Physician Heal Thyself

Please note: this material  is subject to copyright and is not to be copied, distributed, performed or used in teaching without written permission from the playwright. To apply to use any of this material on stage or in teaching, please complete the contact form.

Physician heal thyself is the fictional “day in the life of” Dr. Emma Roberts, a rural GP, who is faced with a multitude of personal, patient and staff challenges during a particularly stressful working day. It is the modified first act of the four act play, Walk a Mile in my Shoes.

It has been used throughout Australia in education sessions for GP registrars, supervisors and medical educators since 2009, as well as enjoyed performances for general public audiences.  Workshops are designed for participants (rather than professional actors) to read the play aloud and then engage in facilitator led discussion.  The participants involved in the reading stay “in character” for part of the discussion and questions can be asked of them. There is a formal exercise to de-role participants.  Discussion points are generated using the play’s plot, characters and themes. Topics can include:

How can GPs balance the sometimes conflicting roles of clinician, educator, business owner and human being?

How and why do doctors tend to put their own health last?

Can storytelling be used not only as a way to debrief and reflect, but to promote, teach and understand General Practice?

It can be combined with a creative writing workshop or a more extensive self care workshop if desired.

There are four versions available:

1) Full length (35 – 40min playreading suiting 90min or longer total session length)

2) Shortened (30 – 35 min playreading suiting 60 – 90min total session length)

3) Abridged (20 – 25 min playreading suiting 50 – 60 min total session length)

4) Full length with extra female parts (35 – 40min playreading suiting 90min or longer total session length), adapted for groups of readers comprising of more females than males.

The full length version is reproduced below for evaluation purposes only. The others are available on request.

Genevieve Yates is available to run workshops using this resource in person and/or to discuss ways in which other facilitators can best use the play themselves.

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Physician Heal Thyself

(for play reading sessions)

Full length version

By Genevieve Yates

Script Title:  Physician Heal Thyself

Plot Synopsis:  Dr. Emma Roberts, a GP, arrives late to work one morning to find upset staff members, a waiting room full of annoyed patients, and news that one of her long time patients has died. Can her day get any worse?

Setting:  Semi rural town,Australia.

Place:  Consulting room in a GP practice

Time:  Present Day

Required set:  3 chairs at front of the room / on stage,

Optional props: Bristol stool chart A5 size, notepaper (2 sheets) (Mr. Black), coffee mug (Michael), chocolate cake on plate (Bridget), thick stack of computer print outs (Alison), photo frame (in consulting room), phone/computer/sphygmo (in consulting room)

Estimated Running Time:  40 minutes

Cast list

Emma Roberts, doctor

Michael Harris, doctor (GP registrar)

Bridget Redfern, receptionist

Patients (in order of appearance)

1)      Mr Black

2)      Jessica Delaney

3)      Dennis Langford

4)      Mrs Ryan

5)      Bill

6)      Casey Lewis

7)      Mr. and Mrs Harcourt

8)      Alison Best

.


One Act play: Physician Heal Thyself

Emma walks in, carrying a bag, looking preoccupied and despondent.  Soon after, Bridget rushes in, distressed.

Bridget:  Oh Emma, you’re here at last.  Merv Briggs has died and it’s my fault!

Emma:  What happened?

Bridget:  Merv’s wife rang this morning saying that Merv had pains in his chest.  She wanted to talk to you about it.  I explained that you were starting late today but that I’d talk to Dr. Michael and get back to her.  She seemed annoyed that she wasn’t put through immediately.  I thought about interrupting Michael with the phone call but he’s been a bit stroppy this morning so I just wrote out a message for him.

Emma:  Did he get the message?

Bridget:  Well I wasn’t sure so I buzzed through to him about an hour later to ask if had returned Mrs. Brigg’s call.  That’s when he told me that by the time he rang back it was too late…. That Merv had died and that I had done the wrong thing by not telling him immediately.

Emma:  Oh no.  Bridget, it sounds like it wouldn’t have made any difference anyway.  Don’t be too hard on yourself.  You’ve only worked here a week – it’s understandable that you are not yet fully across practice protocols.  Has anyone rung Merv’s wife? Rosie’s a fragile creature – she must be going out of her mind!

Bridget:  Not that I know of.  Was I supposed to?  Have I done something else wrong?

Emma:  No, not at all.  I’ll give her a call myself now.  (on phone)  Mrs. Briggs, Rosie, it’s Emma Roberts from Hillview General Practice.  I’m so sorry to hear about your loss.  Is there anything…. What loss?  Well, Merv, of course, I heard what happened this morning…. No one told you?…. (hand over mouthpiece, sidebar to Bridget)  The ambulance took Merv to Nambour hospital’s emergency department.  Merv’s wife is in the waiting room.  Apparently no one has told her that Merv didn’t make it…. What did you say Rosie? …. Oh that’s wonderful news…. I’m sorry to have frightened you…. No, I’m not sure how I came to be misinformed (looks pointedly at Bridget)…. Yes I will get to the bottom of it, I promise.  Goodbye Rosie. (phone down).  Merv’s not dead – he’s fine.

Bridget:  Thank God!  But Michael said….

Emma:  Somehow, wires were crossed.  Is it OK if we sort it out later Bridget?  Ask Michael to come and see me at lunchtime.  I’ve got to start seeing some patients; I’m running so late already.  My appointment in Brisbane took longer than expected and I was held up by road works on the Bruce Highway driving back. (sighs)

Bridget:  Are you OK?  You look kinda stressed.

