My first patient as a 'real' doctor was a very rare bird. All through my training I had read about the rare diseases - and had seen a few. But I wasn't prepared for the first!
This lady has a cancer that is associated with a skin condition. My very large cancer text (over 2500 pages would you believe and bigger each edition!) said that the skin condition was found in 2 families from Liverpool. I remember these 'Trivial Pursuit' facts - which infuriated those training with me! The treatment elsewhere was standard. She came to settle near her family with her three children.
She had a bigger problem that cancer though. She couldn't swallow. Not food, not water, not saliva. A small tube connected her stomach to a liquid food pump. If you like medical acronyms it's a PEG or percutaneous endo… gastrotomy tube. There, another trivia fact! That diverted the food and water but not the saliva.
A call from 300km away said that she had become ill with pneumonia after repeatedly breathing in the saliva, and could they send her back.
From here on the story switches to the children. Their mum arrived in a very sorry state. She was crook. Barring a miracle, she looked like she was going to die… soon.
I introduced myself to the kids, their cousin, uncle and aunt. "So tell me, what have you been told about your Mum's condition?" Their answer was 'nothing'. As a parent and ex-teacher, I am suspicious of 'nothing' for it usually means something. The aunt and uncle confirmed their ignorance. NOTHING!!
So what do I do now? "I would have called a social worker and handed the family over to them" was the serious suggestion of one of my senior colleagues. Standing there I had a mental picture of three kids on train tracks about to be hit by a train and their world shattered. They had little time to learn the truth, absorb it and then act.
Unfortunately I have been in that position. My father died in a car accident and I discovered this in church with a priest's announcement from the pulpit. It is not pleasant. It makes saying good-bye hard. It leads to unfulfilled regrets.
They wanted to look at her chest x-ray first. So that was where we started. Every question was answered. Can Mum hear me? Is she in pain? Will she die? Every one answered. We talked for over 2 hours. I didn't think that I had really done enough. Time was too short. Isn't it always?
I arrived home late and my wife was angry. I explained and she forgave me.
"People in glass houses shouldn't throw stones". One day I hope that my family will be treated the same and have their grief eased by a doctor who stays back to do the job that needs to be done. All the more I hope for doctors who will tell us earlier about the train that's obviously going to hit us.
