Dr Pat Harrold
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Dr Pat Harrold notes down his hopes and fears for the year ahead
Dr Pat Harrold reflects on the modest and quiet pleasures of an unheralded time of the year
The new abortion service is due to be ready to go in primary care by 1 January 2019, says Minister for Health Simon Harris. At the time of writing, this is about as likely as Marty Whelan and Marty Morrissey beating the O’Donovan brothers in a double sculls race, but it begs the question: Why 1 January and why primary care?
The first of January is traditionally the worst day to start anything in the Irish medical calendar.
Lonely senior house officers, who had spent New Year’s Eve in a strange town before starting their new jobs in the morning, would face into work on a bank holiday. There would be lots to do after a long break and nobody would know what was going on. It makes you wonder if Simon Harris is on speaking terms with Leo, Michael Harty, James Reilly or indeed any doctor or healthcare professional at all.
Of course, Simon may be ready to go, but if he wants a first-world, modern service in which both woman and doctor are safe, he should perhaps take his time. I know he has a head of steam built-up from all that cheering in Dublin Castle, but as the late Paddy Hillery used to say: “You don’t rush at a free and score a point; you walk up and score a goal.”
He seems determined to put the service in primary care, presumably to do it on the cheap. I know the claim is that the service should not be based in urban centres, as it will put the rural people at a disadvantage.
To claim this, after years of systematic destruction of the rural way of life, shows breathtaking cheek.
The family planning centres seem to have been completely bypassed, maybe because the HSE supposes that the GPs will just take it on and keep going.
It is another straw on a camel’s back that is well broken, and the wonder is how the camel is still plodding along.
The proposed 24-hour helpline will probably take up most of the funding, with glossy hand-outs and posters of smiling telephone advisers in Irish and English festooned throughout the health service.
I can’t really see why it should run all night. Surely even the most desperate could look up what is available online and ring in the morning, but I suppose an around-the-clock service fits the Minster’s chutzpah.
There are three visits planned and there is a lot to do; a lot of paperwork and forms and probably an ultrasound. Now,while it is simple enough to date a foetus, the medical insurance companies are loath to insure GPs to have ultrasounds at all. An ultrasonographer could do it and send the image to a radiologist, who could report back by encrypted email. Not too many rural practitioners have ultrasonographers sitting quietly in their offices. They are lucky to have a cleaner these days.
I suppose in five years’ time it will all have settled down. Some will provide the service and some will not, like coils or joint injections.
But there is the matter of the conscientious objector. A number of doctors, of as yet unknown quantity, will not even tell the woman where she can go, presumably because if they do, they will roast in hell for all eternity. If you think that a loving God will require you to face a terrified teenager, who you’ve known since childhood, to whom you gave her vaccines and saw through childhood illnesses, who looks up to you and trusts you, and tell her to her tear-stained face that not only will you not help her, but you will not even tell her where to get help and you, because of your beliefs, have determined that she should stay pregnant, then say your prayers well, because He may be equally as hard on you some day.
Many Irish pro-lifers still support Trump, even despite his deplorable sexual, financial and moral past, because he is seen as ‘anti-abortion’. Once the child is out of the womb, she can be denied healthcare, locked in a cage, shot at in the classroom and racially attacked with the blessing of the President.
Minister Harris has a lot to do with protocols, unions, insurance companies and individual conscience, and I wish him well. But he would want to get it right. The first of January was always the worst day of the year for mistakes.
The Devil’s Bit had not changed much since I was there as a lad, but the surgeon had changed in the decades since I had last met him. I was surprised that he was still alive yet here he was, striding towards me on the stony ground, an incongruous sight against the backdrop of the gold hills and blue sky of Tipperary. He had aged, but he still had the bright eye and the energetic manner that had belonged to the hardest-working surgeon in Ireland.
“There you are. If I had been any longer, you would have been late.” I was straight away back on the hospital corridors, when whatever we did was wrong, and wondering why he had summoned me to this remote place.
“Anyhow. I have been reading your hack work in the medical papers. Simple stuff. I would write myself if I had the time, and a lot better may I add, but as you worked for me once you cannot be a complete fool, so I need you to write about this.”
