John wasn’t the easiest of patients. He rarely took my advice on anything but still enjoyed coming to see me now and again to get a few things off his chest. He drank too much and he worked too hard and his diet was pretty awful. He didn’t need me to point out that his health was suffering as a result, but like so many of us he seemed trapped in his bad habits. John reluctantly took pills for his high blood pressure, gout and raised cholesterol. He always had the aim of changing his lifestyle so he wouldn’t need the medicine any more, but despite gym membership fees leaving his bank account every month, he was much more likely to grab a bottle of wine and a takeaway curry after work than eat a salad and run 10 kilometres on a treadmill.
John was in his early 50s and was still bitter about the break-up of his marriage almost eight years earlier. He blamed his ex-wife and ‘that bloody bastard’ she ran off with, but he did admit that he had spent far too much time working on his career and too little effort working on his relationship. He had also confided in me that his marriage had never really recovered from the stillbirth of their son 20 years earlier. He always felt that he should have somehow been able to have prevented his son’s death and he explained that feelings of blame ate away at him. He had always shooed away my suggestion of counselling, instead choosing to throw himself further into work and drink.
I had seen John miserable and angry many times, but today he seemed genuinely depressed. This was the first time he was questioning the point of going on; he wanted me to keep this off his record, but he had actually begun to seriously think about suicide. I was really worried about him, and wanted him to get some help, but as usual John dismissed the idea. I thought at least he would let me sign him off work for a few weeks, but no – despite all his anger and bitterness towards his career and the detriment it had caused to his life, he couldn’t quite imagine living without it. He had a fierce loyalty to his job and over the years it had taken pre-cedence over every other component of his life. You would think that, given its hold over him, John would at least be passionate and enthusiastic about his career, but when I asked him about it, he told me that as each year passed he found it increasingly hard to take any sort of joy or satisfaction from a day at work.
Normally it’s me needing to hurry along a consultation due to poor time-keeping, but on this occasion it was John who brought our consultation to a close. He needed to get back to work. I watched him from my window frantically rushing back to his car.
As he accelerated out of our car park, I could just picture him speeding recklessly the few miles across town, running past his secretary, turning on his computer and grabbing his stethoscope.
I hoped his first patient of the afternoon appreciated him and wasn’t too disgruntled about him starting his surgery 10 minutes late.
Dr Benjamin Daniels is the pseudonym of a doctor currently working for the NHS. He is author of the bestselling book Confessions of a GPand the recently released follow up, Further Confessions of a GP.