Emma:  I’ve had a really difficult morning.

Bridget:  Join the club. It can’t possibly have been worse than mine.  I’ve had to handle the front desk all by myself because Lorraine called in sick, Michael’s been in a bad mood and then I thought a patient had DIED because of ME.  Talk about stressful!

Emma:  It certainly sounds very stressful.  Look I really have to see some patients. Could you send in Mr. Black please?

Bridget:  Of course.  By the way, Tewantin Gardens nursing home has called three times, Steve Butler from Pharmacy Central wants to talk to you and you have two admissions at Hinterland hospital to do today.  Oh, and the drug rep who was bringing lunch has cancelled. (hands Emma a list)

Emma:  Thanks.

(Bridget exits, Emma spends a few moments organising things on her desk and getting herself together.  Mr Black knocks then enters)

Emma:  Come in Mr. Black, I’m sorry to have kept you waiting.

Mr. Black:  Good morning Doctor.  How are you?

Emma:  Fine thanks.  Actually, no I’m not so fine.  I’ve had…

Mr. Black: (ignoring Emma’s response) Doctors seem to think their time is more valuable than ours.  It really is quite rude.  (looks at his watch)  I booked an appointment for 8:30 this morning.  Two days ago, your receptionist rang me and said that you were coming in late today and that I would need to reschedule.  I rebooked for 10:30 and I arrived at 10:24.  I saw you walk into the surgery at 11:14 and it is now 11:20.  Not only was your arrival tardy, but it was 6 minutes before you called me in.  Needed a cup of coffee and a good sit down perhaps?

Emma:  I’m again sorry for keeping you waiting but the delay was unavoidable.

Mr. Black:  Hurrumph

Emma:  So how can I help you today?

Mr. Black:  I have brought you the record of my bowel movements, blood pressures and blood sugars for the past month.  I know you told me that I wasn’t diabetic but I do like to keep an eye on my sugar readings, just in case it develops.  My blood pressure has been a bit up and down but as you see (hands Emma a sheet of paper) the averages are pretty good…. I’ve calculated the mean and the median and written them down here.  Another thing I wanted to talk to you about is about my hair loss.  I have been noticing more strands than usual in my brush and I think it is thinning a bit more at the top (drops head to let Emma look).  I was reading the patient information leaflet in the box of the new blood pressure pills you prescribed me and it mentioned alopecia, that’s hair loss, isn’t it?  It did say it was a rare side effect but I really do think it should have been something I should have been warned about.

(Lights dimmed then lights up.)

Mr. Black:  Well that’s sorted then.  Now back to my bowels.

Emma:  (sigh) Yes?

Mr. Black:  I would firstly like to thank-you very much for that Bristol Stool Form Scale you gave me last visit.  It has been incredibly useful.

Emma:  I’m pleased it has helped.

Mr. Black:  I’ve always had trouble charting my bowel motions.  As you know, I’m prone to constipation so it is very important for me to keep an accurate record so that I can adjust my fibre intake accordingly.  It has always been easy to document WHEN I pass the stool, but much more difficult to describe its CONSISTENCY..

Emma:  I can see that it might have been hard (half smile).

Mr. Black:  (oblivious to joke) Exactly.  Until now my descriptors have been limited to hard, soft or runny.  Grossly inadequate.

Emma:  Certainly gross.

Mr. Black:  But now I have this wonderful method of charting (holds up Bristol stool form guide).  A numerical value is assigned to each faecal type – from 1 to 7 – in ascending order of liquidity.  There are pictures and descriptions of each type (starts reading).  Type 1 – separate hard lumps, like nuts. Type 2 – sausage shaped but lumpy.

Emma:  You needn’t go on.

Mr. Black:  And there are even child friendly descriptions.  Corn on the cob, chicken nuggets, porridge, gravy….

Emma:  Yes I am familiar with the chart.

Mr. Black:  “Choose your poo,” it says to the kids, “choose your poo”!  If only they had such a chart when I was boy.  Parents must be falling over themselves to get their hands on one of these.

Emma:  There hasn’t been a big rush, no.

Mr. Black:  Anyway, as you can see (hands over sheet of paper), I’ve definitely improved since I started the All Bran Challenge 26 days ago. Mostly “3’s” and even two “4’s”!

Emma:  That’s great, Mr Black.

Mr. Black:  Well thank you doctor, I shall see you again soon – at the appointed time hopefully.  (looks at watch)  I hope that you are not going to charge me for a long appointment.  Omitting pleasantries, we only spent 19 minutes and 10 secs discussing medical matters.  Your practice fee brochure clearly states that a long consult is one that is over 20 minutes in duration.

Emma:  A standard consult fee will be fine, thanks.  I will see you again soon I’m sure.

(Mr. Black exits and Emma looks at her computer screen.)

Emma:  (groans) Jessica.  On today of all days.

(Emma takes a big breath and goes to the doorway)

Emma:  Jessica Delaney?…. Hi Jessica, come on in.

(Jessica enters and sits down)

Emma:  So you have made it to the 12 week mark, congratulations.

Jessica:  Thanks, yeah I’m like really excited.  I can’t wait to have a baby too.  ALL my all friends do.  We are going to have play dates and like babysit for each other when we want a night out.  And baby clothes are like so cute.  We are going to like dress them in matching outfits and buy them those little T-shirts with the funny messages on them.  You know, like “If you think I’m cute, you should see my Mum”.  It’s gonna be totally awesome.