I looked around the stony hollow. A chilly breeze rustled the few autumn leaves on the ground.
“Write about what, Professor?”
His walking stick struck me sharply on the knee.
“Fool! I have to explain everything. Take notes.
“Today is 21 September, which is the autumn Equinox, and for as long as anyone can remember, which in my case is long, the surgeons of Ireland have gathered here at The Devil’s Bit for Gallstone Day. Do you have to gape like a jackass? Close your mouth!”
“But Professor,why here?”
I ducked as the stick whistled over my head.
“Look around you. There are none so blind as he who will not see! What are everywhere?” He threw a handful of pebbles at me, as he had once hurled surgical implements at scrub nurses. “Stones! And not just stones. Perfect replicas of gallstones, kidney stones, biliary tract calculi, sharp ones, round ones, cholesterol-looking ones, pigmented-looking pebbles, and great big whoppers like golf balls.
“I see that I have to explain, you nincompoop. Before your time, if you operated on a patient, particularly a private one, for gallstones and nothing was found, it could be damned awkward. Nobody expects to see an appendix, but you had better have a nice gallstone for the punter to take home. And if the patient’s damned insides would not oblige, then the Devil’s Bit would. You would approach the bedside, chat for a minute and then fish from your pocket a fistful of stones, or a big one and a small one, or a few small ones. It didn’t matter, as long as it tallied with what you predicted. Many a house on Taylor’s Hill and in Killiney was paid for by those boyos.”
“As soon as you passed the Fellowship and got a permanent position, you were inducted into the Tipperary Calculus Club. We would comb the hill and fill our bags with gallstones, or the next best thing.
“Then along came the ultrasound. Took the awe out of it. Our God-like prescience was no more, when any fool could count the bastards for himself on an illuminated bread bin.”
His voice grew soft. His eyes were distant.
“We were never wrong. Never! I am the last of them. They are all gone.”
He walked away, suddenly old.
“Tipp did no good this year. But it’s a young team,” said a small voice behind me.
I whirled around. A leprechaun was sitting on a rock.
“And do you know, he never even thanked me for all the stones I picked for him down the years. Not once.”
He looked at the surgeon, now small in the distance.
“I suppose we felt sorry for them, slipping about in their shiny shoes and stripey trousers, dropping their top hats and cursing like rugby players. So we decided to help them out. ‘Get me a gross of cholesterol and two of bilirubin’ and off we would go, after yellow ones and piebald ones. Leprechauns and surgeons together, on Gallstone day. Small thanks we had for it, but I suppose many a one helped those lads out and watched them take the credit. But I would say you know that yourself.”
His eyes were as shrewd as a terrier’s. You don’t hide much from a leprechaun.
It was neither this year nor the last it happened. But I sometimes wonder, on the solstice, if there are any of them still there: Surgeons, leprechauns or gallstones.
“Who will be my role model, now that my role model is gone?” These are dark days, but a children’s author and some musicians give me hope for the future. A few days ago, I spent a magical evening in the company of three pensioners — Bonny Raitt, James Taylor and Paul Simon — who have spent a lifetime on stage and are no strangers to political instability, overseas wars and the dangers of ultra-right-wing ideology. They sang poignantly of nuclear war, personal freedom and love. It was badly needed, and as welcome as rain in a drought.
These are days of miracles and wonder. Angry voices see other countries as competitors. They reduce everything to a capitalist business model, as if countries were fast-food outlets competing for passing trade. These fundamentalists cannot see, or do not care, that we are all on this dwindling planet together. The right-wing ideologues of America, Italy, Romania and Russia have no philosophy suggesting that we share resources, help each other or show humanity. The Nazarene’s vision, that all people Samaritan, immigrant or Jew are your neighbour is shouted down, probably more viciously than when He was alive.
The new god is money and cynical pastors fly in private jets while refugees are camped starving at their gates.
