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?"