Memories of my first tentative forays into medicine linger with a startling freshness. The patient’s faces may be hazy, but many of their names and snippets of our conversations remain immaculately preserved, read-only files that even a subsequent decade’s worth of experiences have been unable to overwrite.
I learned a lot in those early weeks and months: communication and teamwork; time management; how to prioritise tasks; management of medical emergencies. Working on a respiratory ward through the winter months, I witnessed and tried to support countless dying patients and their grief-stricken families. It was the steepest learning curve of my career.
Patients taught me vital lessons on a daily basis, but no encounter from that era impacted on my practice quite like my second case in primary care.
His name was Ron. A warm and engaging Yorkshireman, he was less interested in his red flag symptoms than he was in welcoming me to the area.
It was immediately apparent that something serious was going on. I’d broken bad news before in hospital, but only with the benefit of test results and support of senior colleagues to back me up. Ron, who had entered the room beaming, was to leave subdued. A two-week wait referral confirmed our fears: he had metastatic oesophageal cancer.
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For six months I followed Ron’s journey through the system, from the upper GI clinic through oncology and on into the domain of palliative care. I saw him frequently at the surgery and latterly, as his condition deteriorated, at his home. I shared a cup of tea with him on his patio as we talked frankly about his grim prognosis and administered subcutaneous midazolam in his bedroom as the inevitable end approached.
I can vividly recall my trainer warning me that I’d never have the time later in my career to support dying patients in the way I’d supported Ron. The fact that he was right remains a source of great frustration.
Thankfully the lessons Ron taught me remain equally vivid. Our shared experience inspires me to make the most of the time I am able to devote to the dying and their families.
Dr David Coleman is a GP in Conisbrough, South Yorkshire