And yet the Harry Potter books give me hope for the future. Can one book or writer make a difference? Well, there is the precedent of the Gutenberg Bible, of Luther, Karl Marx and Mao’s little Red Book. Theoretically, one-in-15 people on the planet own a Harry Potter book, as 500 million of them have been sold. So millions of children have attended Hogwarts, battled Death Eaters and been tested by the Sorting Hat. They know a Slytherin when they see one, with their worship of despotic leaders and racial purity. They also know how to curl up with a book. They have been freed from electronic clatter as they spend time thinking and dreaming, page by delicious page. They will know how to read to their own children, passing on countless gifts of literacy and bonding.
Trump does not read books. Pope Benedict was suspicious of Harry Potter. Christian fundamentalists condemn the books, not that they have read them. It is not hard to see why they don’t like them. In the books, Harry makes the choice to fight an evil and powerful regime, which would not go down at all well with despotic institutions. The Dark Wizards are the baddies and I wondered quietly (so as not to break the train of thought of the small person I was reading to) why anyone would ally themselves with murderous bullies. Why would anyone in their right mind join with evil Lord Voldemort, who was sure to put himself first at all times? But many a person chose to follow Hitler and Stalin, Putin and Trump even before they became powerful. I suppose it is a like an abusive relationship, where you appease the bully in the hope that they will leave you alone. James Comey observed that crowds behave more stupidly than individuals ever could, and can be swayed by one person. Kaiser Wilhelm II of Germany was a leader who never read a book, but he was a petulant and ignorant ass who started arguments for no good reason and eventually manoeuvred Europe into a disastrous series of wars.
Mordor is everywhere, as Tolkien remarked. Mordor is a landscape, which has been polluted and befouled. You can see Mordor in the bend of a road when you come across a stinking factory, the fumes from a refinery or a dead stretch of water. It is felt that all those children who read Tolkien played a large part in the rise of the environmental movement. They knew Mordor when they saw it. Readers of Harry Potter will know the Dark Mark when they see it; the Dark Mark of those who promise power through cruelty, greed and selfishness.
I will always be grateful to JK Rowling for the hours and years of reading pleasure she gave my children. She donated money to libraries to keep them open, while George Bush pulled the funding to close them down, and has spent her fortune on good works. She has a big heart, her moral compass is as steady as the Rock of Cashel, and when our children read her books, they are in good hands. Read them yourself, if you haven’t done so already. We all need some magic living in these troubled times.
“Words are, in my not-so-humble opinion, our most inexhaustible source of magic.”Albus Dumbledore.
I have known many remarkable people, some of them doctors. In fact, the longer I spend in the medical world, the more I feel that doctors are in a privileged position because they are able to help others. We can be a source of good through our profession, and while most of us have an effect in our own quiet way, some are truly outstanding.
Of the exceptional doctors I have known, three in particular have influenced far more people for the good than we or they can ever know.
Dr Annraoi Finnegan,who has just retired as the National Director of the CME Small Group Network in Ireland, is one of these exceptional doctors. He has influenced every GP in Ireland and, through them, hundreds of thousands of patients.
When GPs think of the ICGP, they think of CME, which affects them all at local and national levels, and Annraoi has been captain of that ship for many years.
The small group network is a wonderful learning resource.
It is copied and envied abroad, and is seen as the perfect way to deliver scientifically-based and peer-reviewed education to just about every GP in the country. The CME tutors host meetings up and down Ireland, hundreds every week; they are a kind of ‘unseen university’ and bring learning, collegiality and resourcefulness at an extremely high and sophisticated level to every corner of the Irish GP landscape. Annraoi has personally supervised over 500 educational modules, which have spread education, wisdom and best practice to every GP in the country. He has defended and lobbied for CME through good times and bad, overseen a staggering number of tutors and group leaders, ensured standards and provided leadership, and all without losing his statesmanlike calm and sense of humour. It has been my privilege to have been a CME tutor for many years and it has been the most rewarding part of my professional life. There is a great sense of camaraderie, friendship and teamwork at its best among the tutors. He has always led us superbly and set the highest of standards. Thanks Annraoi, for the memories and the good times.
Dr Mike Ryan, like Annraoi, is a big man, a Galway grad, with great leadership skills and an original sense of fun. He works for WHO, the World Health Organisation. He is so successful at what he does, you probably have not heard of him, even though he is one of the most influential Irish doctors of his generation. He is in a field that is usually only talked about when things go wrong.
