Further Confessions of a GP

Disclaimer

The events described in this book are based on my experiences as a GP. For obvious reasons of privacy and confidentiality I have made certain changes, altered identifying features and fictionalised some aspects. Nonetheless, it remains an honest reflection of life as a doctor in Britain today. This is what it’s like. These things really happen!

This book is dedicated to my family and to coffee. If it wasn’t for my family the book would have been finished a year earlier. If it wasn’t for coffee, it wouldn’t have been finished at all.

Contents

Title Page

Disclaimer

Dedication

Introduction

First day

Sarah

Crackhead Kenny I

Maggie I

Brian and Deidre

Maggie II

Communication skills

Maggie III

Maggie IV

Can’t be too careful

Crackhead Kenny II

Army medical I

Tummy aches

Glass test

Mr Lorenzo

Pseudoseizures

Antibiotic resistance

Diabetes

Tarig I

Is the quality of NHS care really declining?

Jimmy Savile

Nathan

Army medical II

Betty Ferrari

Smelly bum

Tarig II

Should we know how much health care costs?

Danni I

The NHS, the envy of the world?

Don’t look down

Mrs Patrick

Danni II

Unnoticed

Man flu

Medical students

Taking benefits away from addicts

Stuck in the middle

Danni III

Funny X-ray

The coroner

Mr Goodson

Mr Raymond

Hannah

Ted

Should we name and shame doctors who make mistakes?

Pseudocyesis

Playing God

Simon

Removing patients from lists

Bravery

Foreign bodies

Retrieving the gerbil

The chemical cosh

Medical science

Gastric bypass

Karen’s baby

Notes

Nurses I

Nurses II

Paradise

Yes/No

David

Hospital deaths

Sinbad

John

How doctors die

Rita

Neighbours

Letter to myself, 10 years ago

Further Confessions of a GP is part of the bestselling ‘Confessions Series’. Also available

About the Author

Also by Dr Benjamin Daniels

Copyright

About the Publisher

Introduction

‘Oh, and just one more thing, Doc, before I go. I’m reading this book …’ With that my patient pulled out a copy of Confessions of a GP from his bag. ‘Have you read it?’

‘No,’ I lied, then added bravely, ‘Is it any good?’.

‘It’s all right, I suppose. Could definitely be a lot funnier and the author comes across as a bit of a self-righteous prat at times. I’ll lend it to you once I’ve finished it, if you like?’

‘Nah, you’re all right.’

I wrote Confessions of a GP a few years ago, all about my experiences as a newly qualified GP. Partly due to the witty anecdotes and insightful social commentary, but mostly due to the extremely low pricing of the ebook version, it sold surprisingly well, and so I decided to write this sequel. I penned the first book while working as a nomadic locum doctor. I have now settled as a partner in an inner city practice and I also work a regular shift each week in our local A&E department.

These are my further confessions.

First day

‘You’re not Dr Bailey.’

‘No, Dr Bailey’s wife had a stroke yesterday and he is taking some time off to help care for her.’

‘But who’s going to look after me?’

‘Well, I’m going to be looking after Dr Bailey’s patients while he’s away.’

‘You’re no good,’ Mrs Patrick huffed, looking me up and down. ‘You don’t even know me. I always see Dr Bailey. When’s he coming back?’

‘I don’t know. His wife is really quite poorly.’

Mrs Patrick tutted loudly and I was left wondering if she was more upset with me for not being Dr Bailey, or Dr Bailey’s wife for selfishly having a stroke.

‘Might I be able to help at all? What’s brought you into the doctor’s surgery today?’

By this stage I was rather hoping that her obvious lack of faith in my abilities would lead to a short and easy consultation, but unfortunately Mrs Patrick sat glued to the seat for another 30 minutes. An endless array of intolerable sufferings were described in gruesome detail, but before allowing me to offer any possible solutions, she would curtly remind me that I couldn’t possibly help and how dreadful it was that Dr Bailey had left her in the lurch like this.

