Punishment from the gods

Pulse's brilliantly surreal blog 'Through the K hole' offers a nightmarish vision of a day in general practice

He opened his doctor's bag, took out his instruments and got himself ready for his morning surgery. There were eighteen patients on his list and two were already in the waiting room, an ominous sign.

His first patient was a middle aged gentleman. He was long and gaunt with a tubular bicycle frame of a body. He wore a distinctive hat and a thin, knee length coat which he languidly removed and draped over the back of his chair like an animal skin.

As he spoke he anxiously thumbed the felt rim of his hat and his speech was faltering, sinewy and reflective. The doctor noticed his tight, thin lips and his shirt which had small, white collars buttoned up, as if by a concerned Auntie, right to the top. He had all the physical characteristics of an out-of-town mail sorter or a brooding office clerk.

He pointed to his face. There was some mild flaking from a perioral dermatitis and a faint web of telangiectasia which had been worrying him. The doctor prescribed him some cream and invited him back if it was no better. The patient slipped un-noticed out of the room and the GP turned his attention back to the computer.

The rest of the morning was a chaotic blur. There were hospital admissions and walk-ins, admin, insurance notes, sick lines and blood results, meetings and staffing issues. There were frustrations, difficult hospital colleagues and angry outbursts and through it all, drumming out the rhythm of the day like a heartbeat, was a rich seam of patients who blurred into one. They formed an unidentifiable line of the worried well who passed through his stream of consciousness like passengers on a commuter train. The afternoon was no better and a further eighteen patients and three telephone requests were heaped on to his funeral pyre of a day.

The doctor was also working extended hours which meant opening up appointments for workers who were too healthy and too busy to make a normal day time appointment.

His last patient came at eight that evening, a full twelve hours after he had started consulting. He looked strangely familiar but bland, and instantly forgettable. The doctor had seen too many patients that day to really care, this was just another problem, hopefully another quick consultation that could be ended with a paper handshake.

The patient was ethereal and gangling, long and underweight with a worried, gaunt face. As he slowly shrugged off his beige overcoat he seemed bleached of colour and through the pale rims of his eyes he was devoid of life's vigour. He pointed to his face. It was a simple case of perioral dermatitis with a faint tracing of telangiectasia.

The doctor would also be on overnight call, a new stunt designed to make him more politically palatable to the general public. That night he slept uneasily, one eye on the clock which thickly ticked out the time.

He was a limp cadaver, his flesh tugged at by Westminster vultures.

He dreamt of a strange dermatitic landscape full of cold slate, scree and windswept scrubland. The sky was bruised with purple clouds and fat drops of rain fell and burst onto the rocks around him. He was wearing a dark cloak and he found himself leading a patient to safety across the barren, unforgiving terrain.

They approached a tor, a rocky outcrop smoothed over by the weather and cracked through with tree roots. The patient that he was helping to navigate through the sharp rocks wore a distinctive hat and had slender, pale limbs. He was at once towering and statuesque and yet at the same time there was something deeply naive and grotesquely child-like about him. His features were distorted and his face with its soft, flaking skin was elongated and stretched out, his mouth a calligraphy stroke of dissatisfaction.

They climbed together, hand in hand, but the GP found himself pulling his companion up the slope and became sweaty and breathless with the work.

They finally reached the top, the doctor's legs were weak and trembling. He wanted to rest but his companion, who had hardly expended any of his energy, wanted to press on. To the doctor's horror, from this high vantage point he could see an interminable ocean of hillocks and cliff faces laid out before them that would also have to be climbed. The only reward for safely navigating his patient to the heights was to descend to the depths and to start all over again.

At 3am the phone rang and thankfully sliced through the gossamer screen of his disturbing night's sleep. On the line was a reedy hesitant voice which explained that in the middle of the night he had looked into his smeary bathroom mirror and had seen a rash on his face that was concerning him. Could the doctor come and have a look?

As the GP, for political reasons, left the warmth and safety of his home, the dream began to formulate itself, to become more coherent. On his way to the patient's house he began to accept that he must have been punished by the political gods and had been cursed to an eternity of frustration.

He would have to lead his patients up the hill, hand in hand, only to watch them descend again. He would have to repeat this process over and over, day after day, night after night on-call. With a growing dread he realised he had been condemned to an interminable Sisphyean fate. The heavy boulder of antiquity had been replaced with the demanding patient of modernity.

Dr Kevin Hinkley is a GP in Aberdeen.