Wednesday, February 10, 2010

Margot (Four little words.)

When Jerry first got the back pain that turned out to be myeloma Margot immediately rallied round, sorted his life out for him and got him to and fro for his chemotherapy like the trouper she undeniably is. After around eighteen months the chemo' was stopped, and the myeloma was declared in remission. Jerry wasn't quite the man he had been, but with Margot's help he got back on his feet and soldiered gamely on for five years before the disease came back again.

Sadly this is exactly what myeloma does. It's the cancer that breaks pretty much all the rules, especially the one that allows chemo' to work. Normally cancers grow more rapidly that anything else in the body. the chemo drugs poison growing cells (which is why they make your hair fall out). It also means you can give doses that will poison just the cancer cells and the hair follicles-- well mainly, and leave the rest of the patient in reasonable nick. Not so myeloma. It grows way more slowly that normal cells and tissues, so to kill it completely we'd have to kill the patients other cells and organs a number of times over, so we have to use pulses of chemo' to contain rather than cure.

In the end Jerry proved unequal to the fight and slid slowly into that good night around six years ago. And poor old Margot, having been utterly solid throughout his illness, finally fell apart. The first couple of years alone were really tough, even the arrival of a couple of grandchildren did little to lift her spirits. Anti-depressants did their bit to hold back the overwhelming tides of grief, and sheer dogged determination hauled her slowly out of the pit.

A couple of weeks ago she was back after an interval of almost twelve months, during which she'd successfully taken herself off the med's and was thriving. We talked it through, and time and the gradual demands of the same growing grand children had worked their inevitable magic allowing her to reconnect with the land of the living. She was smiling, and rightfully proud of herself. Then, just before she got up to leave she innocently asked those four little words, "While I'm here Doc..."

Anyone with any medical training will tell you how freighted with menace that tiny phrase can be. And so it was. She just wanted to mention this little pain she'd been getting in her chest, just for the past few months, just when she was climbing hills or stairs, or, as it's been lately, it got a bit cold.

So now poor Margot's off to see the cardiologist, but she still managed to leave the room smiling-- for the first time in years. I hope it lasts.


Pondering Practitioner said...

Add; "I wasn't going to mention it, but..." and "Just one last thing..."
Poor old Margot, she sounds a wonderfully stoical lady.

Doctor Jest said...

P. P. -- welcome. Indeed she is, and you're quite right, also "I've got this friend..."

A New Kind of GP said...

This story beautifully captures what being a GP is all about - the detailed knowledge we have of our patients' backgrounds, their character, and the care we have for them as people. What D.J. perhaps omits to mention is the importance of his role in providing Margot with the motivation to keep going.
I do hope that such integration of care displayed in this story is not compromised by the drive to fragment chronic disease management by handing it over to specialist nurse practitioners.

Anonymous said...

I get worried about things sometimes, like my DLA renewal or a problem with a repeat prescription and always there's the reassurance from my GP "I know you." He does, and it makes all the difference. We won't get that from polyclinics.

Doctor Jest said...

Newbie-- You're far too kind, but I share your anxieties that in the headlong rush to sub-specialize we risk going the way of our hospital colleagues. A trend I fervently hope we can resist.

Anon-- You're right, we won't. Please tell that to your prospective parliamentary candidates if you can bear to talk to them.