Most of the morning’s patients offered a little more sympathy for Dr Bailey’s predicament, but none seemed to consider me a worthy understudy. By the time I drove off on my first visit of my new job, I was feeling thoroughly demoralised.

My visit took me to a small house set back from the main road. An elderly gentleman with a warm face greeted me at the door with such an affectionate welcome that I was encouraged to believe that I might finally have met a patient who viewed me to be of some worth. As I reached out for a formal handshake, he clutched my hand in both of his and took an eternity to let go.

‘We so appreciate you coming out to see us what with it being your first day, Dr Daniels. My wife is upstairs. Are you going to bring her down?’

‘Erm, what do you mean bring her down?’

‘She can’t really manage the stairs these days, so Dr Bailey always carries her down to the lounge.’

My face must have given away my surprise and the kind old gent apologetically attempted to take back his request. ‘Well if you’re not able to manage her, Dr Daniels, I’m sure …’

‘No no,’ I interrupted. ‘I’m sure I’ll manage just fine.’ I was determined to match the feats of the mighty Dr Bailey on at least one occasion today.

Mrs Alexander didn’t weigh a great deal, but it wasn’t easy hoisting her up into a fireman’s hold and then navigating the narrow winding staircase. I’m fairly sure it wasn’t a technique advised on the ‘Lifting and Handling’ course I was forced to go on before I was allowed to qualify as a doctor. As I finally lowered Mrs Alexander on to the sofa, I tried not to look too exhausted by the whole ordeal.

‘Right, what can I do for you then Mrs Alexander?’

‘I’m all bunged up again, Doctor. I haven’t opened my bowels for two weeks.’

As I started to list the various laxatives and suppositories I could prescribe, Mr Alexander politely interrupted me.

‘None of those work for my wife, Dr Daniels. That’s why Dr Bailey has to clear it out himself.’

‘Excuse me?’

‘We put a towel down on the carpet here and Elsie lies down on it. We’ve got some spare gloves and Vaseline in the cupboard and Dr Bailey just puts his finger in and clears all the hard stuff out. He says it’s the only way once it gets to this stage.’

Before I could think of any way to object, Mr Alexander had neatly laid out the towel and Mrs Alexander was hitching up her nightie.

‘I think these gloves will fit,’ he said as he offered me a pair of medium-sized marigolds.

I had smugly managed to avoid ever having to do a manual evacuation up until now. I can vividly recall the occasion when one of the consultant surgeons made all the medical students in his team stand in a line with our hands held out in front of us. He walked up and down inspecting our outstretched fingers, searching for the slimmest and daintiest of digits to clear out the particularly tightly packed rectum that he had waiting to be evacuated of its hardened contents. I can still recall the relief I felt as I looked down at my short podgy fingers and then compared them to the delicate little hands of the Japanese girl standing to my left. I could almost smell her terror growing as she realised that the consultant was studying her beautiful slim fingers with some excitement. As he led her away to meet her fate, I looked down at my ugly, portly fingers and offered them an instant and unconditional pardon for their fat clumsiness and for all the tasks of dexterity for which they had previously failed me.

My luck had clearly run out though, today. There was no elegant-fingered Japanese medical student to save me this time, so I donned the gloves, took a deep breath and got stuck in. The urge to gag was almost overwhelming as I methodically used my index finger to pick out the rock-hard lumps that were blocking Mrs Alexander’s rectum. As I probed my finger further and further into the depths of her lower bowel, I finally managed to break through that last solid stubborn layer of rigid faeces. There was an ominous rumbling, an almighty stench and then the satisfying passage of soft stool leaking past my finger. I could see Mrs Alexander’s tight, distended abdomen deflating before my eyes.

It was an oddly satisfying experience and I gave myself a metaphorical pat on the back for having finally matched up to the lofty achievements of the wonderful Dr Bailey. I made a swift exit, and as Mr Alexander got on with cleaning up the results of my handiwork, I hurried back to the relative sanctity of the surgery.

