The first thing 22-year-old Casey ever said to me was, “How is your day going, Doctor?”
While not the most unusual opening line of a first-time patient, there was something about the way she said it that rang a vague alarm bell. Casey had complex physical and mental health needs, and over the following six months I saw her numerous times. She had survived childhood leukaemia, but her type 1 diabetes and Crohn’s disease were making daily life difficult.
Regardless of what she was going through, Casey always spent at least a minute or two each consult enquiring about my well-being. I initially thought that her questions may just have been merely social pleasantries. I didn’t think too much about her commenting that I looked tired or asking if I was overdoing things – perhaps because my friends and family were doing likewise. I smiled sweetly when she gave me beauty tips and fashion advice. But when she started asking me particularly personal questions about my relationships, health and resilience levels, and not accepting my brush-offs, I knew things had gone too far.
Casey is certainly not the first patient who has asked me unduly personal questions. I usually find such intrusiveness quite easy to deflect, and for the boundaries between myself and an inquisitive patient to be maintained without the need for explicit definition. There was, however, something different about Casey’s approach: a desperation, a need, something raw. I did not get any sexual vibes, or even overtones of seeking friendship, just a sense that my being happy and healthy was of tremendous importance to her. It felt like she genuinely cared about me – I just couldn’t work out why. Something about it did not sit well, so I decided to address and gently explore this with her.
It didn’t take much probing.
“Twelve months ago our family GP killed herself.”
Casey’s face contorted with the effort of trying to hold back the floodgates of intense emotion.
“Dr Sara looked after me since the day I was born. She found my leukaemia and my diabetes, and was there for me and my family through all of it. And then she suddenly wasn’t.”
She paused, taking the offered tissue and loudly blowing her nose.
“One day I rang the surgery and the receptionist told me she’d left the practice. I asked when was returning. The receptionist said ‘Never’. I didn’t understand. I’d only seen Dr Sara the week before and she didn’t say anything about leaving. I found out later that she’d taken an overdose.
“I had no idea she was suffering. And then I realised that I’d never asked. She cared about my health so deeply and yet I had never even considered hers. I feel so ashamed.
“No one at the surgery ever talked about what happened. They took her name off the door and the website within days, and made out like she had never existed. My new GP said things like ‘Let’s focus on the here and now’ or ‘We are here to talk about you, not Sara’ when I tried to bring it up. Everyone knew what happened; there was no point trying to hide it. So why did they remove every trace of her?”
Casey looked to me, puzzled and angry.
“I don’t know,” I admitted. “I guess it was how they dealt with their grief.”
” I kept thinking of all the years she gave to them… and to us, her patients. All gone. I couldn’t stand it any longer. That’s why I started coming here and seeing you. .”
The depth of her grief and guilt took several consults to reveal. Over time she came to understand and accept that it was not her role or responsibility to safeguard her doctors’ health, or to worry about any emotional burden which may result from the provision of care.
Her questions of me became less personal and insistent, but she continued to ask how I was going. I thought of poor Dr Sara each time, and always answered Casey sincerely and honestly, grateful that my answers were able to provide reassurance.
(names and identifying details have been changed)
First published in Medical Observer, 25th July 2014