many different ways of getting something wrong. But only one way (or at most a small handful of ways) to get it right.

Sanjay jabs the lift button and muses on his 36 years of life.

Just a Little Prick with a Needle

Today’s tests are no biggie. Nothing like the ones Sanjay’s had in the past. Anyway, he’s feeling better than in a long time.

There’s already a queue of blood test patients waiting to be interrogated at reception. You only get a numbered ticket once the bossy boots at the desk finds out if you’re fasting.

NHS

Sanjay gets number 79. The display on the wall says 46. No wonder the place is packed. Pretty soon he’s finished reading the Metro. So he reads people.

The girl next to Sanjay isn’t fasting. She’s shedding sugar from her donut all down her ample front. Fact: nobody who eats donuts ever looks as if they need to eat. And right under the sign that says no eating, drinking or assaulting NHS staff, a man is chomping into a burger. A ketchup sachet lies at his feet.

The plastic chairs are hard. Sanjay wishes he weren’t so skinny. There’s also a bench for urgent patients. The urgent patients look terrible, as if expecting to snuff it while waiting. He was on that bench not long ago, but now he’s been promoted from living dead to living living.

It’s number 67 now. The snoozing woman in the seat next to Sanjay wakes with a start when her walking-stick falls over. Walking-sticks always do. You’d think someone would design a solution.

Some people have brought their entire family, along with their shopping, scattered in carrier bags in and around the chair legs. A toddler with a cold studies Sanjay then removes his finger from his nose and wipes it experimentally on the arm of the chair.

The phlebotomist who finally calls Sanjay isn’t just a phlebotomist. The badge says he’s a cannula technician too. He is about 5’3” and one of his spots is threatening to erupt. He only opens his mouth to ask Sanjay to confirm his name and date of birth. Blood is taken wordlessly. It’s important to make patients feel at ease in today’s patient-centred NHS.

test tubes

Out Sanjay goes, clutching a cotton wool ball to the crook of his elbow.

The imaging department is at the other end of the hospital, down a draughty corridor guaranteed to give you double pneumonia if you don’t have it already.

Nobody’s eating in x-ray. They’re too busy figuring out how to sign in. For chest x-rays it’s straightforward because you can go anytime Tuesday to Friday from 9 to 11am and from 3 till 5pm. He doesn’t like to ask what the hell they do 11-3, not to mention all day Monday.

If you have an appointment, a state-of-the-art machine scans your letter. If you don’t have an appointment, you go to the desk. There’s a third machine that dispenses numbered tickets.   A young man in a moon-boot is waiting patiently while someone tries to fix that one.

Sanjay hangs around the desk while a receptionist makes a hash of explaining a test to the patient in front of him.

Finally Sanjay is told “Take a seat and you’ll be called by your name.” He thanks his lucky stars he’s called Shah, not something like Sivaramalingham. He sits by a wall decorated with enticements to give blood, volunteer for the League of Friends’ shop, give up smoking for good, get help with your alcohol problem, report domestic violence, and donate your organs as soon as you finish with them.

There’s a lot more activity here than in blood-testing. For one thing, there are two calling systems. The staff have the knack of calling out a patient’s name at the exact same time that the automated system calls out numbers. Means nobody can hear either announcement, so patients keep getting up to ask what’s going on, then coming back to their seats, head shaking in disappointment.

One patient has got the system figured out. Now she’s giving out to all and sundry the phone number of the professor’s PA, which is, she reckons, the only way to get your x-ray done and have the results sent to your doctor in the same century.

Only the old man next to Sanjay is immobile. He’s wrapped in so many layers of woolly clothes that he has to sit bolt upright. Probably been wearing them a while, judging from the smell.

Sanjay needs the toilet but it’s out of order. This means a trek halfway round the hospital to find one that works. He could have just asked at the desk for a dozen specimen containers and filled those.

hospital gownFinally it’s his turn for x-ray.  

He is shown into a cubicle and handed a gown. Then he studies the grainy instructions on the wall.

Sanjay tries to tie it as per the picture, but fails. Ah. Two of the tapes are missing.   He goes into his x-ray bare-chested like Putin.