As I walked through the door, the receptionist was holding the phone and covering the mouthpiece with her hand.

‘It’s Mr Alexander on the phone. He’s not very happy with you,’ she whispered.

‘Bloody hell! What more do these people want from me?’

‘Apparently Mrs Alexander is stuck in the lounge because you carried her downstairs but forgot to take her back up to her bedroom again before you left. You’ll have to pop back in on your way home tonight. They keep asking me when Dr Bailey is coming back …’

That was over three years ago now. Despite my disastrous first day, when Dr Bailey decided he wasn’t going to return, the surgery offered to keep me on as his permanent replacement. Initially, I was reluctant to give up my nomadic locum lifestyle, but with advancing years, I craved some stability and decided to stay. I soon found this quirky little GP surgery and its patients growing on me, and I’ve been here ever since.

Sarah

When Sarah walked in she looked familiar, but I couldn’t work out why. It was only my first week at the new surgery, so she hadn’t been to see me previously as a patient. I was going to suggest that we might somehow know each other, but before I had the chance, she launched into a long monologue relating her constipation and dodgy bowel symptoms in some detail. Suddenly, I remembered where we had met before. She was the sister of a girl that my friend Pete had gone out with about 15 years ago. We had met a few times, and I can clearly recall that I once went to a party at her house and made a very drunken and unsuccessful attempt to chat her up. After being very unsubtly rebuffed, I’d decided to drown my sorrows by drinking some more and ended up vomiting into her empty bathtub. As if that wasn’t bad enough, for some reason I then concluded that despite the bath vomit I was still in with a good shot with Sarah after all, and made another doomed attempt to chat her up. A good memory is a must for a career in medicine, but at times like this I really wish my powers of recollection weren’t quite so efficient.

With Sarah not appearing to remember me, it was tempting to ignore our previous acquaintance and continue the consultation in the normal way. However, I couldn’t believe that she wouldn’t remember me at some point and so I really needed to find an appropriate moment to mention that I wasn’t the anonymous doctor she thought I was. I was just considering how best to broach the subject when my hand was forced

‘Doctor, do you think you should have a look at them?’

‘Sorry?’ I had been miles away and completely missed the last couple of things Sarah had been telling me.

‘My piles, Doctor. I think you might need to take a look.’

Now was the time, I really needed to come clean.

‘Sarah, I could have a look at your piles, but I think you need to know that we have in fact met before.’

Sarah looked at me puzzled. ‘But I thought you were the new doctor?’

‘Yes, I am, but I think we actually met some years ago. You’ve a sister called Jeanette and she was going out with my friend Pete for a bit.’

‘Yeah, that’s right,’ she said. Her face lit up, clearly remembering Pete, but then she frowned as she looked me up and down, still having no clue at all as to where I fitted in.

This was getting really painful. I waited a bit, hoping that Sarah would remember me without further prompting, but unable to bear the awkwardness any longer I started to fill in the gaps.

‘I used to live with Pete and we met a few times …’

Suddenly, Sarah threw her hand over her mouth as the penny finally dropped.

‘Oh my god. You’re that bloke who tried to … and then you vomited in my … and then you tried again to …’

By this point Sarah was clearly remembering me with some horror. If she was trying to conceal her overwhelming feeling of disgust, she was doing an extremely poor job.

‘And they let you become a doctor?’ she added finally, with a combination of surprise and dismay.

‘Er, yeah … I mean, well, that was a long time ago, wasn’t it?’

Thankfully, drunken vomiting in inappropriate places and failed attempts at seduction are not considered exclusion criteria for graduating from medical school. If they were I think there would be a massive world shortage of doctors and absolutely no orthopaedic surgeons whatsoever.