Emma:  I’m glad you’ve got supportive friends.  Jessica, when you were last in we were talking about what to do and what not to do when pregnant.  Did you have a chance to read the handouts I gave you?

Jessica:  Yep, and I’m taking my vitamin pill every day.

Emma:  That’s great, Jess.  How about alcohol?

Jessica:  Well…. I’ve been pretty good, but I did have a few with the girls over the weekend.  I’ll try to like say no next time.

Emma:  Just remember that there is no safe drinking level in pregnancy.  Have you managed to give up cigarettes yet?

Jessica:  I’ve cut down heaps.  I’m now only smoking about 15 a day.  It’s like just SO hard.

Emma:  Keep working at it Jess.  Have you checked out the Quitline website?

Jessica:  Nah, not yet.  Emma, is pot safer than ciggies?  I’m finding that if I smoke some weed each night, it helps keep me off the cigarettes.

Emma:  Both marijuana and cigarettes are really bad news during pregnancy.  Try to avoid both.

Jessica:  I have managed to give up tea and coffee though.  Well, I never did like coffee, but I always like had a cup of tea in the mornings.

Emma:  A cup of tea each day is perfectly fine.

Jessica:  But I read in those pamphlets you gave me that excessive caffeine is like harmful in pregnancy.  So I gave up my cup of tea.  I don’t want to harm my baby!!

Emma:  That’s very noble, Jess.  How about you work really hard on applying that to the alcohol, cigarettes and marijuana?

Jessica:  I am trying.

Emma:  (mutters) Yes, very.  (brightly) So how are things going with Damon?

Jessica:  Oh, OK.  We’re thinking of going on a holiday to Bali soon.  Before the baby comes.

Emma: Bali is lovely.  There are some precautions you need to take when travelling overseas when pregnant though.

Jessica:  Yeah, well the trouble at the moment is that we haven’t got enough money.  We are thinking of going to the bank to like get a loan but we need your help.

Emma:  My help?

Jessica:  Yeah, well you know the baby bonus is like $5000, right?  Well, we’re going to get that in 6 months or so.  We were hoping you could give us a letter that we could take to the bank saying I was pregnant and that the money was like coming.  Then we could get a loan against the baby bonus money.

Emma:  I don’t know that that is such a good idea.

Jessica:  We want to go and like party before we have to look after a baby.  We could buy a plasma TV or something with the money later on, but I really want to go to Bali.

Emma:  I don’t think I can do that for you Jess.  If you want the money, you’ll have to try to get it some other way. (pause) So it sounds like Damon is more accepting of the pregnancy now?

Jessica:  Sort of.  We’ve moved in together but we’re keeping his address as his parents’ so our Centrelink money doesn’t go down.  I’ll get like heaps more if I’m a single Mum.  He wants a paternity test though.  You do that like after the baby is born, don’t you?

Emma:  In most cases.

Jessica:  Said he didn’t want to be saddled with supporting someone else’s bastard kid.  Not that he makes enough money to be supporting anyone’s kid.  He’s been on the dole like since he left school.  He can’t work ‘cause he’s got ADHD and anger issues.

Emma:  Does he ever hurt you Jess?

Jessica:  Nah, if he gets mad he just punches a wall and like drives off.  He’s never laid a finger on me.  Well, not like in anger…. he’s obviously laid more than a finger on me in other ways or I wouldn’t be like pregnant!

Emma:  Does doing a paternity test worry you?  Is there any chance the result could be…. well…. unexpected?

Jessica:  Of course not!  I haven’t like been with anyone else for over like 6 MONTHS!

Emma:  Nothing to worry about then.  Is there anything else you’d like to ask about today?

Jessica:  Nope, it’s all good.

Emma:  I’ll see you in a month then.  Jessica…. I’d really like you think seriously about ways you can give this baby the best possible start in life.  Just remember, pregnancy is a responsibility and privilege that shouldn’t be taken lightly.  You are very lucky to be 12 weeks pregnant.

Jessica:  Whatever.  No need to like lay on the guilt trip.  I’ll try harder for you Emma.

Emma:  It’s not me you should be trying harder for, it is your unborn child.

Jessica:  Yeah, yeah.  OK, see you next month.

Emma:  See you then.  And remember you can come back sooner if you have any concerns or if you want to chat further.

(Jessica exits, Emma goes to the doorway)

Emma:  (At doorway) Dennis Langford?

(Emma comes in with Dennis)

Emma:  Hi Dennis, how are you feeling?

Dennis:  The usual… I just came in for another script.

Emma:  That’s fine, I can organise that for you.  How are things going otherwise?

Dennis:  OK I guess. I did want to talk to you about my cholesterol though.

Emma:  Your cholesterol?

Dennis:  Yeah, well as you know it tends to be a bit high.  You told me last year that it wasn’t bad enough to need tablets but that I should improve my diet.

Emma:  Yes, I remember.

Dennis:  Well to be honest Emma, I didn’t do much about it at the time but I’ve now decided to make a really big effort.

Emma:  You have?

Dennis:  Yep.  I’ve always loved my bacon and eggs but I’ve given them up completely and I’m eating organic low-fat muesli and skim milk in the mornings.  I don’t eat red meat at all now actually and have also given up cheese, butter and ice cream.  I do miss them but I know how important having a good cholesterol level is.

