A quiet duet of GP and patient

Sometimes when you think you have nothing to offer, when even listening seems futile, you find the words – or rather they find you

“Was it busy?” my daughter asks.

“Messy,” I say.

She knows what I mean. A morning surgery is always busy, but not always productive. At least not the task-ticking, beginning, middle, and end kind of productivity that I still cling to. 

Instead, three hours of consulting can generate so many new tasks, leading to a sense of time slipping backwards, or disappearing as each patient takes just a little – or sometimes a lot –  more than the allocated amount. So, often, half an hour in, I’m half an hour behind my desired schedule.

Messy lives, tricky software, patients turning up at the wrong time on the right day or the right time on the wrong day, unexpectedly delayed results, hospital reports heralding bad news.

Whatever else, it’s always busy, unpredictable, varied, seldom straightforward, regardless of my many years of experience.

That particular morning, Thomas – a generally agreeable, if guarded man in his mid-50s, and a relatively new patient to the practice – seemed to have saved his frustration for the GP consulting room. I imagine, banking on the usual Teflon-type tolerance of an experienced doctor, he let himself speak freely.

“You can’t say that, Doctor,” he said.

“You can’t tell me that I wasn’t being dismissed, that the doctors in the hospital wouldn’t do that.”

That was exactly what I had said when he told me about a recent experience in an outpatient clinic.

“You don’t know what goes on in people’s heads when they have cancer,” he went on.

“You don’t know what it’s like to live every day with this disease, even when they tell you it’s gone. I do. This is how it is. The fact that I had cancer never goes away. It’s there when I wake up in the morning. It’s there when I go to sleep at night. It’s there almost every minute in-between. It’s there when I feel a bit tired or nauseous or get a pain that someone else would hardly notice.

“It’s like a bad smell that sticks to me and no matter what I do: Eat well, get enough sleep, exercise, meet friends, walk the dog. I can’t get rid of it. And when you tell me that the hospital nurses and doctors would not dismiss me – when you say that refusing immunotherapy wouldn’t make them treat me any differently, after I tell you that they did – you are dismissing me too. You’re not with me when I go to the hospital and I know what I feel when I’m there.”

Thomas barely stopped for breath before continuing.

“When I was first diagnosed, it was different. Everyone was so eager to help me, couldn’t do enough, explain enough, reassure enough, encourage enough. It’s not like that anymore.”

I didn’t necessarily agree with Thomas about the motivations or commitment of the hospital doctors.

But I did agree that I had been too quick to jump to their defence and hadn’t heard him out. I hadn’t meant to be dismissive, but, as with the hospital doctors, he had perceived that I was. 

I told him I appreciated his honesty and apologised. A learning moment. We understand each other better now.  I say less and listen more and he appreciates the shift. After he left, I took a moment away from the screen. Outside the window I noticed pale pink roses spreading themselves along the wooden fence, barely visible amidst a tangled mass of briars. It was time to move on.

Later that morning, Patricia, a young mother of two, brought her baby to the surgery. Within minutes she was describing her feelings of powerlessness, caught in a relentless cycle of nappy-changing, toddler feeding, naps and no naps, tantrums and colic, day drifting into night and back to day –  often with no more than a couple of hours’ sleep.

It felt to me as if the effort of forming thoughts and transforming those thoughts into words, of firing up neurons, and creating the pathways necessary to communicate, was too much effort.

I remembered days like that and I didn’t have a solution short of taking her kids and sending her to bed.

But as sometimes happens, just when you think you have nothing to offer, when even listening seems futile, you find the words. Or rather they find you, slipping from your tongue like an oft-sung lullaby and the patient hears them too and so it begins. A quiet duet performed with elegance and grace, and the futility and frustration slip away, and without knowing why, you know that you are where you are meant to be and this is why you do what you do.

Patricia’s face relaxed, her speech slowed, and gazing at her baby as if noticing her for the first time that day, she smiled and said: “I really am blessed, Doctor.”