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Gratification delayed by a generation – the reward of continuity

Gratification delayed by a generation – the reward of continuity

Coming in third place in Pulse’s writing competition, Dr David Salkin’s entry on the theme ‘A case I’ll never forget’ explores the reward of having a long-standing relationship with patients

A call interrupted a busy evening surgery – a mum describing her four-month-old’s rash.

‘It’s definitely NOT meningitis,’ she asserted.

I asked about the glass test, but it was mum’s insistence, her blind confidence, that troubled me. So I asked her to bring the baby in anyway.

When she arrived my heart sank as I saw an almost lifeless grey infant, whimpering pitifully.

There are few moments like that in general practice, and everything seemed to happen in slow motion. All I really recall from that evening, as I injected the benzylpenicillin, was the port-wine stain on the baby’s neck, a benign island surrounded by sharks of petechiae swimming around the infant’s body with malign intent.

In those days, an emergency ambulance request resulted in just that. And unlike my only other experience
of this deadly disease, the correspondence I got a week later was a discharge letter, not a postmortem report.

‘Meningococcal meningitis, baby fully recovered.’ I waited for – indeed expected – the plaudits. And I waited. Nothing. No flowers from the family, not so much as a card. No words of admiration from the paediatrician.

So I confided in a senior colleague.

‘Your reward,’ she said gently, ‘is the good you do for others, not the good others do for you.’ Sensing my
frustration, she added: ’It’s a vocation, not a vacation.’

I wasn’t convinced, but was able to suppress my disappointment enough to deliver general practice for a further 18 years, until a Monday afternoon clinic in the middle of a red-hot summer. I hadn’t realised, but my most memorable consultation was in fact in two parts, and I was just about to experience the second.

As I started the postnatal check, I saw the port-wine stain on the mother’s neck. Instantly recognisable, albeit much larger than when I’d last seen it, and surrounded by healthy skin. I looked down at the baby boy, sensing pride, continuity, almost – dare I confess – attachment.

The baby, I was informed, had been named after a singer who was pivotal to mum’s life and without whom she doubted she would even be here.

I had to confess I’d never heard of said famous singer, but said naming her baby after such an important person in her life was absolutely a meaningful thing to do.

As I did the routine – Moro, red reflexes, hips and the rest – I sensed the owner of the port-wine stain, and meningitis survivor, looked a bit down.

‘How are you coping as a new mum,’ I enquired, with the sensitivity of, say, a grandparent.

‘It’s really unrewarding,’ she replied. ‘So much work, so much responsibility, and so very little in return.’

I passed back the baby tenderly and said: ‘What matters is the good you do as a mum, rather than the good you receive.’

And as she left I wondered if, one day, she’d discover what I had really meant.

Dr David Salkin is a GP in Leicester



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David Mummery 1 May, 2023 2:46 pm

Wow David – so moving ! Many congratulations!