Moan grone droan....

Soul searching is a wretched occupation to be sure, and yet sadly there are times when it becomes unavoidable. For me the past few months have been just such a time, and the truth is I'm far from happy with the conclusions I am reluctantly drawn to make.

You see folks, before you stands a creature as obsolete as the diplodocus, the marsupial lion, the dodo. It appears the job I spent almost half my life training for, and the remainder practicing, is no longer relevant. Family Practice, at least the sort of practice I understood as such, is dead.

The thing that hurts most about this is the knowledge that I and my colleagues have been at least complicit in, if not active proponents of its demise. Never has it been more true that good intentions make for the poorest choice of paving. It matters little how we got here, except perhaps to historians who in years to come may pore over the all too brief social experiment that was the post war Labour administration's establishment of the welfare and national health systems that now lie in tatters. It's what we do next that really matters. So for what it's worth, and for as long as I am able, I shall continue to ply my trade the best way I know how to any who wish to avail themselves of my services.

But with an uncaring, pettyfogging, beureaucratic civil service under a runaway political class on the one side, and an increasingly litigious, narcissistic, solipsistic populace on the other, I'm starting to feel more than a little like Han Solo in a trash compactor.

And the walls keep on closing in.

Just had to share this, lest I forget it....

You get to see all sorts in this job. We are the "window cleaners" of the medical fraternity. And then, just occasionally, you might even brush up against the paranormal. I’ve already told you about our resident reggae loving apparition in a past post, but today I have had a visitation from the Fair Folk.

Yes indeed, gentle readers, today I have consorted with a real life denizen of the land of Faerie. Thankfully one of the Seelie Court, so I think I’ve escaped without ill effect.

Now I’m sensing some skepticism out there, but I can promise you all it’s true. And how, you might ask? Well, because he told me so himself, and without me even having to grasp him by the beard (which was just as well, what with him being clean shaven and all), traipse three times (or should that be thrice to maintain the idiom…) widdershins round a mulberry bush by the light of the silvery moon or anything. Nope, he just came right out with it in the middle of morning surgery, bold as you please.

It transpires this particular sprite had suffered an accident at work. Namely he had barged his shoulder on a doorframe in a desperate attempt to conceal his identity from the mortal he was visiting. As a result he’s bruised his acromio-clavicular joint. In the end we got to do the examination through his T shirt since it had a broad neck, no doubt so he could keep it in place to save revealing his wings and all.

Still it remains the case that today I met with the Ambridge Tooth Fairy. He’s about six feet tall, and answers to the name of Steve* but Tooth Fairy he assures me he is. So when the kids of the Ambridge First School tell you they know for a fact that the tooth fairy has a very deep voice and knows a lot of interesting Olde English words for bodily functions and general Oaths try not to act at all surprised.



* obviously not really "Steve", but he made me promise not to reveal his true name. You’ll just have to trust me it’s something similarly non-descriptly male, and does not end in “-erbell” or in anyway sound floral.

Ecclesiastes Ch3 V1

Over the past couple of weeks it has become increasingly apparent that I need to cut down on the day to day distractions for a bit. I know posting here tends to be erratic at the best of times, and I regret to report that these are far from the best of times for the Ambridge Surgery, or at least for my own little corner of the same…

And so, regretfully, I have decided to place the caseblog in abeyance for a while. It remains my intention to return when I can, but I can’t give you any precise indication when that might be. In the interim rest assured I shall still lurk the bloggosphere, and likely will pop up from time to time in comments pages elsewhere. Feel free to use the comments that follow as you will, I shall be checking them still whilst on hiatus, and I very much hope to be back amongst you all again ere long.

Acquired empathy

Our case for today is a professional gentleman in the first flush of middle age. He has been favourably compared with Daniel Craig* with respect to his chiseled good looks, and likes to think of himself as pretty healthy. In short he is your humble narrator.

“Whatever then can be the matter?” I hear you all ask.