When I was simply the anonymous new doctor, Sarah had been only too happy to describe to me her bowel movements in bewildering detail and had no qualms about presenting to me the haemorrhoids protruding from her backside. Now that I had been exposed as the drunken idiot who once tried to chat her up after vomiting in her bathtub, she seemed less enamoured with the idea.

‘Maybe it would be better if I waited for Dr Bailey to come back. I mean, I’ve known him for years. You know, as like a doctor rather than someone who … well, you know.’

By this point, I already knew that Dr Bailey wasn’t coming back, but before I had the chance to explain that, Sarah was out the door. In fact, her getaway was almost as quick as the one she’d made 15 years ago when we last met.

Crackhead Kenny I

It was 4 a.m. and I had just given myself a little hit of coffee and chocolate in an attempt to help drag myself through those last few painful hours of an A&E night shift. The caffeine was giving me palpitations and an odd buzzing sensation, but not successfully eradicating the overwhelming hazy blur of exhaustion. It had only been an hour since I had necked two cans of Red Bull, but I just needed one more coffee to help me muster the energy to see my next patient.

Despite having one wrist handcuffed to a prison officer and the other hand chained to the metal frame of the trolley, Kenny was, metaphorically, bouncing off the ceiling. The prison officer’s grey and expressionless face was in stark contrast to his prisoner’s, whose beaming grin and intense shining eyes were almost mesmerising. It was apparent that the drugs market within our local prison could provide stimulants considerably stronger than my vending-machine coffee and out-of-date Twix bar.

Kenny reached out his cuffed hand, but I paused. There is something about someone being handcuffed that makes me automatically think he must be horrendously dangerous. If I took his hand would he somehow be able to slip out of his cuffs and take me hostage? Being taken hostage by a drug-crazed prisoner is a scenario I would handle particularly badly. Looking Kenny up and down, I realised that my sleep deprivation was making me paranoid. Kenny really didn’t look very dangerous. He was scruffy and scrawny, but his missing teeth didn’t inhibit his childlike smile. I reached out my hand and he gave me a warm and enthusiastic handshake.

‘I’m Kenny, but all my friends call me Crackhead Kenny.’

‘I’m Dr Ben, but all my friends call me Big Nose Benny.’

I instantly regretted the informality of my response, but I often find myself slightly less reserved during the early hours of the morning. It’s as if patient-doctor etiquette has a vaguely different set of rules at night. Either that or I simply become increasingly inappropriate the more sleep deprived I become.

‘I reckon my nickname trumps yours,’ Kenny declared triumphantly.

‘I suppose, but you’ll have to change yours when you stop taking crack. I’ll always have a big nose.’

‘True,’ he nodded. ‘But I reckon I’ll always be Crackhead Kenny,’ he added ruefully

I wanted to ask Kenny why he was in prison, but it was none of my business really, so instead I stuck with the more conventional question of why he was in hospital.

‘Well, I fell over and these clowns are covering their arses, so they wanted me in here for a check over.’

I looked over to the prison officer for some sort of response but his face remained expressionless. I wondered exactly what it would take to prise any sort of emotion out of him.

I started scanning Kenny’s medical record and noticed with some surprise his date of birth.

‘We’ve got exactly the same birthday.’

Kenny looked at me oddly.

‘We were both born on 6 March 1977.’

‘We’re time twins!’ Kenny shouted enthusiastically.

‘Yes, we are,’ I replied smiling, unable not to be caught up in Kenny’s infectious drug-induced gusto.

‘I tell you another thing we’ve got in common, Dr Ben. As a boy I always dreamed of being a doctor. I wanted to do something good with my life. I really wanted to help people and make them better. I also liked the idea of driving a nice car and flirting with lots of sexy nurses.’ He gave me a wink. ‘Although I think I might have left it a little late now,’ he added ruefully.

‘It’s never too late to flirt with the nurses, Kenny, but I’d give our charge nurse Barry a wide birth. He’s a grumpy old bugger.’

‘Yeah, I spotted him on my way in. Perhaps a career in medicine isn’t for me after all.’