Emma:  Dennis, I don’t think such a huge change is required.

Dennis:  But you said, last year, you said how important it was and what a difference changing my diet would make.

Emma:  I know I made a fuss about your cholesterol last year.  Cholesterol is an important long-term risk factor for diseases such as heart attacks and strokes.  But I don’t think it is something you need to be focusing on now.  A lot has changed for you since last year.

Dennis:  You mean the cancer.

Emma:  Yes, I mean the cancer.

Dennis:  You don’t think I need to worry about my cholesterol because the cancer is going to kill me soon anyway.

Emma:  I’m sorry Dennis, but yes.  We’ve talked about how the cancer is all through your bones and liver.  We spoke about why the oncologist said that further chemo is pointless and that now we are focusing on controlling the pain.  Have you got any further questions about all that?

Dennis:  Nah, I understand…. So I can eat bacon and eggs?

Emma:  Absolutely.  Guilt free!  (starts writing script *see explanatory note at end of play)  So how is the current morphine dose controlling your pain?

Dennis:  Mostly pretty well.  I still wake up at night from the pain occasionally but I just take an extra dose of that liquid morphine and it settles down.

Emma:  We’ll stay on the same dose for now then.  Did Carol bring you in?

Dennis:  Yes she’s in the waiting room.

Emma:  See you next week then?

Dennis:  No worries.

Emma:  You know I’m happy to come and visit you at home if you prefer.

Dennis:  I know, but I’d like to keep coming here for now.  It’s usually the only time I get out of the house during the week!

Emma:  Righto.  See you soon.

Dennis:  Thanks Emma…. for everything.

(Dennis exits, Michael pops his head into consulting room carrying coffee mug)

Michael:  You wanted to see me?

Emma:  Yes I did Michael, please come in.

Michael:  What’s up?

Emma:  Bridget was in quite a state this morning over the death of Merv Briggs.

Michael:  Death?  He didn’t die. He had a bit of reflux.

Emma:  I know that…. now.  Heartburn, not a heart attack.  I found out when I rang Mrs. Briggs to offer my condolences.  She burst through the emergency ward’s doors and ran to her husband’s bedside, only to find him sitting up in bed and eating sandwiches.

Michael:  That’s hilarious!

Emma:  Maybe to you, but not so funny for Mrs Briggs who thought the emergency doctors hadn’t told her that her beloved husband had died.  Not so funny for Bridget who thought she was to blame for Merv’s death.

Michael:  I suppose not.  But still, bloody funny from where I’m sitting.

Emma:  So why would Bridget think had he had died AND that she was to blame?

Michael:  How should I…. oh.

Emma:  Oh?

Michael:  But I was joking!

Emma:  Go on.

Michael:  Well, Bridget buzzed me to ask if I had called Merv.  I said something like “By the time I rang back, it was too late…. he had already gone.”   Merv had indeed gone – to hospital by ambulance.  I must admit I did kinda suggest that he had “gone to a better place” rather than gone to Nambour, but strictly speaking I told the truth.  (chuckles)

Emma:  And the blame?

Michael:  I was just informing her of practice protocol.  I told her that in future, if a patient calls with chest pain, either transfer the call immediately to a doctor or tell the patient to ring an ambulance.  I said that it looks bad if our patients die at home from a heart attack while waiting for a doctor to call back.  Oh, yes, I see.  Oops.

(knock at door)

Emma:  Come in.

Bridget:  (Bridget walks in carrying a cake) Sorry to interrupt, but Dorothy Smith dropped this in for Michael.  (hands cake to Michael)  She told me to tell you that it was her special recipe and that she appreciated all that you had done for her.

Michael:  Fantastic, I’m starving.  Haven’t had any lunch cause that bloody drug rep cancelled.  (starts eating cake with gusto)  Hey Bridgy, sorry about this morning.  No hard feelings eh?

Bridget:  I’m just glad that Merv is OK.

(Bridget exits)

Michael:  Mmmm…. Chocolate, my favourite.  Not ALL women misunderstand me.  Want some?

Emma:  No thanks.  Look Michael, this is not the first time your “humour” has been taken the wrong way by staff and patients.  We’ve talked about this before.  It’s great having a bit of a laugh at the office but you really should be careful, particularly with people who don’t know you well.  Patients in particular can misinterpret things – most will take seriously what comes out of their doctor’s mouth.

Michael:  Yes boss.  Message received loud and clear.  Relax, Emma.  All’s well that ends well.  (looks at watch)  Lunch time’s over.  I’d better get back to the coal mines.  You’d better get a move on too – Mrs. Ryan has been sitting out in the waiting room for ages and she looks even more cranky than usual.  No lunch break and you’re still running late – don’t you just love being a doctor?

(Michael exits.  Emma sighs, taps a few things on her keyboard, straightens her hair / desk, takes a deep breath then dials phone)

Emma:  (On phone)  Hi sweetheart, it’s me.  Just touching base.  Sorry I didn’t call earlier.  It’s been a crazy day.  My appointment in Brisbane didn’t go so well.  He told me…. no, this is not a conversation for voice mail, we can talk tonight.  I’ll probably be pretty late home.  Don’t forget to buy some milk.  Love you.  Bye.

(Emma stares into space for a second or two then goes to doorway)

Emma:  (From doorway) Mrs Ryan, please come in, I’m ready to see you now.