I thank you for your concern, but pleased be assured all is well, or at least soon will be. For now though it appears I have been stricken by a comedy ailment. You know the sort of thing, ailments that are a source of amusement to all but the poor victim. The boil on the bum, or dose of the piles; the glowing scarlet hooter of acne rosacea or alcoholic liver disease; or as in this case the throbbing agony of the hammer splattered thumb or gouty toe.

Yes, ladies and gent’s, your poor old interlocutor has been stricken with the gout. It’s not the first time to be honest. In fact the last bout was only just around Christmas time, though the one before that was a good few years ago. So here I sit, like the plethoric squire in a seventeenth century cartoon, foot held aloft, wincing and any slight movement within three hundred yards whose trajectory might imperil the affected hallux. The good news is, from past experience, both my own and that vicariously obtained, I know it will be gone in a few days and do not then expect it to return anytime soon. Better yet, it seems still to be responding to good old Indomethacin, so no need to seek out the apothecary monks for their Colchicine…

Happily it affects but a single joint, and yet, in so doing, I am given a glimpse into the daily reality of a number of my regular customers who have far more widespread and longer lasting inflammatory joint diseases. And such an insight makes it easier to appreciate just why so many of them are so keen to continue their painkillers, even when it becomes apparent that the anti-inflammatories are slowly but surely rotting their kidneys.

I can’t help thinking they are all an awful lot tougher than me. Arthritis really isn’t for wimps.



* Readers are encouraged to ignore the off camera sounds of Milady spluttering into her tea mug in disbelief… a lad can dream after all.

I give up!

Eddie came to the chest clinic this morning. His asthma is pretty well controlled with his present inhalers, and his lung function is appropriate for his age, and this despite his four decade smoking history. He says he would like to quit, but has tried all the methods available, with no lasting success. Still, this year he has decided to get serious and so, for Lent, he has given up.

Smoking.

Indoors.

Sadly, this behaviour modification has coincided with a bit of an upturn in the weather. In the past couple of weeks, Ambridge has been graced mainly by clear skies and brilliant sunshine or scattered, scudding clouds and a stiffish breeze. So in reality he’s not so much given up as changed venue.

Admittedly that makes it less likely that he will light up first thing, what with the rather frosty mornings such clear skies also cause; or last thing, since it’s still a bit nippy for standing on the patio in PJ’s, dressing gown and slippers. So this in part explains his drop from ten a day to six or seven. The problem is Lent will be up in another three weeks.

I’m also a bit baffled by the logic. Is it somehow more sinful to smoke indoors, polluting your own space, than outside, polluting everybody else’s? Or is God just watching what we get up to inside, knowing he can safely leave outdoors to Her Britannic Majesty’s Government, with their plethora of CCTV cameras and US loaned spy satellites? Or is this a new variation on the “calories don’t count if you’re standing up” argument?

I’m left wondering what other sins it might be safer to indulge outdoors, but, to be honest, so far I’m coming up blank.

The circus is in town.

Most of the time I’m more than happy to make do with a boring old mobile phone. The sort that just makes and receives calls. In fact, if I’m honest, I’m even more content to have the thing switched off in the glove box, or left back on the dresser at home. I know, I’m a grumpy old man, and I don’t care, so just get over it people.

Except that today I really, really wish I had one of those third generation, umpteen megapixel, all singing, all dancing, camera-phone-music-player-teasmade-filofax-blonde-bombshell-PA thingies. Because today I appear to have stepped through the looking glass and come out in Monty-Pythonland. You see, I know it’s not an acid flashback, ‘cos I never had the acid to flash forwards from in the first place, and yet the sight that greeted me on the way in to work this morning takes some explaining, and a picture really would have helped. I’m afraid you’ll just have to take my word for it instead. Still, you know you can trust me. After all I am a doctor….

I sense some of you in the cheap seats at the back getting restless. “Once again we haven’t got a clue what he’s talking about!” I hear you mumble above the background hubbub. I shall, at last, explain.