Maybe it was just too much emotion caused by lack of sleep, but I couldn’t help but feel a connection with Kenny. Sharing a date of birth is fairly insignificant really, in the big scheme of things, but at four in the morning during our peculiar substance-enhanced encounter, it seemed to hold some meaning.

I imagined us both as small babies, beginning our lives on that same day. We would have started off similarly enough as two equally innocent infant boys, new and full of potential. Our first steps and first words would have coincided and at some point during our childhoods we both decided that we wanted to be doctors. What had ebbed away at Kenny’s potential while mine was being steadfastly encouraged?

After giving Kenny a quick check over, I wandered out to the nurses’ station where Barry the charge nurse was slumped in his chair looking unshakably miserable. I told him about the connection I’d made with my time twin and reflected on why and how our lives had taken such different paths.

‘He’s just a smack head who happens to share your birthday. Stop being a sentimental twat and get some work done. Most importantly, get him discharged before he comes down off whatever he’s taken and starts kicking off.’

As I finished writing up his notes, the prison officer walked Kenny out of the department to his waiting van. ‘My carriage awaits!’ he exclaimed giving me a regal wave with his non-cuffed hand. ‘See ya later, Big Nose Benny.’

‘Nice meeting you, Crackhead Kenny.’

Maggie I

‘It’s my leg, Doctor. It doesn’t really do what I want it to do. It’s as if it’s not really part of me any more.’ Maggie tried to crack a smile but I could see she was really scared.

‘Right, let’s have a look then.’

Maggie was quite right. Her left leg wasn’t doing what it was supposed to be doing. She could sort of move it, but her coordination was shot and she had resorted to walking with a stick.

‘I’m walking like an old lady, but I’m only 56. It just came on over the weekend and it’s getting worse.’

Maggie was clearly looking for some reassurance, but the truth was that I was worried too.

‘We need to get this looked into,’ I said, stating the obvious.

I’d met Maggie a few times, but usually only when she was accompanying her husband for his blood pressure appointments.

‘Any medical problems in the past?’ I asked as I scanned through her notes.

‘No, I’m fit as a flea. Well, I had breast cancer in 2003, but that’s long gone. It can’t be anything to do with that.’

I looked up from my computer screen and she held my gaze. I was trying to find words that might be both reassuring and honest, but before I could even open my mouth, Maggie was crying.

‘The breast cancer’s all gone,’ she blubbed, trying to convince herself more than convince me. ‘They discharged me from the clinic five years ago.’

‘It may well be nothing to do with the breast cancer, but let’s just get some tests done.’

Maggie clearly needed to see a specialist and have a scan. She didn’t really need to be admitted to hospital that morning, but then it wasn’t appropriate to make her wait two weeks for an outpatient appointment either. When stuck with this sort of quandary, I generally default to the ‘What would I want if it was me?’ option. This turned the decision into a bit of a no-brainer and I phoned the medical consultant on call who agreed that she should go straight up to the hospital.

Sometimes it’s really satisfying to get a diagnosis right, but I took no pleasure in having my suspicions confirmed this time. Maggie’s leg symptoms were due to her breast cancer returning. It had already spread extensively and it was lesions in the brain that were causing her leg symptoms. After being told the result of the scan she was discharged with some steroids.

Maggie had still been in a state of shock when they’d given her the diagnosis in hospital, so she made an appointment with me to go over a few things. First of all she wanted to know how the cancer had lain dormant for all those years before coming back. I would like to have been able to answer that question, but the truth was I just didn’t know. It wasn’t something she’d done wrong; it was just one of those awful facts about cancer. Sometimes we think we have beaten it, yet somehow this horrible disease has a dirty habit of reappearing. Maggie hadn’t even noticed a breast lump, but by the time she had her scan there were cancerous lesions in her liver, bones and brain. The cancer specialist offered her some chemotherapy that might temporarily shrink the tumours, but he made it very clear that he could offer her no cure.