(Emma enters with Mrs. Ryan)

Mrs Ryan:  I have been waiting for 46 minutes.  You were running late last time too.

Emma:  I’m sorry to have kept you waiting.  Do you want to reschedule?

Mrs Ryan:  No, I’m here now.  (Brings out a list) My headaches are worse again – I think it might be my blood pressure.  I’m getting funny wavy lines in my vision and I feel dizzy when I turn around quickly.  My stomach has been bloating again and I’m getting pains low down in my groin most evenings after dinner.  My right shoulder has been giving me curry and I’m getting pins and needles in my right foot.  I’m worried about my shortness of breath – I’m coughing now too.  Worst of all I feel so tired – I’ve got no energy at all.  I also need a drivers’ licence medical certificate, three scripts, two referrals and a full skin check.

Emma:  I don’t think we will be able to cover all of these concerns today.  Which ones would you like addressed most urgently?

Mrs Ryan:  Now don’t fob me off saying you haven’t got time.  I waited 46 minutes and I intend getting my money’s worth.

Emma:  But you are bulk billed.  You don’t pay anything.

Mrs. Ryan:  Don’t get smart with me.  I’ve paid with my time.  Time is money and I want my 46 minutes’ wait worth.

Emma:  (sigh) Let’s start with your blood pressure.  (applies cuff and starts to inflate it)

Mrs. Ryan:  Ow, that hurts.  Do you have to make it so tight?

Emma:  (listening with stethoscope)  Shhh….

(Lights dimmed during which Mrs Ryan exits and Bill, a tough old farmer, enters. Lights up to see Emma kneeling on floor, looking at Bill’s foot)

Bill:  Pardon?

Emma:  Why aren’t you wearing your hearing aids?

Bill:  What?

Emma:  (pointing to ears) HEARING AIDS!

Bill:  They’re a pain in the bum

Emma:  (muttering) In that case you are probably wearing them in the wrong place

Bill:  Pardon?

Emma:  Never mind…. NEVER MIND!  THIS IS A VERY NASTY INFECTION.  YOU SHOULD HAVE COME IN EARLIER.  I’VE TOLD YOU BEFORE THAT FOOT INFECTIONS ARE VERY DANGEROUS IN DIABETICS.

Bill:  I haven’t got diabetes, Doc.  Just a touch of sugar.

Emma:  HAVE YOU BEEN TAKING YOUR MEDICATIONS?

Bill:  Nah, I ran out a while ago but I’ve been feeling fine so I thought I’d give ‘em a miss.

Emma:  IT IS VERY IMPORTANT TO TAKE THEM EVERY DAY, FEELING WELL OR NOT.  BILL, I AM GOING TO HAVE TO SEND YOU TO HOSPITAL WITH THIS FOOT.

Bill:  Hospital?  No way!  Can’t you just give me some tablets Doc?

Emma:  IT IS FAR MORE SERIOUS THAN THAT.  THERE IS GANGRENE IN TWO TOES AND A LARGE ABSCESS.  I THINK YOU ARE LOOKING AT AMPUTATION.

Bill:  Me ‘ole leg?

Emma:  I DON’T THINK SO.  YOU’LL PROBABLY LOSE A TOE OR TWO.  HOPEFULLY NO MORE BUT THEY WON’T REALLY KNOW HOW BAD IT IS UNTIL THEY GET IN THERE.

Bill:  Fair enough.  You know best.  Got 10 of ‘em.  One or two less won’t be the end of the world.  But I don’t want to go into hospital for just a coupla toes.  Strewth.  Who will milk me cows?  Can’t you have a go at lopping ‘em off here today Doc?

Emma:  THAT’S OUT OF MY RANGE OF EXPERTISE, BILL.  THE SURGEONS ARE GOING TO HAVE TO TRY TO IMPROVE YOUR CIRCULATION TOO OR YOU’LL LOSE MORE THAN YOUR TOES.

Bill:  Well how ‘bout we leave it a coupla weeks.  Me son’s due to visit soon.  He can keep an eye on things at home.

Emma:  SORRY BILL.  IT REALLY CAN’T WAIT.  COME ALONG AND WE’LL ORGANISE TO GET YOU TO HOSPITAL.

(Emma and Bill (limping) exit and almost immediately Michael wanders into Emma’s room.  Michael looks vague, is walking clumsily and acting strangely.**See explanatory note at end of play.  Emma then enters and notices his strange behaviour.)

Emma:  Michael, what’s going on?…. Are you OK?

Michael:  I don’t feel well at all.  It’s that cake, it has to be the cake.  The silly old bitch has tried to poison me.

Emma:  (closes door behind her and then picks up phone) Just calm down.  You’re obviously in no state to work.  (on phone)  Bridget, could you reschedule the rest of Michael’s bookings for this afternoon.  I’ll see any that are urgent, otherwise ask them to return tomorrow or next week…. I’ll explain later…. Thanks…. (puts phone down, turns to Michael)  What are your symptoms?

Michael:  About half an hour after I ate the cake I started to feel really strange – sleepy, dizzy, nauseous.  It’s got worse and worse.  Now my pulse is racing and my hands feel numb.

Emma:  That certainly sounds suspicious.  I’d better ring Dorothy and find out exactly what was in the cake.

(Emma looks up phone number on the computer and dials phone).

Emma:  Hello Mrs. Smith, this is Emma Roberts from Hillview General Practice… Yes the weather is lovely today. The reason I am calling is that Dr Harris is feeling a little under the weather and was concerned that it might have had something to do with your cake….  