On the outskirts of town there’s a field (if I repeated this line now I might have a halfway decent beginning for a blues ballad—but we shan’t be going there today). In this field the are some sheep (yes, I know, “with a Baa Baa here an’a Baa Baa there”). So far so normal you might think, and so, on every other day it has turned out to be. But today these same sheep are auditioning for the Cirque d’Ambridge. In short they appear, gathered together in the corner of their field, in a seemingly perfect two-tier ovine pyramid, with a cluster of sheep at the base, and two very haughty specimens, side by side and faced Pushmipullyu fashion on the top tier.* So now you can see why I need a camera-phone.

Oh, and an in-car photographer, ‘cos otherwise all you’d actually get to see here would be a very fuzzy snap-shot of two headless sheepy blobs atop a mound of cotton wool.




*the boringly mundane reality is that the top layer sheep are standing on a very flat, very broad tree stump of an old, long ago felled, oak, with the remainder of the flock gathered in attendance around its circumference, which explanation rather spoils the illusion, but might help in my defense when the men in white coats come calling.

Ars longa...

It’s a rather disappointing discovery to be sure. You see the exigencies of child care have occasioned me to take the middle three days of this past week off. In effect I have worked a two day week, namely Monday and today (Friday). Monday was a moderately busy Duty Surgery day, but the knowledge that this was to be followed by three days at home with the kids reduced the normal stress levels this would entail to near zero. And today, back for just a day before another weekend at home, has felt every bit as good.

I have been at my empathic best. I have explored every patient’s knowledge, expectations and concerns* to the uttermost. Dare I say it, I have even come over all “Peak Practice” on a couple of occasions.

All of which is leading me to the inescapable conclusion that far from being the macho, stress busting 24/7 Dr Kildare of the 21st century, I am in fact far more suited to the occasional commitments of the hobbyist, and well on the way to the pipe and slippers.

I think I feel a bit of a mid-life crisis coming on, and that’s a real blow. Especially since heretofore I was rather hoping to give Metheusala a run for his money, which would put the whole “mid-life” thing almost 440 years too soon.

Bugger.



Knowledge, expectations and concerns-- the "Holy Triad" or the Royal College of GPs, to be explored in every consultation. You know the sort of thing. " I know I've got a sore throat. I expect antibiotics. I'm concerned you won't let me have them."

Solar Power *

It’s been a bad month. You might have been able to tell, what with the total absence of posts and all.

No need to bother with the whys and wherefores. Most folk resident in Blighty might have some clue, although the press coverage of he latest spat between GP Land and Her Britannic Majesty’s Government hasn’t exactly been at the fore-front of the news agenda. Add that to the arrival of a new Student (whom I’m trying desperately to inoculate against the cynicism of my confreres—after all somebody’s got to step up to the plate and keep working to pay for my pension) and a rash of young adults bent on their own self –destruction, and overall the latter half of January through to now has been, in common parlance, “a bit of a bugger”.

And yet today, on the usual drive in to surgery, things somehow feel a little brighter. For one thing, half term is upon us, so no school run and no school traffic. Also all weekend, and again this morning, the sun has been shining, with nary a cloud in the sky. Daffodils are starting to nod in the verges, and a scattering of purple-pink crocuses dapple the floor of our own little wood at Jest Acres.

On the road to the surgery, roughly half way between Borchester and Ambridge, the road climbs sixty metres or so on to the Ambridge Escarpment. It’s a pretty enough stretch of road, but today, under Canaletto Blue skies suffused with the golden glow of the early morning sun, at this spot God is plainly in his heaven, and very little can be wrong with the world.

Governments come and go, as indeed do GP’s, students, suicidal teens and all the other trappings of modern existence. Yet some things still hint to us of eternity and perfection.

And in that context all the distractions of the past month boil away to nothing.




*For those who were wondering Dr J is indeed an unreconstructed hippie and flower-child who's formative years were profoundly affected by the Summer of Love. Not that you'd ever be able to tell nowadays.

One for Dr Freud

Eddie has been having some problems with neck pains. The pains have been with him for years, but until recently he was managing pretty well with regular painkillers. A bit before Christmas the pains got worse so we repeated some blood tests, looking for evidence of arthritis, and an x-ray.

