Wednesday, September 28, 2005

Good Grief

Something the Great British public seems to be increasingly bad at. Twice this week I have seen bereaved patients who are having problems.

One a mother of an adult child who was a blamelss victim of a road accident three months ago. Now it's bad enough to lose a parent or a sibling, but to loose a child always hits especially hard, being so against the natural order. What was making matters worse for this woman was the reaction of friends and neighbours. Since the accident they have taken to avoiding her on the street. No-one calls at the house any more. It's almost as though the apalling luck she has had visited upon her might be contageous.

The other, a man, lost his wife just over a year ago, within a few weeks of diagnosis of cancer, and within a year of their marriage. His first wife had died a few years before, again with a rapidly progressive malignancy. He has been grappling with his second loss all year and has found the past month particularly difficult since it contains both the aniversary of their wedding and her passing.

There seems to be a view in the community at large that bereavement is a time limited finite process that should last no more than a week or two -- perhaps a month at most. After that any "sane" person should have moved on, putting all feelings of loss behind them. This is plainly totally unreasonable. Many people are undoubtedly "back on their feet" emotionally in a short span, but beneath the surface their sense of loss can be easily provoked. We lack a vocabulary to talk to the recently bereaved about their loss, and often in these days, have no commonality of experience we can share with them. It becomes easier to avoid awkwardness by not seeking them out, even avoiding them altogether.

Prior generations have had the misfortune of living through turbulent times, with mass exterminations in warfare or natural tragedy that have bound communities together in common grief. We see outpourings of such sentiment at times of terrorist outrage, and with recent catastrophes, even when celebrities are snatched away by horrific accidents. Flowers materialize by the roadside when accidents have ended in fatality. But no-one wants to talk to or comfort the bereaved.

If anyone reading this knows somebody in such a position, please just pick up the phone, or call round and just offer to talk to them. Doesn't have to be about thier loss. Talk about the weather, cricket, the gardening, anything. Restoring contact will ease their isolation and really help to move along their "recovery".

Time does not "heal" that which cannot be mended, but it allows distance and perspective. It gives some space for the good memories to come back, blunting the edge of the loss. Talking about the mundane, the everyday, helps this process along more than people can imagine, so don't hold back. Go ahead, make that call.

Dr J

Tuesday, September 27, 2005

body art

In this line of work you get to see a lot. The quality varies from the self inflicted teenage scrawl to some really breathtaking (or very scary) artwork.

I recall a young woman who had a very fetching disney character tattoo on her tummy. This was proudly displayed every summer for all to see when her midriff was fashionably on view. Unfortunatley when she became pregnant the effect was rather spoilt as Thumper the Rabbit appeared to transform into Dumbo the Elephant, so, ladies, choose the site of your adornments with care!

Today I have seen my youngest aspiring body artist so far. At age 5 he was poked in the forehead with a pencil last week, then his school mates filled in the resulting hole with pale blue ink! The small blue dot should be easy enough to conceal for now as it lies very close to the hair line, and the ink may yet fade, but I wonder if I am witnessing the start of a new trend here.

Tuesday, September 20, 2005

A RTFM moment

I recently took a calll from a patient I had prescribed antibiotics. He had a recurrent bronchitis and as such I felt he warranted a ten day course to be sure of clearing the infection this time. Of course these days all prescription meds are dispensed with a label offering instructions on how they are to be taken, and often with a supporting, more detailed, data sheet.

I had asked him to take his antibiotics four times daily, to make sure he took the whole course, and thought no more about it. Three days later he called, in obvious distress, to ask he he really needed a ten day course. When I asked him why he said they were making him feel so weak. This was not a side effect I would have expected so I asked him what made him think it was the medication doing this.

Well, he said, the instructions say the tablets are to be taken on an empty stomach so I have had nothing to eat for three days so far!

He had apparently missed the bit that said to be taken 30 mins before food or on an empty stomach!

After the call he was able to complete his antibiotics and his bronchtis is now resolved. Happily he has not suffered unduly from 72 hours of medically induced starvation either.

Dr J

Monday, September 19, 2005


Life is full of little coincidences that make the hairs on the back of your neck stand up for a moment, but once in a while whopping great monster chunks of synchronicity can knock you dizzy. Here follows one such story.

Mr & Mrs A have been patients since I joined the practice umpteen years ago. As is the way of such things I got to know Mrs A reasonably well as she attended over the years with her high blood pressure, but Mr A, being employed, attended far less often. Some time ago Mrs A injured a leg and required orthopaedic attention and Mr A was then drafted in to provide the necessary taxi service for his wife to make appointments. In observing them throughout this time, and on those odd occasions before when they had attended together it was clear that they had a very close, even a devoted relationship, and both seemed very happy even in occasional adversity.