Michael:  You tried to kill me you stupid old hag!

Emma:  (hand over receiver)  Shh, pull yourself together for God’s sake and just sit quietly.  (on phone)  Sorry, Mrs. Smith.  What were you saying?….  yes the cake you brought in at lunchtime…. yes, he ate quite a lot of it,  nearly half?  (looks to Michael for confirmation.  Michael nods) …. Now calm down.  It’s OK, no one is blaming you.

Michael:  I am, give me that (reaches for phone clumsily, Emma prevents him getting it)

Emma:  …. I don’t think he was expecting such a gift…. He asked you to bake him a hash cake?…. Last appointment?…. Are you sure he wasn’t pulling your leg? Sometimes it can be a little hard to work out if he is being serious or not.  (glares at Michael) …. No, we won’t be reporting you to the police.… (Michael starts to stand as if to interject, Emma gestures for him to sit) …. Yes I’m sure he will be fine…. I’ll do that Mrs. Smith.  Goodbye now.

(puts down phone).

Emma:  So…. No recollection of saying that you would like to try one of her hash cakes when she told you she used them for pain relief from her arthritis?

Michael:  No way, I didn’t ask her to supply me with drugs!  I never touch the stuff.

Emma:  Nothing come to mind at all?  Nothing like “I could sure use some of those.  Do you accept orders?  Chocolate is my favourite.”

Michael:  Maybe I said something like that as a joke.

Emma:  A joke? Doesn’t sound funny to me.

Michael:  Not ha ha, laugh out loud funny, no.  But it can still be classified as a joke, an attempt to lighten the mood.  She’d just told me she used illegal drugs…. a sweet little old lady.  I was just trying to make her feel OK about it.

Emma:  Worthy motives perhaps, but next time, let the other person in on the joke.  I don’t want to have to talk to you about this again.

Michael:  Hey, I’m the one who’s suffering here.

Emma:  Yes I know, but you can understand why I’m not feeling overly sympathetic.  Go and lie down in your consulting room and stay there.  I’ll organise to get you home.

(Michael exits, Bridget enters)

Bridget:  God he looks terrible!  I’ve cancelled his appointments.  What on earth’s going on?

Emma:  Seems that the special herbs and spices in that chocolate cake were a little more potent than one usually finds in baked goods.

Bridget:  Huh?

Emma:  It was a hash cake.  Marijuana.  Michael’s stoned.  He didn’t know it was spiked….  Turns out his sense of humour has got him in trouble again.  Twice in the same day!  I don’t know whether to laugh or cry.

Bridget:  I’d go with the laughter option.  It’s terribly funny.

Emma:  (picking up phone) I’ve got to call Jane and ask her to come in and pick Michael up.

Bridget:  Michael’s wife?

Emma:  (nods) She had a baby only 3 weeks ago. Poor thing is not going to be happy.

Bridget:  Oh can I do it?  After this morning’s experience and all….

Emma:  Sure, be my guest.

Bridget(on phone)  This is Bridget Redfern from Hillview General Practice.  Michael has become intoxicated from consuming marijuana at work and needs to be picked up and taken home…. Thank-you.  See you soon.  (puts phone down, turns to Emma)  She says she’ll be right in.

Emma:  Thanks Bridget.  Could you send in Casey Lewis please?

(Bridget exits, a few moments later, Casey enters)

Emma:  Thanks for coming back Casey.   Still enjoying the Uni holidays?

Casey:  Pretty much.  It’s hard living with my parents again after being at college for 6 months though.  They still treat me like a kid sometimes – “Where are you going?  Who are you seeing?  When will you be home?”  When I’m living down in Brisbane, I can stay out all weekend without anyone fussing.  It’s nice to have my meals cooked and clothes washed though.  So why did you call me back in?  Have you found something?

Emma:  We have, I’m afraid.  The swab that I took when I did your PAP smear last week shows that you have a sexually transmitted infection.  Chlamydia.

Casey:  (visibly relieved)  Oh, just Chlamydia.  I thought you were going to say that I’d caught something serious.   Chlamydia’s nothing.  I’ve had it before.  You just take one tablet and it’s cured.

Emma:  Chlamydia is treated with a single dose of antibiotic, yes, but it can be serious if left untreated.  It can lead to infection and scarring of your fallopian tubes and ovaries, and can cause infertility.

Casey:  Oh I don’t care about fertility.  I’m not going to have kids anyway.

Emma:  You’re only 19, Casey.  You will probably change your mind when you get older and you’ll care about your fertility then, believe me.

Casey:  Middle aged woman always tell me that. (Emma visibly winces) They don’t know me.  I have my career all planned out.  I’m going into advertising – it’s the perfect blend of creative and corporate.  Kids are not on the agenda.   Look I know I’m pretty slack when it comes to using condoms and I really should be more careful.  I’m very good with the pill though – I bluetack it to my college room door so that I remember to take it when I leave each morning.  It’s a bit trickier when I end up sleeping in someone else’s room but I carry a back up packet in my bag – look (gets pill box out of her bag) – and, touch wood, no stuff ups yet.

(Lights dimmed during which Casey exits and Mr and Mrs Harcourt enter. Lights up)

Mrs Harcourt:  I’m not surprised his cholesterol is up. He spends all day on the couch watching television and eats lots of chips and chocolate.  I told him that he needs to exercise but the furthest he goes is to the toilet and back.  He doesn’t listen to me at all.