The bloods were quite normal, but the x-ray has shown worn disks in a couple of places in his neck and these will undoubtedly be the cause for his pain. So he will press on with the painkillers. I did offer him physio, but he has tried this before and is not keen.

“I used to come here for it when you had that blonde girl upstairs. We did it three times a week, but I had to give it up ‘cos it hurt too much!”

Then he realized what he had just said, and neither of us could entirely suppress a schoolboy smirk.

Some days here it's just like being on the set of a Carry On film.

Absent friend

Way back when, as one of my first tentative steps in compiling the rolling memoir that you now see before you, I wrote about an old friend and his best friend. My old friend Ray was back again today, this time on his own. Sadly, his best fried succumbed to a heart condition sortly after Christmas and is now serving guide dog duty for the choir invisible.

Ray reminds me that the initial consultation I described in the original post was almost a decade ago now, and yet the passing of his guide and companion still seems way too soon. Throughout the consultation we are reminded of the absence in the room as toys are not fetched to be deposited in either of our laps, and the "whumph" of a slightly pudgy labrador settling at his master's feet for the remainder of the consult is strikingly absent. No bowl of water appears at the door as once it did, and poor Ray is denied the fawning attention of one of our more dog mad reception team that was once his by right.

Happily this hiatus will not last for long as he has already been interviewed with a view to receiving a new companion. But for today we are left mourning the passing of a very special animal.


"The dog is a gentleman; I hope to go to his heaven, not man's." Mark Twain

Winter Wonderland?

Overall it’s hard not to feel a bit swindled. The reports for the preceding forty-eight hours had been full of blizzard warnings for most of the known universe, or at least for dear old Blighty. And to be sure the East Coast did get a bit of a snowy pummeling.

We might have known when first the forecast started to slip from “Thursday” to “… around tea-time” to “… probably after seven”, that we were not to be blessed by so much as a solitary flake. Although actually I might have seen one or two playing fitfully on a chilly gust in the middle of the afternoon visiting round yesterday, or it might have been a slightly tardy post-hogmanay hang-overish sort of thing.

Instead today sees Ambridge submerged in the middle of a damp, clingy cloud of fog, and swept with successive bursts of fine cold drizzle. And the same cold, wet, numbing grip appears to have descended on the minds of most of the locals, or at least most of those attending surgery this past couple of days.


Fair to say, the rot had begun to set in on New Year’s Eve. It’s almost a cliché I know, but I can’t seem to get through a NYE surgery without encountering a least a couple of suicidally depressed patients presenting that day, for the very first time, and wanting everything sorted out right then. This year was no exception and it has sort of set the pattern for the past few days.

O.K. the high drama of NYE has been replaced by the dawning realization that we’ve all got another whole year ahead of us, so the actual impetus to self immolation has receded. Instead consultations seem to alternate between the flat, affectless and moping on the one hand, and the jittery, agitated, “free-floating” anxious on the other.

I can’t help noticing some of the patients seem a bit down in the dumps too.

Bonne Annee

So this is it then. Goodbye and, more or less, good riddance ’07.

It’s not been a specially great year here in Ambridge. A bit like the Nikkei, we’re closing the year a good few percentage points down. That said there have been highlights, both personal and professional along the way. It just seems they have been significantly outweighed by the lowlights this particular year. As a prime example, the year that began with exuberant chocolate fountains (yes I did mean plural) to a full house on New Year’s Day, goes out to a much more sedate chocolate fondue for five tonight, and for the first time ever we get two New Year celebrations exactly one hour apart, as one of our little flock will be celebrating Bonne Annee in mid exchange visit far away from the familial bosom.

(And if he doesn’t ring us close on the stroke of Minuit local time there’ll be ructions).

So all in all ’07 goes down in the Jest family annals as a bit of a damp squib.

