It’s easy to be miserable at the moment. At our practice meeting last night, we made emergency plans for the coming weeks. Demand is unprecedented, appointments are like gold dust. Receptionists battle on the front line but the tsunami is coming, and its being surfed by disgruntled patients: will our defences hold firm? Most consultations now involve a clenched-teeth sideswipe at the appointment system, one lady last week threw in the threat of a PALS complaint.
But then you encounter patients who help us keep perspective. Take Steve, for instance: 53 and diagnosed with terminal pancreatic cancer. He was also the first patient I’ve helped to manage from diagnosis to death.
I met him last July when he presented with ongoing pain. Colleagues had tried for months to alleviate his symptoms with PPIs and pro-kinetics and his ultrasound was normal. Alarm bells rang when he mentioned his weight loss: two stone in as many months. A CT scan confirmed the new diagnosis.
Steve died last week in the hospice. His carcinoma had spread like wildfire through his lungs and liver.
I visited him two days before he died, barely resembling the chirpy cab driver who’d first sat opposite me. But cancer is not discerning and like its many victims, he had taken on its waxy gauntness.
Throughout his illness, though, he’d retained a firm hold on hope.
First he said he’d beat it, then he said he could live with it. Only three weeks before he died, I provided a letter detailing his meds for the airline so he could take one last family holiday to the Caribbean. I doubted he’d be able to go, and he didn’t, but none the less he had hoped he would.
The day he died, he woke from his nozinan-induced daze, smiled at his partner and said, ‘I’m going home today.’
I’d often found his optimism challenging, but surrounded by chaos, he’d held on hope. So for our sanity’s sake, let’s take occasion to step into of the eye of the storm and think of all that’s good about general practice.
Tom Gillham is a GP in Hertfordshire and Specialty Doctor in A&E. You can follow him @tjgillham.