The radiographer tuts.

Two hours for two simple tests. Finally Sanjay breathes a sigh of relief and exits to the fresh air, rushing straight into a crowd of smokers by the revolving doors.

 

Next week it’s the London Book Fair. I look forward to meeting friends old and new, and reading an excerpt from my novel to fellow indie authors. I have yet to choose the passage, but you can bet Sanjay will be in it.

Learning to be Sick in Washington, DC

When my mother went to live in Washington, DC, in the 1960s, she discovered that being ill there was not like being ill in her home town of Alexandria, Egypt, where everyone fussed over her and soon made her feel better.  Here’s one of her stories.

“When will Dr Smarts be able to come and see me?” I asked the receptionist who’d answered the phone.  His name had been given to me by a friend.

The receptionist laughed. “Come and see you?”

“I have a sore throat and a temperature, my nose is stuffed up, and I can’t taste food.”

“I have a cancellation for 3pm tomorrow. Take two aspirins, drink plenty of fluids, and we’ll see you then.”

“Doesn’t Dr Smarts make house calls?”

“Not unless you’re in your 80s.  Even then, he prefers to see patients in the hospital.”

Hospital? I shuddered.

I called the school where I taught to say I was ill and wouldn’t be in. The secretary was understanding.  “There’s a virus going round.  Drink plenty of fluids.”  What was a virus? No Alexandrian had ever mentioned the word ‘virus’.

It was a miserable day spent alone.  My friends were either at work or otherwise engaged.  The only visitor I had all day was the building engineer who came to check the air conditioning.

Polish TV

But there was American TV, to which I had quickly become addicted. Alas, the early afternoon movie was an old one, Suez, and it made me homesick for Egypt.  When I saw all that sand and all those familiar persistent flies, I burst into tears.

Where was Nagibeh, our old housekeeper, to sit in my room till I fell asleep, and my little sister’s nanny, the fat Dia with her rosary and fervent prayers? Where was my mother to read me stories? Where was the kind Greek doctor who puffed his way up the stairs and who made me feel better even as he blew smoke rings into my face?

The following morning my temperature was up.  Although it was a warm September day, I was shivery.  I wrapped up as for a polar expedition and walked the one block to Dr Smarts’ office.  How extraordinary that he did not make house calls, and me so nearby too.

Dr Smarts was unimpressed with my symptoms. So I coughed over him and exaggerated my aches and pains. I did such a good job that he decided to run some tests.  He also wanted to know the medical history of every member of my family.  He was beginning to get on my nerves.  All I probably had was a bad case of la grippe, which some nasty-tasting medicine would cure in no time.  And here he was asking me about my family.

Sick as I was, I gave him a colourful account of being ill in Egypt.  Egypt? He wasn’t quite sure where it was. I even told him about the time I was so sick with indigestion, Father called the doctor in the middle of the night. I’d eaten a whole kilo of sudanis, delicious peanuts bought off a street vendor, and had thrown up 10 times.  Nagibeh had cleaned the carpet with savon de Marseille.  Dr Smarts had never heard of savon de Marseille.  His general knowledge was pitiful.

“Couldn’t you have just put the carpet in the washing machine?”

To give him credit, Dr Smarts was a good listener and jotted down everything I said.  No doctor I knew ever wrote anything except prescriptions.

“What do you normally eat during the day?” he asked.

“I have an English breakfast: eggs, bacon, toast, coffee.”

“Lunch?”

“Well, first there’s elevenses.”

“What’s elevenses?”

Ignoramus, I thought.  “It’s a mid-morning snack” I explained patiently. “I have hot cocoa and biscuits.”

“How many biscuits?”

“In our culture it’s considered rude to count what one eats.  However, if they’re chocolate, most of the box.”

“Lunch?”

“Where I teach, lunch is usually cold cuts and salad.  I’m not fond of lettuce.  I’m not a rabbit. But at 3pm before I pick my daughter up from her school, I have a chili hot dog at People’s Drug Store.  My main meal is dinner: chicken or meat, potatoes, spinach, a banana. No dessert. But sometimes before bed I have a tuna sandwich with mayonnaise.”