Mrs A was in the habit of bringing in poems, quotations and other snippets, reflecting the couple's very positive approach to life for my appreciation. Seeing either of their names in a surgery helped to brighten even the dullest day.

Around three years ago Mr A attended to request a blood test. Retirement was looming and he wanted a "check up", particularly of his prostate, since he was having very slight symptoms of Prostatic Hypertrophy. I also suspect he had been sent in to request the test by Mrs A. To our mutual surprise his PSA was returned very elevated, and after a short course of further investigations Cancer was diagnosed.

This is not a bleak a finding as might be imagined, since even inoperable cancers of the prostate can be very successfully controlled using hormonal treatments, and so it proved for Mr A. Three years in his PSA levels had fallen back into the normal range, he had no symptoms, and was in effect entirely well. The least time I saw him I was teaching a medical student, and we were greetd with a consultation for both Mr and Mrs, who were planning a trip away soon, and so were attending a little early for Mr A's hormone analogue injection. Mrs A proffered another print out for me to read later, and after a cheerful consulation they departed for their trip. I put the print out to one side and carried on teaching and consulting, meaning to get back to it later.

A week on I had a call from Mrs A telling me her husband had collapsed the day before and was now hospitalised near to where they were staying. He had fallen and sustained a head injury. The Doctors at the hospital told her he was unlikley to recover. A day or two later came the fax from the hospital confirming that Mr A had passed away.

Later that day I came across the print out they had brought in a few weeks before. It contained the following poem:

SAYING GOODBYE ( A Tribute Poem to those who were lost)
Yesterday was just a normal day...
You smiled... said "I love you" and said goodbye...
Told me to remember to pick up milk.....
And said you would see me tonight....
Well yesterday has come and gone
and many things have changed...
For ever since 9/11/01 my life has been rearranged...
No more smiles...
no more kisses good bye.....
No more "I love you's" as you walk out the door...
Now I see your face only in my dreams....
And know you are gone forevermore...
I love you, I miss you and my heart still breaks....
But I know that one day in heaven....
We will smile and say I love you and look into each others eyes..


Let me know what you think.

Tuesday, September 13, 2005

The one with the go faster stripes.

I'm beginning to think that "The last of the summer wine" is a documentary. Last evening I was called to visit and old friend, now in her eighties, because she had injured her leg in an accident. When I arrived at her flat she had a huge bruise distorting her calf, and could not stand on the injured leg.

The reason-- she had been trying out an electric scooter becuase she has not been out much after a stroke last year, the weather was good, and a friend suggested she try it out. All went well on the ride up the hill, but on the return the scooter sped up and she could not let go her death-grip on the throttle!

End result-- she crushed her leg betwen the body of the scooter and the hub of a 4WD parked kerbside.

I admitted her to exclude a tibial fracture, but she was in very good spirits when I left. When I called for the ambulace to take her to A&E for her review the call handler wondered if her scooter had been the sort with the go faster stripes!

Monday, September 12, 2005

Seeing a man about a dog.

Ray is now something over fifty. In his late teens he first developed back pain sufficient to require medical attention. He was soon diagnosed as having ankylosing spondylitis. In med school you learn that this potentially nasty rheumatological condition has two main associated conditions, namely ulcerative colitis (an inflammatory bowel disease) and uveitis (inflammation within the eye). Both are worrisome in their own right as the former can, over time, result in bowel malignancy, and the other can end in blindness.

In fairly short order Ray suffered with both these complications. The colitis was treated by excision of that portion of the colon affected, leaving him with a stoma. Repeated episodes of uveitis progressively deprived him of his sight. His arthritis has been a source of constant pain and has often significantly limited his mobility. Somehow, despite all these problems Ray manages to remain one of the most cheerful people I know. Whenever he attends surgery he greets the staff with a smile, and his first statement on entering the consulting room is "How are you today Doc?"

Some time ago he attended surgery to ask a favour. He wanted to increase his steroid medication (a potent anti-inflammatory). His reason for this was that he was going to be applying for a guide dog to help him now that his sight was gone. To do this he needed to go away to spend a week with his prospective dog at the training center, and he needed to be fit enough for "walkies". He told me it was his ambition to take the train to the nearest city to go to concerts again, and the dog would be a big help in this.

Increasing the steroids (and sheer grit and determination too) got him through the training, and got him the dog he needed. Now they both come to see me in the surgery, and Ray remains as cheerful as ever. Two hip replacements later, so far as I know, he still hasn't ventured into the city, but is often to be seen around our small town being towed by an impatient but good natured Labrador. In the meantime he has taken to playing piano for himself, and still whenever I see him he smiles and asks "How are you today Doc?"