On the theme ‘A case I’ll never forget’, Dr Toni Munno writes about the importance of supporting both the medical and non-medical needs of patients
He spreads his hand across his chest, grips his shirt and tugs. ‘This is where the food sticks,’ he says. His hand is now a fist, and he tugs again. ‘Just here.’
He leans forward, rests his elbows on my desk and cradles his head in both hands as if the weight is too much.
‘How long?’ I ask.
‘A few months.’ He rocks his head from palm to palm. ‘I’ve not had time,’ he says. ‘I had to look after my wife.’
He is new to the practice having just moved to the area. I can see from his record he lives alone.
‘She had breast cancer. I was looking after her at home. She died.’
Silence, like the heavy air before a storm.
His head drops to his chest, and he sinks into the chair. He looks small and scared; in my mind I see him shrink and shrivel to the size of a nut or a pebble.
‘I just want to be with her.’
I want to ask him about weight loss, and appetite, and pain. I want to feel his abdomen; I want to send him for bloods and sort out a two-week rule referral.
Instead: ‘Tell me about your wife.’
‘We were together for 42 years.’ He looks up and meets my gaze for the first time. His eyes are sky blue, set deep in the sharp shadows of his angular face.
‘We were at school together, she fancied me, but I never knew it until when we met again a couple of years later.’
His fingers trace white stubble from his neck to his chin; his back straightens in the chair.
‘She was a real catch. So beautiful. Right until the end.’
He is looking my way, but it’s not me he sees.
My medical history is in there, one part of his story, the thread that ends as a line of text in his record: worsening dysphagia, refer for urgent endoscopy, recently bereaved. The line that sets the actions, the progression from history to investigation to treatment.
But his needs are more than that. Keep listening. Embrace the rest of the story – the heavy path of love, life, and death – because on that journey of medical intervention he will need someone to walk with him, and he has chosen me as his witness.
Dr Toni Munno is a GP in Bedford