Keeping abreast of the situation

old-lady-in-bikiniLorraine and Frank Cooper were booked in for skin checks. I had previously met Frank a few times but Lorraine only once. Like many older Australians they had managed, with the assistance of unprotected fair skin and direct sunlight, to achieve decades of perfect skin-cancer-growing conditions, and their crops of lesions were maturing nicely. Frank in particular rarely escaped without donating a skin chunk or two to our friendly local pathologist.

I quickly scanned their charts then walked into the crowded waiting room.

“Frank and Lorraine please.”

Frank sauntered over from where he’d been standing. Lorraine closed the two year old New Idea, placed it back on the rack meticulously, and headed towards me. They met in the doorway. Frank beamed at Lorraine, she returned his smile with her mouth but frowned with her eyes.

“You want us to come in together?” Lorraine asked.

“Only if you’re comfortable doing so.”

“No worries, Doc!” Frank said without hesitation.

Lorraine shrugged, “I guess so.”

“So who wants to go first?” I asked after we were seated and the usual pleasantries exchanged.

“Ladies first,” Frank volunteered.

Lorraine looked mildly irritated. “It should indeed be me, but not because I’m a woman. I was booked in first.  I heard the receptionist saying that his spot was at 3:15. Mine was at 3.”

At that point, I recall wondering whether Frank had done something to really annoy her that particular morning, or whether her touchiness was simply a result of years of accumulated frustration.

Lorraine’s history-taking unfolded uneventfully, but I hit resistance when it came to her examination.  As is my habit, I asked her to undress down to her underwear behind the curtain and to cover herself with the provided sheet.

“Is he going to stay?” she inquired.

“Not if you don’t want him to,” I quickly countered, sensing her discomfort.

“It’s OK, Luv, you’re behind a curtain, and anyway, it’s not as if you’ve got anything I haven’t seen before.”

“But you haven’t seen mine!

An alarm bell rang. It didn’t seem like something a wife would say – at least not without a “for years” or “recently” tacked onto the end.

I glanced again at their charts: same surname, different phone numbers, different streets, different towns. Uh oh!

Taking a deep breath, I somewhat sheepishly inquired, “This may seem like a silly question, but you are married, aren’t you?”

“Married? I’ve never met him before in my life!”

Luckily for me, both were very understanding and forgiving, and could see the funny side.

Frank was relegated post-haste to the waiting room while Lorraine had her solar keratoses cryotherapied in private.

Later, Frank lamented, “I was hoping to get a peek at some live bosoms. It’s been a long time.”

I must have looked shocked.  He rushed to explain. “I’m no perv.  I just happen to love breasts. All of them: pancakes or melons, firm or dangly. The only complaint I’ve ever made about a pair of bosoms is that they’re too… clothed.”

When I sought their individual consent to write this column (I didn’t want to breach their privacy a second time!), Frank’s face fell when I explained that I would need to give him an alias.

“I’d quite fancy my name in print,” he lamented. “Well, at least use my ‘all breasts are beautiful’ line, OK? I want to do my bit to help all the ladies out there be proud of their assets. And hopefully, bare them more often. But not too much time in the sun, of course, Doc. There’s too much breast cancer around nowadays as it is!”

(names and identifying details have been changed)

First published in Medical Observer, 25th July 2014

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Could I have saved my doctor?

image stethoscopeThe 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

Short story: The Cat 4s

Winning entry into the national “Are you a Scribe?” competition, run by Medical Observer, published on 6th December, 2013.

Perched on a somewhat precarious looking stool, she surveys the waiting room, her domain, rattling off the platitudes she spews out countless times a shift to those who dare approach her…

“We’re very busy at the moment.”

“Patients are seen on a priority needs basis.”

“The doctors will see you when they can.  They are tied up with seriously ill patients.”

“Perhaps you’d like to go home and see your GP in the morning.”

It takes a special type of person to be a triage nurse, without a doubt.  A nightclub bouncer of the hospital world sans the steroid induced musculature.  A human shield, protecting the emergency department’s precious doctors from stampedes of the mad, the bad and the slightly unwell.  Sorting, prioritising, gatekeeping.  There has to be an element of enjoying the power… just look at her slightly bored and rather haughty expression, her air of superiority.  Just like the last one.  Is it part of their training or a job prerequisite?  Chicken or the egg?