Emma:  Let’s check your blood pressure, Morris.

(As Emma is measuring Morris’ BP, Mrs Harcourt stands up and wanders around the room.  She picks up a framed photo of Emma and her husband)

Emma:  It’s a bit up today, Morris.  160 over 95.

Morris Harcourt:  Yours would be up too if you had to live with her nagging, day in day out.

Mrs Harcourt:  Don’t be ridiculous, Morris.  (to Emma)  So are we going to hear the pitter patter of tiny feet soon?  You’ve been married what…. 3 years now?

Emma:  (brusquely)  Four.

Mrs Harcourt:  Better get a move on.  You don’t want to leave it too late….tick tock…. Of course we don’t want to lose you as our doctor, but you girls nowadays can do it all, can’t you?  Motherhood and career.  In my day, a woman….

Emma:  (with gritted teeth) Thank-you for your opinion.  Let’s get back to Morris.

Mrs Harcourt:  I’m only trying to help dear.  I’m often reading stories about career women putting off having kids and then finding out they can’t when they eventually get around to trying.  I don’t want that to happen to you.

Emma:  (more firmly) As I said, thanks for your opinion.  I’m fully aware of the statistics.  I really think we should focus on Morris’ problems right now.

Morris Harcourt:  All she does is focus on my problems.  It is a rare relief for me when she is bossing around someone else.

Mrs Harcourt:  Well if you just looked after yourself better, I wouldn’t have to keep telling you what you should be doing.

Morris Harcourt:  I’d be a lot better if you LET me look after myself.  A man has his needs.

Mrs Harcourt:  What nonsense are you on about now? Not the Viagra thing again.  I thought we’d settled that.

Emma:  The Viagra thing?

Mrs Harcourt:  Morris wants to try Viagra.  He thinks it will make him young again in the bedroom.  I told him that we are too old for that carry on and anyway, his heart is too weak, isn’t it doctor?

Emma:  It’s a difficult topic and I’m glad we’re talking about it.  I don’t think there are any physical reasons why Morris can’t try Viagra but there are….

Mrs Harcourt:  No physical reasons?  Look at him – he’s fat, unfit and old.  A walking heart attack.  I refuse to have him drop dead when we are in the middle of….

Morris Harcourt:  Shut up and let the doctor finish, will you woman!

Emma:  As I was saying, there are other factors to consider.  I believe that the decision to try Viagra should be a decision for the couple, not just the man.  A decision both have to be happy with.

Mrs. Harcourt:  That’s easy then.  No Viagra.

Morris Harcourt:  Thanks a lot, Doc.  Whose side are you on anyway?

Emma:  Look, I’ll give you some information to take home and read.  How about we talk about this again next time?

Mrs. Harcourt:  I don’t think there will be much to discuss.  I have a vote and I vote no.

Morris Harcourt:  Maybe I’ll remove your voting powers by finding someone else… someone who will vote in my best interest.

Mrs. Harcourt:  Don’t be ridiculous Morris.  Who on earth would want to be saddled with looking after you?  Even if there was someone out there, you’re too darn lazy to get off the couch to look for her.

Morris Harcourt:  She’s right you know.  The sad thing is, she’s absolutely right.  See you next time, Doc.

(The Harcourts exit, Emma types furiously on the computer, a few moments later Bridget enters)

Bridget:  Michael’s wife still hasn’t arrived.  It’s been an hour.  Michael wandered out of his consulting room and was found by a patient lying facedown on the bathroom floor.  His shirt was unbuttoned and he was muttering paranoid nonsense.  He’s back in his room now but I don’t like my chances of keeping him there.  Oh, I took a picture of him on the bathroom floor (shows Emma her mobile phone).  That will be one for the Christmas party.

Emma:  (picking up phone)  I’ll call his wife myself…. Jane, is that you?  It’s Emma here, from the surgery.  We thought you’d be here by now, to pick up Michael.  He’s in pretty bad shape…. yes that was our new receptionist, Bridget…. no, it’s not one of Michael’s pranks…. yes he did ingest marijuana, though not deliberately…. It’s a long story…. Great, thanks, we’ll see you soon.

Bridget:  I’ll keep an eye on him until she arrives.  Cheer up, you’re nearly there, only 4 more to go for the day.  Alison Best is the next cab off the rank.  She was booked in with Michael but didn’t want to reschedule.  She said it was “super urgent”. Do you want me to send her in?

Emma:  (sigh) Thanks Bridget.  Yes, send her in.

(Bridget exits, a few moments later, Alison enters carrying a stack of computer print outs)

Alison:  I’ve got a phaeochromocytoma (triumphantly)

Emma:  Hello Alison.  Take a seat.

Alison:  It all fits.  I’ve worked it out.  Dr. Google is going to put you out of business soon I reckon.

Emma:  There’s more to medicine than…

Alison:  I typed in all my symptoms and I found the diagnosis.  How come I have been to three doctors in the past six months and no one has tested me for a phaeochromo..thingo

Emma:  It’s a very rare diagnosis and….

Alison: .Yep, I know it’s rare…. (looks at printouts) 2 in 100,000.     I always knew I was special.  See, I have all the symptoms.  (reading out from printouts) “Elevated heart rate, elevated blood pressure, palpitations, anxiety, diaphoresis” (stumbles over this word)

Emma:  Diaphoresis

Alison:  Yeah that means getting sweaty, right?  (Emma nods) “Headaches, fatigue, pallor” – My Mum says sometimes the colour drains right out of me, “weight loss” – well  maybe not weight loss, but that’s only cause I’m on the pill and that makes you gain weight.