The doctor put his pen down and looked at me. “It’s a wonder you’re not the size of a house.”

“I ate much more in Alexandria” I replied hotly.  “My father and grandmother ate like horses, and weren’t fat at all. My mother hardly ate a thing and was always ill.”  Dr Smarts looked shaken.

“You know, Dr Smarts, in Alexandria they say ‘Eat, eat, bil hana wal shifa.’  That means with pleasure and good health.  We also say ‘Bon appetit.’ And doctors all make house calls.”

“We used to make house calls too.” He sounded wistful.  “Anyway, you’ll be fine.”

“What about a prescription?”

“Just drink plenty of fluids and take aspirin.”

I bundled up again under the amused eye of the receptionist.

As I walked home, I thought of what I’d write for La Reforme Illustrée, our friendly Alexandria Sunday paper. No house calls, no prescription, counting biscuits! How uncivilised.

I resolved never to be sick in Washington, DC, and you know what?  I never was.

© Jacqueline Cooper

When I’m not Writing

It’s a fun life, this novelist business: publishing and promoting a book, and getting a sequel going, while ideas for the prequel are also bubbling away.

What did I do before novelling?medical bag

A lot more doctoring, for a start.  Every day, the rich pageant of life played out in the consulting-room.  Many patients shared their innermost secrets, told me their darkest fears.  Most had washed, some hadn’t.  Their socks stood up unaided. 

A lot of them talked while I listened to their chests, so I had no chance of picking up the subtle signs learnt at medical school.  Or hearing what they were saying.

Frequently a patient would promise “This won’t take a minute, doc.”  Which was true.   It usually took at least half an hour.   The ones who took longest had often brought me newspaper cuttings about the latest ‘breakthrough’.   Sometimes it was an article I’d written myself. 

These days it’s all about patient-centred medicine.  I realised how far along this road we’d gone when a patient just to ask how feather pillows should be washed.  Some patients, of course, were really ill, like the young man with meningitis who turned up thinking he’d just badly strained his back.   Despite being sent to hospital by ambulance right away, he still ended up disabled. 

doorway to patient's flatWhen I was training to be a GP, I visited a lot of housebound patients.  Finding their homes could be a challenge.  Houses with names were the bane of my life, as were those where the numbers were too small to see from the road.  It was a straight choice:  stop every so often to peer at them, or drive with two wheels on the pavement. 

There were homes so dirty you wiped your feet on the way out. 

And high-rise blocks of flat which smelled of urine and carbolic (but mostly urine).  The lifts never worked, and if they did nobody would have willingly entered them anyway. 

There were tiny bungalows where a lot of patients kept the front door key hanging on a length of string inside the door.   You fished the string out through the letter box and let yourself in. 

Often there were dogs where you least expected them.  There were two kinds: the protective type bared their teeth as soon as you touched their master, and the other kind  stayed curled up on the sofa, unnoticed till someone sat on them.  Then they yelped into life and bit you on the bum. dog

Sometimes the patient was dangerous, like the young psychotic who locked me into the dining room and threatened me with shards of broken mirror.   

It wasn’t a wealthy area.  I’d get called out to see patients with minor injuries, if they weren’t sure it was worth getting a cab to A&E.  Funny they could always afford cigarettes.

The ones that I remember most vividly were the old people, living out their lives in one-bedroomed homes, surviving on their pensions (if they turned the heating down), their memories, and not much else.  They usually had a knitted blanket on their knees, a couple of faded photos on the mantlepiece, some tacky souvenir from a seaside holiday, and maybe a china dray-horse on the window-sill.  While there I’d check the kitchen cupboards.  They were often bare apart from a huge collection of medicines. 

All of human life could be found in patient’s homes, providing insights that are rarely glimpsed 25 years on.  I still see patients, but these days it’s almost always in the consulting-room.  Even full-time GPs don’t have the nearly same volume of home visits these days.  There’s no time in today’s high-pressure, high-tech primary care.