This site is intended for health professionals only

Twenty years of shared history and diagnostic blind alleys

Twenty years of shared history and diagnostic blind alleys

On the theme ‘A case I’ll never forget’, Dr St John Daly writes about a patient whose life revolved around his GP appointments

His entrance into the consulting room was accompanied by the smell of stale beer and tobacco.

‘Good morning, Mr Coates. How can I help?’

‘Doc, all my friends call me Bill. You do know I’ve got cancer, doc?’

‘You don’t have cancer, Mr Coates. We’ve done all the tests. It’s just dyspepsia.’

‘Justice Pepsia? Is that serious, doc?’

‘Dyspepsia isn’t a diagnosis, it’s a symptom. You have gastritis.’

He looked confused. Then, after a moment of consideration, he slumped back into the chair, evidently relieved. The lower few tyres of his obese abdomen jiggled against each other beneath his frayed jumper.

He grabbed my right hand, locked it between his sweaty palms and shook it vigorously. Before leaving, he slapped me on the back, bubbled his thanks and sprayed me in a fountain of saliva. Much to my annoyance, he refused to see any other doctor, and over the next two decades we were to have many such meetings.

In those early days, my heart would sink when I saw his name on my list. But over time, we grew to know each other well, and he became an integral part of my working week. I learnt to embrace my heart-sink.

There was always some new ailment. No organ system of his was unaffected nor went uninvestigated. The surgery and hospital appointments were his life. He had no family. No friends who called him Bill.

One day I called him down as usual, ‘Mr Coates to room three, please.’

He puffed his way into my room. He had come for his blood test results. I coughed and cleared my throat.

‘Ah, good morning, Mr Coates. How are you feeling today?’ He winced, looking hurt.

‘Doc, all my friends call me Bill.’ Then, the familiar refrain, ‘You do know I’ve got cancer, doc?’

He’d lost weight and looked pale and diminished. I shifted uncomfortably in my seat. My mouth was dry as I cleared my throat.

‘Mr Coates, I’m afraid it’s bad news. You do have a form of cancer. Leukaemia. A cancer of the blood. I’m so very sorry.’

I nervously awaited the inevitable recriminations over the delayed diagnosis. But none came. He looked straight at me.

‘That’s alright, doc. It’s not your fault. You see, I always knew I had cancer.’

Vindicated, he seemed almost elated. He continued, animatedly, ‘It was just a matter of time ‘til we found it, eh, doc? But you kept looking. You were always on the case. I’ll be okay, doc. You’ll see.’

He accepted his diagnosis bravely and without complaint. Now that he was justified in being ill, he endured his treatments with stoicism and fortitude. A trip to Blackpool was planned to celebrate the end of his treatments, but cancer is no respecter of people’s plans.

A few weeks later, we were meeting up again, for the last time. He had made an effort for my visit. He’d had a haircut and was wearing rather pungent aftershave. His sweaty hand reached out to greet me. I accepted it gladly.

‘Doc, it’s good to see you.’

He pointed to his emaciated body. ‘Fucking cancer, eh, doc?’

Then, ‘Doc, I have to thank you. If it wasn’t for you…’

We chatted for over half an hour, reminiscing over 20 years of shared history and diagnostic blind alleys.

Finally, he said, ‘Doc, you look tired. You must get off. I’ve taken enough of your time. Thank you, doc. Goodbye, doc.’

As I stood up, my heart sank. I looked him in the eye, smiled ruefully and said, ‘Fucking cancer, eh?’

Then, ‘Goodbye, Bill.’

Dr St John Daly is a GP in Birmingham



Please note, only GPs are permitted to add comments to articles

David Church 8 June, 2023 6:31 pm

lovely – we all have them!

Paul Burgess 8 June, 2023 6:39 pm

Yes -but I fear the young GPs won’t have that experience -because there’s barely any continuity of GP care nowadays

Anthony Daly 10 June, 2023 9:19 am

Thanks for the comments. The continuity of care aspect didn’t register with me when writing this. That’s just how things were where I worked for most of my career. Family practice felt a bit like the corner shop. Comforting and familiar but far from perfect. We think back on it wistfully but it had its problems. The past is a foreign country: they do things differently there.