The inevitability of saying goodbye

Dr Pat Harrold writes that a doctor’s life is full of dawns and departures

There comes the time when a patient will say goodbye to you or you will say goodbye to them.

I was reminded of this last week when I bade a young client of mine farewell.He was heading off to court and then to jail and was a good bit more cheerful about it than I would have been if I was going there myself. Mind you, he knew what to expect, having been banged up before and he took pains to reassure me that he would get Champion’s League football in his cell as he knew I shared his high hopes for Jurgen Klopp’s team.

We only borrow patients really. I am the current GP in Tyone, on the leafy road across from Nenagh Hospital, in a place where doctors have practised as long as anyone can remember. Being the doctor in any area is a bit like being the  Bishop of Gloucester, or the host of the Late Late Show. There will be those before you and those after you and you are only occupying the space until you hand it on, like a cosmic game of pass-the-parcel.

Medicine is full of dawns and departures; the COPD patient who is running out of options; the terminally ill; the troublesome drug addict with black clouds around him; the frequent flier; the worried parent will in their turn be replaced as you will be replaced.

There is a Karmic law that if you kick a troublesome patient off your list you will get an even worse one assigned to you in the return of serve. The rule of “The divil you know”can often apply. Though sometimes the patient [or client, or whatever they are called these days] and you just run out of road. You are sick of the sight of each other, words have been said that cannot be taken back and you are both better off with somebody else.

I have moved around more than most. It is a lot more difficult than you would expect, to say goodbye to your patients. It always amazes me how badly we get it wrong. The ones who you think cannot do without you and that you are irreplaceable in their eyes,will often be completely unmoved and will transfer onto the new doctor without fuss, hugs or even handshakes. While the one you are sure detests you and only comes into the office to argue and complain will tearfully give you cards and presents and extract promises to stay in touch.

In this as in many other things, older people are the best. I suppose they have had more practice at saying goodbye

Many an Irish person spends their working life abroad, always planning to come back when the time is right. The few who do return often find that the local doctor is the first person they will get to know well and they get into the habit of coming to the GP with every problem. So you are not only advising them about the long-term illness scheme and where to find a chiropodist, but you find yourself giving numbers of reliable plumbers and lads who will cut the grass and only the grass, thank you very much.

In recent months I have had some elderly people from Eastern Europe join the practice as they come to live with their grown up children who settled here during the Tiger years. They mime to me about how much they like Ireland and mention Skype and Facebook, while I try to translate their tablets into something the chemist might stock.

Other retired people depart to new homes to be near their grandchildren and ask can their notes be sent on before them.

An old friend and patient slipped away recently and I saw his tired face for the last time at the funeral and I shook hands with his family when I signed the death certificate, which was the last thing I will do for him.

My young friend and patient mentioned above got probation to his great surprise. A letter of mine might have had something to do with it. I will be drug testing him and scaling down his meds for months to come. I know that we will say goodbye eventually one way or another, but I have a feeling that it will end well this time.