We’re hoping for better in ’08, and despite the preceding misery (“the poor old lad’s come over all Seasonally Affective on us again” I hear you all shout, and you might have a point…) I would like to take the opportunity to wish all who tread here hereafter, the very best of years ahead.

And, of course, as much chocolate as you can comfortably accommodate ;-)

For want of a nail...

Ivy has had a bad winter so far. She started coughing and wheezing in October. The cough has never really gone away, and after three courses of antibiotics (the last two with a steroid chaser) it is becoming apparent that her COPD has really taken a significant downturn, and now she is left breathless on minimal exertion.

And then, last Friday she arrived back at surgery in grip of another nasty respiratory virus. It’s still not exactly clear how she made it this far, because she arrived in extremis. Indeed after one look at her I was afraid she was on the verge of a respiratory arrest. With judicious use of the nebulizer we managed to get her breathing rate down to below sixty a minute and removed the awful dusky blue tinge from her lips and tongue, but she was plainly still in a lot of trouble and needed to go in to hospital to get sorted out, or at least to be assessed for oxygen therapy.

Except that there was no way to persuade her to go into hospital.

“You see I’ve got to get home to look after Mr. Tiddles.”

No,Ivy’s surname doesn’t even approximate to Tiddles.

She was, of course, referring to her cat, Mr. Tiddles the little black and white bundle of fluff she calls family. It appears her nearest relative lives about as far away from Ambridge as is possible and still be technically resident in Blighty, and may not be in the best of health either. Her closest neighbour on whom she might call is a sprightly ninety five, but not steeped in the lore of feline husbandry, and anyway “it wouldn’t …be right…. to impose … she has ….problems …enough.” All this between gasps which just go to underscore the imperative of Ivy’s admission to Ambridge General.

And so it is that Mr. Tiddles now has a daily entry in our home visit book for the duration of Ivy’s stay on the wards at A.G.H.

Delusions of Grandeur

“He’s ready for you now” Miss Moneypenny nodded towards the office door, marked with typical ministerial frugality with a single letter-- M.

In I went, full of trepidation. Two hours later I emerged triumphant. Horizons had been scanned, forward motion was observed and a jolly nice Macedoin de Fruits analogy slipped in under the wire. All told I had shoe-horned in a grand total of five reader submitted buzz words or phrases. And more importantly, my Double-O status is safe for another year. The denizens of Ambridge can sleep safe in their beds, knowing that Dr J is on watch.*

So thank you to all contributors for your sterling efforts in making this year’s appraisal more amusing. It is possible there will be concerns at NHS management level about my sanity after the report goes in, but there’s probably nothing new in that anyway. I now expect my call up to visit Q branch for some new goodies any day, so just one question remains.

Where do I sign to get my new Aston Martin?

*Although actually of course night work and weekends are no longer in my purview…

The dog et it......*

Brothers and Sisters I stand before you full of contrition. The thing is, the servers at work started playing silly buggers. Then things at home got a bit busy for a while. Then there was this whole clinical presentation to the entire practice thing that I had to get ready for Monday last, and finally the dread annual GP appraisal looming for Monday coming. In short these are my feeble excuses for the lack of posts (and comments elsewhere) this past few weeks.

Not that I haven’t been thinking of you all you understand. And now I’m back and already I’m after a favour.

“Bloody typical…” I hear you all muttering, “It’s always Me-me-me with him. We don’t know why we bother… honestly… “ and so forth. And you’re probably quite right. Still you can’t blame a chap for asking, so here goes.

As last year, next Monday morning I am to be appraised. A colleague and mentor will be stopping by for a chat, to try to detect if I have developed any homicidal tendencies since last we spoke. I’m pretty sure I haven’t, so that should be ok, but the whole process can be a bit of a travail. To lighten the mood last year we tried a game of “buzzword bingo”, a little something I shamelessly plagiarized from Blogger par excellence, Greavsie.

So what I’m looking for are a few choice buzzwords for this year. All suggestions gratefully received. Of course if you felt you wanted to submit them wrapped in a ringing endorsement stating how the Caseblog has transformed your sex life, cured that embarrassing little crop of warts, given meaning to an otherwise drab and hopeless existence, or other such fitting tribute, then however much it might embarrass me, you should give free reign to those feelings.