He quashed 17 Ebola outbreaks without fuss and only when he was off on a different job eradicating polio for a few years did the last breakout get out of hand.
He fights outbreaks of disease and epidemics, all day, every day with his teams from around the world. They are, as he says, the ‘fire engine’. If there is an outbreak of some disease that threatens humanity, his force arrives, empowering governments and taking over hospitals and cities. You can sleep easier knowing Mike is on watch.
Prof Geraldine McGinty is the first female President of the American Institute of Radiologists and the first Irish-born person to hold that exalted position in the 97 years since the Institute was founded.
She is also a Galway graduate and an expert on policy and health economics.
She could run a health system, or indeed a country, effortlessly, all the while maintaining her sociable personality.
This year, Geraldine is bringing her particular talents to every state and city in America, influencing policy for that vast country and, ultimately, worldwide. Every time she addresses an audience, chairs a conference or supervises research, she sets the standard for ethical and humane medicine.
The Irish medical world is small, intimate and can be friendly.
We like to think that we have high standards.
Everybody knows everybody else.
It is nice to see your friends do well and when those who know what they are talking about comment on their ability, and the great job they are doing, you feel a warm glow.
I am proud to call all of these pioneers my friends and wish them well wherever else their genius takes them. They have all left the world a better, safer place through hard work, good example, inspirational leadership and good humour.
GPs give a weary smile when they are called, usually by some well-meaning politician or consultant, the ‘gate-keepers of the health system’ (I used to see the same weary smile on Mick Lally’s face when some jovial soul would shout, ‘well, Holy God!’ at him in a Galway bar). We have heard the phrase ‘gate-keeper’ so often we are sick of it, and it is only part of what we do anyway. It is hardly flattering to be treated as a glorified bouncer when your job is so diverse and, at times, head-wreckingly complicated.
However, somebody has to keep an eye on the consultants, so if protecting specialists from themselves — like a patient and fatherly doorman — is part of our job, then so be it.
I was reminded of this a couple of years ago, when I had occasion to visit a hospital consultant myself.
I waited an hour, although there was obviously no other patient in with him. The dust lay thick on the elderly magazines which were, as I recall , The Mercedes Owner and Practical Yachting. He brusquely called me in without any apology for the wait and barked a series of questions at me.
I thought that at first it was my fault that I could feel a berserker rage rising within me, much the same as the one that must have gripped my Viking ancestors as they laid waste to Harold’s Cross (look it up if you don’t believe me). Maybe I had seen so much of that kind of superiority complex in hospitals in my youth and I was simply contaminated, and therefore unreasonably vexed. He probably loved his mother, I told myself.
As a GP, I had spent years studying consultation skills: Conscious and unconscious cues, transactional analysis, the whole Cambridge Calgary guidelines, and simple good manners, about which this poor man had no clue at all. It was like asking the chap who has come to fix the lawnmower to play a madrigal on a harpsichord, expecting him to know how to talk to a patient. The fact that I was a doctor myself was obviously of no importance. Few enough of them realise that we are GPs because we choose to be, not because we were born on the wrong side of some hospital blanket somewhere in their aristocratic fantasy world.
Anyway, does a hospital consultant need people skills? I know surgeons who are shy and inarticulate, but gifted, with brilliant brains and skilled hands. You would happily let them loose on your insides, and let’s face it, you shouldn’t need them too often and when you do, you should ideally be asleep for most of it. But if you have a chronic condition, if you are in it for the long haul, then you hope for a bit of give-and-take on the days you meet up.
Occasionally, I get an invite to a condescendingly titled ‘GP Study Day’. These consist of family doctors sitting in rows, like Mass-goers in Ireland long ago, devotedly staring up at a PowerPoint while a series of hospital consultants read off the screen. I am longing for the day somebody comes up with a ‘Consultant Study Day’ given by GPs.
