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

More Certain Than Taxes, and More Painful

In a few days I’ll be at a Cambridge University event, speaking to students who look forward to careers in the media.  But today I’m looking back at a serious topic.  My piece last month in The Sun newspaper went a bit like this…

Life is complicated, but dying is even more so.

As a doctor I’ve seen many patients whose lives are utter misery.  They’ve reached a stage where nothing can relieve their suffering and make their days bearable.   Some of them beg for death.  But assisting a suicide is against the law in England and carries a sentence of up to 14 years.

If it were the beloved family pet, the answer would be clear and compassionate.

It’s heart-breaking to have a relative who longs to die, and I really feel for the families, especially as my own mother is now suffering horribly. 

My mum’s spine is deformed and broken from severe osteoporosis.  She howls in pain, and in anticipation of pain before even being touched.  She’s incapable of doing anything now.  Every single thing the devoted team of nurses do for her hurts acutely. 

Sometimes she lies in bed yelling that she’s in agony. Or else she shouts over and over “Please help me, please help me.” Mum and me crop

No longer the person she was, she weighs 35kg and stares with blank eyes.  Everything she has been through in the past two years, including a major op that she nearly didn’t survive, has left its mark.  The pain is literally causing her mind to go, but she is still aware of how bad things are.  I sit by her hospital bed and hold her hand, and she sometimes tells me she wants to die.

Increasing the painkillers makes her more confused.  Some of the drugs make her paranoid.  I’m still hoping there’s an answer because it’s so awful to watch her suffer.

Don’t get me wrong.  I was never immune to the suffering of patients in situations like this, but when it’s one of your own you can appreciate the back-story and see the whole perspective of their lives.

Medicine has a lot to answer for.  Many people wouldn’t be alive had it not been for doctors.  On the other hand, medicine isn’t a perfect science and never will be.   I’ve been a doctor long enough to know at first hand that medicine is good at prolonging life, but not so good at sustaining its quality.   

When quality of life is appalling, or treatment too awful to bear, then the balance of pros and cons may suggest that treatment doesn’t benefit the patient.  In making that decision to withhold treatment, the relatives and patient’s wishes are vital.  If the patient can’t take part in the discussion, his previously stated wishes are taken into account.

Withholding treatment is totally different from deliberately hastening death, whether or not it’s with the patient’s consent.    

But there is what’s called the doctrine of double effect.  This makes a distinction between acting with the intention to kill, and performing an act where death is an unintended effect.

For instance large doses of pain-killers can shorten life.  But doctors give them only with the intention of relieving pain. The doctrine of double effect says that’s morally right, even though the primary effect (pain relief) comes with the risk of a harmful side-effect.  Sometimes that harm can even be foreseen, but according to the doctrine it is still OK, as it achieves the main benefit, which is relieving pain.

However the double effect isn’t often the get-out clause it appears to be.  Nowadays there is a huge range of pain-relieving drugs, and dosage changes tend to be tiny, so they rarely shorten life.

Medicine has come so far now that we need an urgent way forward on that most basic event, death.  Not all doctors are agreed on the right course of action.  If assisted dying is introduced in any form, we’d need strict safeguards against abuse, greed, negligence, incompetence, and probably a few other things as well.

Some doctors are vehemently opposed.  Personally I fear that legalising assisted suicide could change the doctor-patient relationship forever.  On the other hand, there’s also the hope that it would help medics honour Hippocrates’ order: “To cure sometimes, to relieve often, to comfort always.”

Since then, my mother has died, ending our suffering, though it continues for other families.  

 

Germs and Geriatrics

She is asleep with her mouth open, so Geoff sits down quietly and watches for a bit. At 92 she still has some of her own teeth but the interior of her mouth has that glazed look that comes with age, and with candida.

Geoff is a GP from the pages of One Night at the Jacaranda. He can’t help making these observations.

Grandma stirs, and soon she’s sitting up yelling for the nurse.  “I’m in agony” she’s saying as she jabs the bell repeatedly.  “I’m in agony” she repeats to the rest of the ward.   The three other old ladies appear to have heard this before. 

Today Geoff had to put on a mask and gown before entering the ward.  Some nasty germs have been isolated on the unit, but high bed occupancy means it can’t be emptied and deep cleaned.  He’d asked a nurse which germs, and got a shrug by way of reply.

agar plates

The lunch tray arrives.  It looks vile, all that sloppy food designed to slip down elderly gullets.  “Feed me” demands Granny.

She watches Geoff with beady eyes as he spoons some of the beige slurry into her mouth.  That’s probably where the germs are, he thinks.   After a couple of mouthfuls Granny has had enough.  She’s staring at his head now.  “I like your hair” she says and reaches out to touch it.

She reminds him of Davey.  She might like to see her great-grandson again, but hospitals aren’t good places for 5-year olds, unless maybe they’ve got Henoch-Schonlein purpura.

There’s a miniature Christmas tree on the bedside locker. “It’s nearly February” Geoff points out.  “And you’re Jewish.” 

“I’m 95 now” Granny replies with impeccable logic. 