Just don’t tell anyone I asked…..



*excuse supplied to Mrs Badcrumble for non-appearance of homework, circa 1969. (And no we never did have a dog).

Stop me if you've heard this one before.

“The thing is…” Nelson pauses for effect, “it doesn’t seem to matter what I do, I just can’t seem to stop putting weight on.”

Nelson has Type II diabetes. You know. The grown up sort. The kind that won’t put you into a coma in just a week or two, and, that seldom requires insulin at the start. One of the problems with this is that, in an effort to get his blood sugars to target, he has ended up on rather a lot of meds. And some of those meds can, paradoxically, cause weight gain. So he may just be experiencing a side effect.

“So,” say I, “what exactly have you tried?” A reasonable request I think you’ll agree. But Nelson’s body language comes over all discomfited.

“Well, I don’t have sugar in my tea anymore. And I’ve started using all those low fat thingies….” At this point his brow creases as he casts around for other lifestyle changes made in the three years or so he has been afflicted.

He dries.

“So have you tried dieting at all?”

The stunned look in reply says it all. It appears he was hoping for a visit from the “Weight Loss Fairies” to magic the excess avoirdupoids away.

And so we agree to give it a go. In the end he is weighing in a good three kilo’s heavier than he was in the spring, and this tips him over into the dread “Obese” category, which, coupled with his diabetes is not the best news. He has a target to make in the next four weeks, and if he can hit or get close to the required 2.5kg weight loss we shall be in a position to start him on some meds that might help (yes yet more meds, Type II Diabetes Mellitus is not for the faint hearted—‘scuse the pun).

If not he gets to go to the endocrine clinic for further advice.

Or we could always send in the Weight Loss Fairies...

If you go down to the wood today...

The ghost of Monty Python is apparently abroad. Or to put it another way I’ve just had another of those completely surreal consultations that leave me marveling on the vagaries of the human character and chortling quietly to myself.

The first clue that things were going to be less than straightforward was Lynda’s admission right at the outset that she was “… in a bit of a mess.” Lynda is a woman of middle years, and not generally prone to euphemism. The second clue passed me by at first, but on the desk she had deposited her car keys—nothing unusual in that—hanging from a cutesy teddy bear key-ring.

It transpired that a few weeks ago Lynda had an intimate liaison with a “new partner”. Or a good old fashioned one night stand to be more accurate. Some weeks on she was left with a continuing reminder of the same, and requires investigation to rule out STI. We agreed that rather than refer her straight to the GU clinic, to spare her blushes we could initiate investigations here and only refer if we found a complicated case of infection. From her symptoms the most likely culprit remained candida and so the full rigours of the GU clinic might well be unnecessary.

So as I was completing the microbiology form to arrange the requisite swabs, I happened to glance over to where teddy lay resplendent on the desk. There he lay in all his glory. I can assert his masculine gender with some certainty, since there he was hung quite literally “like a bear” and with a “Prince Albert” to boot. Keeping a straight face through the remainder of the consultation was a real challenge I must say…

Welcome to Tombstone!

First a small matter of house keeping. It appears that after fifteen years the domain that also supplied my email address has been withdrawn. My very kind ISP have supplied me with a shiny new domain of my own and a new mail account to go along with it, so for those who feel the need to know, I can now be reached at “the-doctor-is-in(AT)doctorjest(DOT)co(DOT)uk”

Now on with the motley….

I’ve seen some pretty odd indications for admissions to nursing homes in the past. On at least a couple of occasions we have had to admit patients to a local Home for healing of their pressure sores (it helped that the Home’s matron was at the time an internationally published authority on the subject and a true mistress of her craft, thus disproving the old axiom that “those that can’t teach”).