I reach the front of the queue.  Her ID badge reads “Darna”.

“What brings you here today?”

“I have a headache.  It came on suddenly about three hours ago.  Never had anything like it.  Really sharp pain.”

“Does it feel like a migraine?”

“Wouldn’t know, never had a migraine.”

“How bad on a scale of one to ten?”

“Seven.  I took two Panadeine but they didn’t help.”

“Any fever?  Flu-like symptoms?  Vomiting?”

“No.”

“OK, take a seat.  There’ll be a bit of a wait.”

She types her verdict.  I sneak a look at the screen.

“Headache.  ?Drug seeking.  Cat 4.”

The feeling of déjà vu is almost overpowering.  Same emergency department six months ago, except it was “Tanya” not “Darna”.  Identical symptoms presented, almost identical questions asked, no examination performed, same conclusion reached…

“Headache.  ?Drug seeking.  Cat 4.”

We waited six hours on these same hard plastic chairs bolted to the lino floor, my wife increasingly distressed with the worsening pain in her head.  It comes back to me almost involuntarily…

“How long will it be?”

“I can’t say.  We’re very busy.”

“But my wife’s pain is getting worse.  She needs to see a doctor.  She needs something for the pain.”

“You must be patient sir.”

“You’ve let in eight people in the past fifteen minutes and we were here before all of them.”

“They have more serious ailments than a headache.  Category 2s and 3s.  You’re a Category 4.  People are seen in order of priority, not arrival.”

How long am I going to stay here today?  It will be on my terms this time.  The knowledge fills me with calm.  I won’t rush it.  The system deserves a second chance.  I can afford to bide my time, stretch out my legs, calmly inhale the antiseptic-laden air, soak up the ambiance.

I glance around at my Cat 4 companions, an eclectic mix of vulnerable human beings: an exhausted mother with a coughing infant, a young man holding a blood stained teatowel against his lacerated forehead, a middle aged woman with an icepack on her ankle, four family members each holding ice cream containers and looking green around the gills, a dishevelled man of indeterminate age pacing up and down and muttering about the listening devices the aliens implanted in his brain.

Strangers find themselves waiting together in so many different situations: waiting for a plane at the airport, waiting for the gates to open at the football, waiting for a restaurant table on a Saturday night.  Lumping an often disparate group for a common purpose inevitably creates a camaraderie of sorts.

Nowhere else, however, has the same mix of desperation and exhaustion that pervades the atmosphere of the hospital waiting room.  In a place where everyone is suffering and no one wants to be, good manners, patience and cheerfulness can prove elusive for many.

The latest arrival, a teenaged girl sporting peer-group-appropriate body piercings and tattoos, is a case in point.  After trying in vain to convince nurse Darna that her needs are “super urgent”, she stomps towards us, colliding with a frail octogenarian clutching a wheelie walker on her way.

“Hey, watch where we’re you’re going.  You could have hurt my baby…. I’m pregnant you know.”

Arthritic hands trembling and struggling to catch her breath the elderly woman replies, “Oh I’m sorry.  I didn’t see you there.”

“Maybe you should get your eyes tested.”

Despite wanting to keep a low profile, I cannot help but jump up to assist the poor old dear.  The teen sits in my vacated seat and proceeds to subject us to her inane chatter.  I can’t work out whether she is brazenly narcissistic or just ignorant and self absorbed.

“This sucks.  I’ve got, like, the sorest throat ever and a really, really bad cough… oh and my nose is running, like, heaps.  The man at the chemist said I couldn’t have any, like, cough syrup or cold and flu tablets ‘cause I’m pregnant.  How unfair is that! So I’ve come here to get some antibiotics from a doctor but that Nazi bitch nurse said I’m wasting everyone’s time.  She told me I should, like, go home and see my doctor in the morning.  How am I supposed to get any sleep when I’m, like, so sick?”

“Ignore her,” I plead silently to my Cat 4 comrades. “If no one engages with her, she’ll shut herself up soon enough.”

Alas, my unspoken warnings are unheeded.  Someone asks, “How far along are you dear?”