There would be advice on how to talk to a patient, so they might come away knowing anything at all about what you have just said in your purest argot; how to write a letter with the important message highlighted, not buried down in the text where it is sure to be overlooked; how to avoid telling GPs to refer all sorts of simple stuff to other specialists; why we can’t email patient details on private servers; how we are all computerised and how they should be too; and why we don’t have access to the tests they have done, so don’t ask the patients to come to us looking for them.
GPs know how to talk and how to listen.
We know and love our patients, speak their language, and we hear their stories back. We hear about the rude ones, the greedy ones, and the burnt-out ones. The dictatorial consultants of my youth are getting scarce but there are still a few about who need a bit of gate-keeping. But not my consultant friends and colleagues, you understand. You’re alright. You probably have some Viking in you.
Being blessed with lots of curly hair saves me a lot on hats and umbrellas. I am now working on the gravitas. Let me explain. Having reached the age when having a social life is something to be pitied rather than celebrated, I am happy to watch gardening programmes until I become exhausted at the sight of so much hard graft that I then switch to cookery shows. I have noticed that the best presenters on garden and cookery shows are adorned with great shaggy heads of hair, like an Irish Water spaniel in his prime. Think of Monty Don. Think of Marco Pierre White.
On the BBC, Monty stands tall, his voice quiet, a lump of muck in his mighty hand as he tells you exactly what to do this week. The birds sing decorously. The dogs stretch discretely, not missing a word. The garden has become a cathedral and Monty is the bishop, quietly praising nature and its Creator. God is in his heaven, all’s right in this world and if you want to know what God is like then his personification on earth is before you. If he tells a plant to grow it will and in the right place.
Over in The Restaurant, Marco enters the restaurant to an ovation for just being his splendid self. He does not acknowledge the applause. He is only interested in the food before him. He is judge, he is jury and he is comfortable in his great knowledge. It might be a boiled egg, and it might be cooked by a legend of stage or sport, but the egg is all that matters.
Jeremy Paxton is another one. “Oh come on King’s College Cambridge!” he snaps. How did such young idiots get into college/into parliament/on television, he wonders, sometimes aloud.
The Supervet tries hard and has plenty of hair, but he is scruffy and intense and he looks like he has been up all night. Monty and the others sleep the sleep of the just and trust that tomorrow will be on time and in good order. He is also Irish.
You see, the Irish do not like to be told what to do. Hooky and Ivan Yates try, but nobody really listens to them. We just let them off. We have no time for the heavy grandfather – we prefer the fun uncle, like Ryan Tubridy or Dermot Bannon. Eamonn Andrews was a hit in Britain but we preferred the light touch of Terry and Mike Murphy, Marty Whelan and, of course, Gay Byrne who was once referred to as ‘the oldest Young Man in the business’.
They are all chatty and convivial and go easy on the gravitas. I know The Restaurant is an Irish show, but there is always a rowdy and disrespectful gang in the kitchen. Not for us the cursing Gordon Ramsay. We have Neven chatting away like an old pal over the garden wall, or the impish Francis Brennan who can insult you more painlessly than any man alive.
Jeremy Clarkson should have the gravitas factor, but he doesn’t. He is big and imposing and he has the curls, but he is peevish and he can be petty. You could see him and Boris Johnston as the kids in school who tried to be in with the ‘In Crowd’ by poking fun at other kids. They are funny all right but would you turn your back on either of them? Boris Johnston is particularly unnerving, with his Malfoy hairdo and permanent smile.
Ivan Yeats and George Hook certainly don’t have the curls and while they both have a modicum of gravitas they are more contrarian than authoritarian. Dunphy and Brady are diminutive and while they clearly have a great opinion of themselves, if not always each other, you could hardly imagine them planting an acre of spuds in a day, or even cooking some. Anyhow, they barely have a decent head of hair between them.
Simon Cowell has the hair and I would imagine that it costs him as much to maintain as Monty’s garden, but he uses his domineering character to harass teenagers who sing. Nobody has asked him to sing. He is a mere critic and not seriously worth any attention.
I am working on the gravitas. Someday my dog will lie adoringly at my feet instead of charging about yapping like Louis Walsh and when I enter a CME meeting I will get a standing ovation. I just have to watch more television.