Emma:  (looking at Alison’s computer records) You mentioned high blood pressure and elevated heart rate.  Your blood pressure and pulse have always been normal.  We’ve measured them several times.

Alison:  That doesn’t mean anything. The blood pressure and pulse can go up and down at various times.  It says it right here.  (reading from printouts) “The blood pressure elevations can be episodic making it more difficult to detect.”  Sometimes my heart beats really fast and I can hear the blood pounding in my ears.  That will be when my blood pressure goes up for sure.  I’ll explain it to you.  There is a release of hormones from….

Emma:  I know what a phaeochromocytoma does Alison.

Alison:  Then you’ll know how serious it is and why I need to have the special tests for it right away.  I could die!

Emma:  I don’t think you have phaeochromocytoma Alison.

Alison:  You don’t know that for sure, do you?

Emma:  No I don’t, but I think it’s highly unlikely.

Alison:  It says here that they are often missed.  It says (reading from printouts) “It often goes undiagnosed until autopsy; therefore patients might wisely choose to take steps to provide a physician with important clues.”  I’ve given you the clues!  I need the test, now!  I am not going to wait until I’m dead!!

Emma:  OK, OK, we’ll do the test.  You will need to collect a special bottle from pathology and collect all of your urine in it over a 24 hour period.

Alison:  I know all about it. It says right here that…

Emma:  I’ll do you the form now (starts writing form) and we’ll see you back for the results in about a week.

Alison:  Oh and I’ll need a medical certificate for Centrelink.  I can’t be off looking for work while all of this is going on.  It’s very stressful you know.  And when I get diagnosed I’ll need heaps of time to get the operation and everything.  (Emma sighs and starts writing a Centrelink Certificate). If the test is negative, I must have (shuffles through printouts and then starts reading) “postural orthostatic tachycardia syndrome”.  The symptoms match mine really well.  It causes (reads from printouts) “lightheadedness, dizziness, fatigue…”

Emma: (cutting Alison off) Let’s just take it one step at time, shall we?  So as I said, results will be back in a week. Perhaps you would like to make an appointment with Dr. Harris.  I’m sure he’ll be feeling well again by then and would be happy to help you out.  (gives Alison her Centrelink Certificate)

Alison: (Alison looks at her Certificate) FYI, I’ve changed the spelling of my name.  By Deed pol.  It’s now A, double L, Y, S, U, O, N, Q.  The Q is silent. The old way was just too boring.

(Emma modifies the Centrelink Certificate)

Emma:  That’s an interesting spelling.

Alison: (proudly) It’s unique. Just like me.

Emma:  You certainly are that.  Please let Bridget know on the way out and she will update your details on our computer.

Alison: OK then.  Thanks for seeing me today.  I know you squeezed me in but as you can see, it was pretty urgent.

(Lights dimmed during which Alison exits.  Lights up to see Emma alone, tapping on her computer.  Bridget enters.)

Bridget:  Another late finish eh?  At least you got to start late today.  I’ve been here since 8am.  I’m off home now.  Just a couple of messages (gets out piece of paper) Annie Smithers has another migraine – wonders if you can do a house call this evening and Comfie Care called to say Mr Denner has a fever and is confused.  I’ve switched the after hours phone over to yours.  I know it is Michael’s turn to be on call, but I don’t think he is in any fit state.  Oh and don’t forget those two hospital admissions – they are waiting on the ward for you.  See you tomorrow!

Emma:  Goodbye Bridget, see you tomorrow.

(Bridget exits. Emma stares into space for a few seconds then dials a number on the phone.)

Emma:  (on phone) Hi Mum…. Yes I’m just finishing up some paperwork and then I have to do two hospital admissions, a house call and see a nursing home patient…. Yes I know it is late…. Yes Mum, I know you worry about me…. It’s been an unusual day, but then every day brings surprises in General Practice…. Yes I had my appointment this morning…. The curette results from the miscarriage were rather unusual…. It’s cancer, Mum, endometrial cancer…. The lining of my uterus…. Rather unusual in my age group…. Please don’t cry Mum…. They’ve found it early, doesn’t look like it’s spread anywhere…. Almost certainly cured by an operation…. A hysterectomy Mum…. They have to take it out…. That’s right, no kids…. No I haven’t told Shaun yet.  I’ll have to tell him tonight I know…. He wants kids SO badly Mum…. He’s not interested in adoption or fostering, we’ve been through all that before when we had so much trouble getting pregnant.  I’m afraid that…. that…. I’ve got to get going Mum…. I’ll talk to you tomorrow…. Thanks Mum, I love you too.

(Puts phone down.  Few seconds of silence then lights down)

Curtains close

** Explanatory note

The intense high produced by orally administered marijuana can create effects that mimic serious illness.  Physical effects include
sedation, dizziness, numbness, rapid pulse, dry mouth, dry eyes, thirst, muscle relaxation, loss of coordination, sensory deprivation, nausea, vomiting, headache, and flu-like symptoms.  Psychological effects can include racing thoughts, disorientation, confusion, memory loss, hallucinations, paranoia, psychosis, fear of dying, depersonalization, nightmares, and depression.


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