We have also felt in necessary, on more than one occasion, to admit frail patients to nursing homes rather than to hospital to keep them away from the Jabberwock strains of MRSA or C. Difficile (prn dif-ik-illy not dif-iss-eel it’s LATIN people!). There was even one occasion when I admitted a chap to get him away from the maggots (we are talking real live wigglies here, not the Lovecraftian imaginings of a diseased mind).

Still today’s notification takes things to a whole new level. I have a patient who was recently admitted to a nursing home for her own safety after a fist fight developed between her family and her carers.

From now on I’m thinking of changing the old monicker to Doc Holiday.

Gosh, look at all these trees!

Bert’s angina has been playing him up. Over the past few years he has been a diligent attender at the CHD clinic, and his blood pressure, cholesterol, glucose et al are all perfectly managed. He takes his allotted and guideline mandated handfuls of pills as required. In short, Bert is a model patient, and he is managed to the last scintilla exactly to protocol.

As a result, he is a bit put out to find his angina back again. It isn’t that severe. He can still manage hills and stairs pretty well. He just has to remember to pace himself a little better. And if he forgets (because inside he still feels closer to twenty eight than to his chronological “pushing eighty”) he gets a short sharp reminder. Given that he had been symptom free for much of the past three years this has come as a bit of an imposition, and he is keen to learn what I am going to do about it.

“These pills are no help at all!” he says, brandishing a green and white packet at me. It’s not one I immediately recognize, and with all the waving I can’t quite manage to read the tiny stick on pharmacy label that would inform me as to which precise anti-anginal medication has been letting him down. I take the packet off him, and call up his current meds on the screen. The box contains his statins (cholesterol meds useful for preventing further deterioration—but not for relieving the pain of angina when it hits). The screen shows he has no regular anti-anginal medication. But then, until the past few weeks he has not has regular angina either…

The screen shows his last script for any angina reliever medication was over two years ago, and this has long run out.

So he leaves with a script for a new spray, and my encouragement that he ought also to continue his statin and other meds as well. He’s also going to have a few follow on tests to make sure he hasn’t become worse, but all the evidence of his last investigations shows things were quite stable within the last three months.

I am a little troubled that both he and we have slightly lost the plot here. After all he did already have angina when he began attending the CHD clinic , and for all the preventives he is now receiving, it remains the case that his pre-existing ischaemia will, from time to time, make itself known, and when it does it is quite o.k. for him to react to this with reliever medication. It seems we both need to learn to see the wood again, as well as focusing on the trees...

In which Dr J has a bit of a moan...

This post has been quite hard to write and might be equally so to read. I’m afraid you’ll have to take my word for it that in no way is it intended as a whinge, however it turns out…

Tony called yesterday to update me on his progress. He was effusive in his praise of the surgery, and of the hospital team he was referred to. In charming and measured tones he took me through his last few weeks, from my referral to the initial surgical outpatients appointment just a few days after. Thence to CT scanning and back to a different, oncology, outpatients appointment where they gave him the expected news, that he did indeed have a carcinoma, and that it was too invasive and widespread for surgery. He goes for palliative radiotherapy in the near future.

He appreciates that the prognosis is poor, and yet is quite unreasonably grateful to the team that have made the diagnosis and given him that information. It may sound surprising, but in my experience such innate nobility and generosity of spirit is not at all unusual. Indeed I would go so far as to say I often feel most appreciated* by those patients for whom I can do the least.

Annoyingly, the converse is also often true, and patients for whom one has attempted impossible feats of logistics, who have then accessed the specialist of their , often quite unreasonable, choice and undergone the high tech intervention for whatever problem they have presented, return to moan about delays in treatment, parking problems and the quality of the hospital food. After consultations like this you will find me tearing what little remains of my hair out, and wondering just why it is I heave myself out of bed each morning to come here...


And then Mrs Archer will wander in for a review of her Diabetes and High Cholesterol, and with a twinkle in her eye, and not a hint of irony, hand over a box of Clotted Cream Fantail Shortbread, “for you Doctor, from my holidays…”.

Well at least it helps explain her sugars and cholesterol!


*Such utterly unwarranted appreciation comes with a large slab of guilt on the side.