Our students are often surprised when a “theme” emerges during a surgery. However it works sometimes the fates play quirky tricks and one surgery will have all of our “John Smiths” booked in to be seen one after the other, quite by coincidence, or there will be a stream of pre-schoolers with lego bricks or beads up their noses… that sort of thing.
Yesterday morning it was elder men and relationships.
Three of them.
One after the other.
EM 1 came in to review his repeat medication. Just three items, and two of them for blood pressure. We checked his BP (well within target on this occasion) and I agreed to renew his script for a further twelve months quite happily. He needed a new issue so just before printing I thought I had better check with him about item three, not filled since April. Sildenafil… or Viagra if you need the brand name. Our conversation went a little like this:
Dr J-- So would you like -
EM1 (hastily interjecting)—No thank you!
Dr J -- ? (the TM quizzical eyebrow)
EM1 – I’m not like that Des O’Connor you know.
And that was that. Plainly he didn’t want to talk about it and we moved on to the renewal of his BP meds.
EM2 was widowed eighteen months ago. We reviewed his osteoarthritis and agreed it still rendered him unfit for work. It is likely he will be medically retired in the near future so we agreed to review the position when his employer’s insurers had been contacted. Then he looked a little bashful and said he wanted to ask a “personal” question.
It transpires he has been “dating” again as our U.S. cousins might put it. Nothing too involved, just dinner out on a couple of occasions, but each time when he got home after a pleasant evening of one to one female companionship he has felt terrible. It’s a mixture of guilt and anxiety which he thought was unique to him. He seemed happier after my reassurance that it was not, and that it would be ok for him to persevere if he wanted. Hopefully he now understands the origins of the guilt, and the fact that he has no need to feel so terrible. It’s like he was looking for my approval. I hope he now knows that he has it—but that he shouldn’t need it in any event.
EM3 has been caught like a dolphin in a tuna net. He has Ischaemic Heart Disease. This is well managed by our thoroughly able in house CHD team. This year, as part of our contract we are obliged to screen our “Heart Disease” population for depression as well as reviewing their other CHD risk factors so the nurses asked him the required two question screen… along the lines of “Do you feel sad?” and “No go on, really, do you?”
Indeed he does. But not through his, entirely well managed, IHD. No, his problem is Mrs EM3. She has dementia. It has been progressing for some years and is now increasingly severe. She hardly goes out. She sees old friends as strangers, and strangers as a threat. She declines the offered help and flatly refuses to contemplate respite. Every three to six months in outpatients the Psych’s ask her how she feels. She Says “OK”. They ask her about her memory and she shrugs and chuckles.
All through our consultation he is looking at his watch. She has been left alone at home and he worries she will have left the gas on or microwaved the cat. If he talks to her about his need for help she gets nasty and says spiteful things, or, when it’s really bad, hits him. “But” he says, “we promised each other for richer or poorer, in sickness and in health….”
He knows he is struggling, but “When I look at her when she’s sleeping I KNOW it’s not her fault.” He’s thoroughly trapped. So the next time they see the psych’s he’s going to chime in when they ask how she is, and really tell them. Till now he has felt it’s not for him to comment. I hope he is now persuaded he really needs to.