A nurse comes in, switches off the call button and offers Granny tablets for pain. Which Granny refuses, saying she’s fine.  

The nurse then rearranges things at one of the beds.  Geoff notices that she hasn’t bothered with a mask, gown or gloves.  She senses his stare and says “I’m not touching the patients.”  The nurse probably wouldn’t believe it if Geoff told her that viruses and bacteria can live on call buttons, beds and bedding. 

“The priest came to see me” Granny tells Geoff.

“Why, Grandma?”

“Because I’m getting married, of course. To Marvin.”

This is news to Geoff.  “Do I know Marvin?”

Granny swats at him with a bony hand.  “Of course you know him.  He sits next to me in class.”

She’s gone downhill faster than he thought.   Only last week Geoff was thinking of testing her with the SAGE questionnaire for cognitive problems.  He hasn’t used it on patients yet but it looks a useful test, with low false positives, and no copyright issues, unlike the MMSE.  But not much point trying it on Granny any more.   Although her mental state fluctuates from day to day, she seems proper demented now.  An MRI of her brain would probably look like cheese.

Swiss cheeseNow she says “Make me comfortable.” 

The nurse has gone, so Geoff tries adjusting the hospital bed.  It has lots of buttons.  Granny develops a liking for the buttons that controls the foot end.   

No harm in that, thinks Geoff.  After she raises and lowers the foot of the bed about a dozen times, he remarks that it’s just like a see-saw.

She gives him one of her stares.  “You’re really very stupid.”

Before Geoff leaves, he asks if Marvin’s going to visit.

“Who’s Marvin?” replies Granny.

elderly hands

You may also like to read:

How are you today, Granny?

Alzheimer’s online test crashes university site

Where on earth can you meet someone?

When you’re 30-something, it’s tough to meet people.  I know a couple who met on an allotment, but, when I tried growing vegetables, all I pulled was a bunch of deformed carrots.

Laura has a similar problem.  At uni, men were young, plentiful and persistent.  Now it’s a different story.

She dreams she’ll randomly meet a hot guy while out shopping.  He’ll have eyes like molten chocolate and a French name like Yves.  They’ll swap phone numbers and then – well, the rest will be in soft-focus.   shoppingIn point of fact, the only time she spotted anyone attractive in a shop, she up-ended her handbag in the aisle.  Instead of helping her collect coins and tampons off the floor while begging for her number, the guy turned away and carried on studying tea-bag prices.

Back to dating websites then.  Where she’s 34, called Emma, pretends she’s not a lawyer, and gives a fake phone number.  It’s a pay-as-you-go mobile she can easily discard.  All those phoney layers will have to come off if (or when?) when she meets someone nice.  She’ll cross that bridge when she gets to it.

Geoff is another character out of my forthcoming novel.  He’s a newly divorced doctor, and the nice pay packet no longer makes up for sky-rocketing patient demand and new government diktats every other day.  During his years working in hospitals, women threw themselves at him, and academic awards came equally fast and thick.  stethoscopeBut he’s been a GP for over 10 years now, and the sea is remarkably empty of fish.  GMC guidelines forbid relationships with patients, and he doesn’t fancy the new receptionist, even if the patients adore her.   Plus there’s a new problem now.  He can’t perform as he once did.

Geoff returns the call to the nursing home.  Bad news: 94-year old Mrs Montgomery fell out of bed again so he’ll have to visit.  She seems fine, they say, but as always the staff want to ‘cover’ themselves.

Get yourselves a duvet, thinks Geoff as he gets into his car.

Karen, now.  Men haven’t exactly been beating a path to her dilapidated front door.  No, her best friend tells her, the meter reader doesn’t count.

Newly single, Karen has 4 children and no job.  She’s still confident she’ll meet someone eventually, even if all the evidence so far is against it.

After a clear-out, today she’s headed for the recycling centre.  It’s on her way to the hairdresser’s for a much overdue appointment, via the shoe repairers and the bank.  Why spend more on petrol than you have to?  Karen doesn’t obsess about her appearance, especially when she’s busy cramming her clapped-out Toyota with bags of garden refuse, broken toys, mouldy trainers, 994-piece puzzles, and clothes that her kids have worn to death.recyclingParking her car in front of the containers, she notices a man in a green T-shirt unloading a wardrobe from the back of his estate car.  Nice buns.

He turns to face her.  It’s a Nike T-shirt, and more to the point he has a great smile.  She makes eye contact and returns the smile with a Hi, ready to talk about the wardrobe, or anything really.

He clocks her, but his smile promptly fades.  In fact he hot-foots it back to his car, driving off a lot faster than the 5 mph limit.

When she gets to the hairdresser’s, Karen is ashamed to see in the mirror just how bad her roots have got, how much garden rubbish she has on her sweatshirt and, in short, how bad she looks.

Michael knows exactly where to meet women.  After all, he’s an accountant, so he’s got it planned down to the last detail.  That’s how he does everything, even watching porn.

More to come in my novel on dating. Meanwhile why not take a moment to share your experience of meeting people? I’d love to hear your tips too.