 “Nineteen weeks,” the teen replies. She becomes animated, her cold forgotten. “I can’t believe I’m going to, like, be a Mum in just like a few months. 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. And then there’s the baby bonus.  Did you know you get, like, $5000 just to, like, have a baby?  $5000 for free!  Why wouldn’t anyone do it?

“Peter Costello has a lot to answer for,” I mutter, going against my own advice to stay quiet. 

“Who?  My boyfriend’s name is Damon.  Why do people always, like, question who my baby’s father is?  I’ve been faithful to Damon for, like, six months!  And I’ve never slept with anyone called Peter.”

It seems to me that the trouble with our society is that, by and large, the wrong people are the ones having most of the kids.  There seems to be an inverse relationship between IQ and family size.  Darwinism in reverse.  Survival of the dumbest.  Someone should put a little chlorine in the gene pool.  OK, I admit, that’s going too far.  I didn’t used to be so bitter but since I lost Emily my once half-full glass is now decidedly empty.   My optimism has been damaged beyond repair.

I’m tortured by pregnant women in particular. Emily desired nothing more in the world than to have a baby.  She wanted to start trying years ago. I put her off, convinced her to wait until ‘the time was right.’  Now the time will never be right.  She will never be a mother and I’ve been left without even a piece of the woman I love.  I’ve got no one for whom to keep Emily’s legacy alive.  Why was I so adamant that we should wait?  I don’t remember.

My eyes are drawn involuntarily to the clock on the puke-green waiting room wall.

The second hand limps around the clock face agonisingly slowly. I feel as though I am trapped in a parallel universe where time has been stretched to double.  A minute feels like two, an hour like eternity. Paradoxically, the clock is running five minutes fast, according to my watch.

We all know that long waits are to emergency departments like fees are to banking – inevitable.  There are some who accept this with a zen-like calmness.  I admire them.

Three hours.  It’s been long enough.  I sidle up to the nurse’s desk.  Darna is updating her Facebook status and barely looks up.

“We’re very busy.  Don’t know how long the wait will be.  A doctor will call you in when he can,” she drones habitually.

“Is Tanya still working on triage?”

“Which Tanya?”

“Tanya Harrison.”

“Yes, she got back from holidays last week.”

“Holidays?”

“Yeah, went to Bali.  Got a great tan and had a pretty wild time from all accounts.  You a friend of hers?”

“Not exactly.”

Darna takes a closer look at me.

“An ex eh?” She chuckles almost maliciously.  “She has plenty of those floating around.”

“No.  I was… involved… with the incident six months ago.”

“Incident?  You’ll have to be more specific.”

“The collapse and subsequent death of a thirty-two-year-old woman in this very waiting room.  On Tanya’s watch.”

“Doesn’t ring a bell.”

“Complained of a headache, waited six hours, ruptured cerebral aneurysm?”

“Oh yeah, that’s right.  I remember hearing about that.  Bit of bad luck for Tanya.”

“Bad luck?”

“Well it wasn’t her fault.  She was just following protocols.”

“Were the protocols changed?”

“I don’t think so.”

“Did the triage nurses receive extra training in assessment of headaches?”

“Wasn’t considered necessary.  Why the twenty questions?  Yes it was sad, but these things happen.  Aneurysms kill people.  It’s not Tanya’s fault.”

“The doctors said that if she had been seen earlier they could have operated and that my wife might have lived.”

“Look, I’m really sorry you’ve lost your wife.  It is tragic.  Hanging around here is not going to help though.  You need to let go, move on.”

“I can’t accept that nothing has been done about the system’s failings.  That the same thing could just as easily happen to someone else.  That my wife’s death was in vain.”

“It has nothing to do with me.  I’m just the messenger.”

“And sometimes the messenger has to be shot.  Metaphorically speaking.  To send a strong message.  To effect change.  I’m sorry Darna, but this will give you quite a headache.  Perhaps deserving of prompt assessment and some pain relief.”

Before she is able to press the panic button, I take the hammer from my backpack and deliver three short sharp blows.

Am I seeking revenge?  Perhaps.  I like to think I am trying to knock some sense into the system.  Speaking up for the Cat 4s.