Turning the tables
An outstanding entry in Pulse’s 2015 writing competition by Dr Matthew Piccaver
In the early stages of our careers, patients will often stand out. If familiarity breeds contempt, then rarity breeds enthusiasm. Our eager thirst for knowledge as medical students would often see us seeking out additional time on the wards: after all, the pathology is in the patient, not just the textbook.
As we progress through our studies, the novelty gives way to a perpetual sense of de ja vu. The name changes, but the story has been heard before. You begin to second-guess what comes next. Like some kind of internal game of clinical Bingo, you tick off the signs…
’Coughing up blood’ - check.
’Weight loss’ – check.
’Smoker for decades’ – check.
’Lung cancer’ – full house.
A strange glee emanates from what is often terrible news for another. Confidence verges on arrogance, negating the misery which envelopes the diagnosis. Youth brings with it a sense of immortality, of misplaced invulnerability. One patient taught me that none of us are immune.
Other writing competition entries
(2nd place) Dr Ellie Cannon: ‘Why hold back the tears?’
(3rd place) Dr Roger Henderson: ‘A presumptive diagnosis’
(Under-35s winner) Dr Ahmed Rashid: ‘The famous razor of Occam’
A twenty-nine year old male, recently married, with an exciting future presented to his GP.
’I’ve found a lump,’ he said, ’in my neck.’
Questions and answers were exchanged. The patient converting his feelings into words and gestures, translated in the mind of the doctor to patterns and pathology. A complex transaction, replete with nuance and ambiguity.
’We’ll get you seen within the fortnight,’ replied the doctor. ’We’ll get a scan whilst we’re waiting.’
Both impressed and anxious with the speed of response, the patient soon found himself in a waiting room with row upon row of life’s rich tapestry - some patiently waiting, some complaining fruitlessly to the browbeaten receptionist - all the action punctuated by the scurrying of staff and the ferrying of patients.
A scan followed, poker-faced radiologists muttered a few spoilers about the possible diagnosis, and back into the system the patient plunged. A case history, a hospital number, a set of notes, and somewhere amongst that a person.
The time to see the consultant soon arrived.
‘You’re going to need an operation, and by the looks of things pretty soon.’
The NHS moves with what feels like glacial speed. Rapid does not always mean good.
If it wasn’t obvious, the patient was me - one of the few cases for which I can safely break confidentiality. I had developed a thyroglossal cyst, The size of a golf ball, infected, and eroding through the front of my neck. After ultrasound and an ENT appointment, I was listed for surgery.
Being a patient surrounded by colleagues is an odd experience, but a reassuring one. Sitting on the other side of the consultation is daunting, but none the less gave me a little extra empathy that I might otherwise not have had.
We are either patients already, or will be soon. I’ve been taught that none of us are impervious to the misfortune of malady.
Dr Matthew Piccaver is a GP in Cambridge