How are you today, Granny?

old persons crossingNo matter how good a doctor you are, if you don’t look after your own, you’re right at the bottom of the class. That’s the opinion of Geoff, a 30-something general practitioner from the pages of my novel One Night at the Jacaranda.

Granny shuffles to the door in furry Elmo slippers. ‘I haven’t been for three days,’ she says, adding, ‘I’m 92 you know.’  Geoff is pretty sure she’s only 90 but Granny often adds a year or more for effect.

She doesn’t see her friends anymore.  Yet today she insists she sees them daily and plays bridge.  ‘Elsie even brought me chocolates this morning.’  When Geoff looks at the box, he sees the sell-by date is 2011.

Apart from her bowels, Granny’s life now revolves around food and meal times, but she only picks.  Geoff checks her fridge and throws out rotten pears and expired cheese.

Today she demands a haircut.  ‘You were going to be surgeon,’ she reminds him.  He’s not sure he was training to cut the three strands of white hair left on the old girl’s head, but he gives it a go.  She stands in the bathroom, clutching the sink and bending down so he can reach even though he’s no longer the small boy she read stories to.  He’s 5’11” and she’s shrunk to about 4’10”, so he practically has to kneel.

Although it’s August, there are Christmas decorations all over the bathroom, or rather the bits she can reach.  Granny has never before celebrated Christmas.  Now she reaches out with a sinewy hand to adjust the tinsel on the towel rail then looks at him proudly. ‘I’m 93, you know.’

Today is a good day because it’s only her shoulder and her constipation.  Last week it was her knee and a rash.  The week before, it was her ankle, which she sprained on VE Day 1945.   He said it was just wear and tear, so she poked him with her walking stick and called him stupid. Geoff can’t understand why her mental state fluctuates so much.  Obviously dementia has a vascular component, but how can it possibly change to that degree?

‘I’m going to do Big Poo,’ she announces.  This reminds Geoff of his son.  The difference is that five-year old Davey’s brain is still making new connections between cells.  In Granny’s case, the opposite is happening.  He imagines her brain full of holes, like Emmental cheese.  He’s glad his mother died before she got like this, even though it meant Granny lost a daughter.

She installs herself in the toilet, legs not touching the ground.  Geoff knows this because she won’t let him shut the door.

So he waits in the darkened living room, where there’s a pile of plastic bags, all neatly folded on the sideboard, a stack of old envelopes which could be useful for making lists, and electricity receipts going back to 1988.

Alte kakers.  Only Granny makes Geoff want to break into Yiddish.  She makes him want to break into the Bristol Cream sherry too.  There must be an unopened bottle in the sideboard.

Geoff remembers that alte kaker means ‘old shitter’.  As he waits for Granny, he thinks of the words patients use.  Faeces.  Number Two.  Dump.  Crap.  Ploppies.

He’s sure an hour has passed, but when he checks Granny is still on the throne, with her legs sticking straight out.

‘You know I love you, Bubala,‘ she calls out from the toilet, voice still strong.

‘I love you too, Granny.’

elderly hands

 

Related posts: 

An Evening at the Proms

Hospital Tests: Has the Doctor Got it Right?

Germs and Geriatrics

Six Characters in Search of a New Year’s Resolution

My first time

Yes, it’s my first time.  My first post. Here, that is.

Although I’m a doctor, don’t expect this blog to cover worthy health topics. The one on thehealthcounter.com does that.  Today I won’t be going on about the BRCA1 gene, measles outbreaks, a vaccine for Dengue fever, the dire state of the National Health Service, or why you should have a smear test (though obviously you should).

This baby blog is my sabbatical from medicine:  a space to share what I’m writing and doing, and for you to tell me what you’re up to. But please don’t ask me about your fungal toenail infection.

I’ll be writing a bit about my novel One Night at the Jacaranda which I started a couple of years back. It’s hard not to now that it’s become part of my life.

While it’s completely fictional, the characters are real to me.  Like my three sons, they don’t do rules. They get up to things I don’t want them to, such as saying things they shouldn’t and jumping into bed with the wrong people.  But they’re looking for someone special, and everyone makes mistakes.  I’m talking about my Jacaranda characters, not my sons.  I’m sure they do some of those too, but they’re wise enough not to tell the world about it.

Characters do things because they want to (or they did at the time, as when getting a tattoo after a few drinks too many).   In much the same way, I’m blogging because I want to.

This won’t be Danny Buckland’s blog FuturePills. Or Ben Goldacre’s.  Or Joanna Penn’s.  It’s mine,

I’m on the steep part of the learning curve and I don’t mind borrowing crampons to help me stay on.

It all takes me back to my first day at high school. Remember tiptoeing around in squeaky new shoes, trying to work out who the cool kids are, and smiling at everyone in case they want to be your best friend?  Yes, I am cringing that much.

Or maybe it’s more like a first kiss, that first love.  As daunting as it is, you still throw yourself into it.  I think I’ve taken all the precautions though you can’t insure against getting dumped or your heart being broken.

So let me know if you’ve got some great tips on blogging. And please be gentle, cos after all it’s my first time.

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