Working with people

I walk down the ill-lit corridor, past the stale-smelling kitchen, towards my room. It is time for my afternoon surgery. I place my post-prandial cup of coffee next to the computer and log myself on to the system. As the computer slowly inches back to life, I glance at my watch. I will be seeing patients for the next three hours and, during my last hour of unpaid work, I shall enjoy some alone time with my paperwork. I try not to let this cloud my mood.

My first patient is a rotund middle-aged Bangladeshi man. 
"Hello! What can I do for you today?" I say, in the friendly customer-service voice that I have been taught by medical school.
"Nuffink, I don't think," he says while chewing gum. 
I can see the masticated product move around his mouth. I try not to gag. Instead, I nod sympathetically and ask, "What makes you say that?"
"It's because you doctahs don't care, innit. All you do is throw pills at me or send me to that bimbo psychologist. Wassah mattah wiv you lot anyways?"
"I'm sorry to hear that you feel that way," I say, the mechanical response sliding off my tongue glibly.
"Are yah? Are yah tho'?"
"How can I help today?"
"Put my diazepam back up to where it was, innit. That cocksuckah Harland, excuse mah French, he took it right down last week. Why you lot wanna make me feel this way, man?"
We didn't give you the anxiety, I think. That's your genes and your environment. I consider explaining that sentiment to this irate patient and instead opt for a thoughtful nod. That makes the customer feel acknowledged.
"I'm afraid I cannot make that decision without speaking with Dr. Harland first. We always advise that patients go to the same doctor where possible. It ensures continuity..."
"Not gonna go to that prick evah again."
"I'm sorry you feel this way," I repeat. I don't bother with the thoughtful nod this time. 
"Give me my pills, man. Seriously, yo, this ain't funny."
"I'm afraid I have to speak with Dr. Har..."
"Don't mention that prick's name again, alright," he interrupts. 
I finally give in to my rising irritation. "I think it might be best if you let me finish what I am saying as it is counter-productive for us to be going around in circles in this manner," I say, feeling a little guilty about the smugness I derive from knowing that he probably does not know what counter-productive means. I know that I am trying to emphasise that I am better-educated and therefore know better than him. The rational doctor in me realises the flaws in this logic, the compassionate doctor in me knows that this is cruel but the irritable doctor in me just wants to be left alone. 

My strategy half-works. As he processes what I have said slowly (I can almost see the cogs turning in his brain), I return to my computer screen and pointedly ignore him as I type up the consultation.
"If you would prefer for somebody other than Dr. Harland to act as your GP, that can be arranged. I am happy to see you regularly, " I say. My guilty conscience has forced these words out of my mouth.  "I will arrange to see you in two days' time. That will allow me to catch up with Dr. Harland and come up with a plan. How does that sound?" I say, in a business-like tone. 
"Alright then, see yah later," he says, as he shuffles out of my room. I almost wish I had made some perfunctory small-talk before he had left. I could have left things in a better place with him for next time. It would have only made my surgery run twenty two minutes late compared to twenty. 

My next patient is an older Muslim gentleman wearing a maroon fez.
"Salaam aalaikkum, sir" I say, hoping that I haven't butchered the pronunciation.
"Waalaikkum salaam, doctor," he says, all smiles. I feel the tension in my shoulders relax. 
"How can I help today?"
"I was given this, what you call it, antibiotic for a foot infection."
"Do you know what it was called?"
"No, no. Terbie-something."
"Terbinafine?" I ask as I check the system.
"Yeah, yeah. Why they not working?"
"I see. How long have you taken them for, sir?
"One day."
"One day? How many doses did you take?"
"One dose but it didn't help. Last time this happened, I have a long bath. I think that is why this happen, no?"
"There is no reason to believe that the bath caused the infecton, sir. I would advise that you try finishing a course of the tablets. Perhaps I can arrange to see you in a week's time?"
"But my foot really hurts, no? Why this infection like this?"
"I think the tablets will get rid of the infection if you take the full course and give them time to work. Have you tried anything for the pain? Paracetamol?"
"No, doctor. You know, I don't like taking these pills..."
"I'm afraid I don't know what else to suggest for the pain, sir, unfortunately. I'm in the pill-prescribing business, I'm afraid." 
"No, no, I understand. Modern medicine can't cure eveything, ha?"
"Not without the pills, no..." I try to smile so I don't seem too caustic.
"Of course, of course...Are you married?" he asks, as I continue typing.
"Yes. One year ago." I smile.
"Wonderful, wonderful. Family very important for a woman, no? You have any children?"
My smile has become fixed at the sexist comment but I try not to show it. 
"Not yet, sir. Hopefully soon."
"Women need children, no? All this running around, no good. Children make everything good."
"Hmm, hmm, yes," I say, the tension in my shoulders returning. I bid him adieu with a glassy smile, a goal that I did not achieve with my first patient. 

The third patient is a teenage girl who is 'tired all the time' but baulks at the mention of blood tests and flees for her life. I try not to feel pleased with this outcome. After that, I deal with some routine requests for repeat prescriptions while making chit-chat. The clock ticks on and my mood improves. 

The last patient for the afternoon is a thin bespectacled lady who manages to suggest a highly-strung personality before even opening her mouth. She has been suffering from fatigue recently and a routine set of blood tests have been ordered.
"My blood tests have just come back and, apparently, my Sodium levels are low," she says, her wide eyes peering at me through her spectacles. 
"The value is 134," I say, pulling up the results on my screen.
"What does that mean?" she says, as her hands fidget in her lap incessantly.
"The normal range is 135-145. So it is slightly low. This may have just been an aberrant reading. It would be worth repeating the test before jumping to any conclusions."
"But what does it mean?"
"A low Sodium level can be the result of a number of medical conditions. In order to find out, I will have to perform a thorough assessment."
"But don't you know why it is low?"
"It can be low in a number of conditions." I then answer her question with more details, forced to draw a flow-chart with all the possible diagnoses.
"I've got heart failure?"
"No, I did not say that, " I say, trying to be emphatic without being brusque. "It is important to repeat and confirm the test before we discuss this further. Let's not put the cart before the horse."
"What about my past blood results?"
I draw up some results that were done a few years ago.
"So it was low in June 2001?"
"Yes, but all the other results have been normal."
She pulls out a diary and starts copying the results down. "I will chart it as a graph at home."
"I can do that for you," I say and offer to print her a copy of the results and graph.
"131, 134, 143, 145...Oh! It was high in February 2003. Why was this never discussed with me?" 
How am I supposed to explain why the test was a little high five years ago?
"I'm not sure why that was the case. Anyway, it is best if we focus on the present and repeat the test now. It would be ideal if you saw the doctor who ordered the test. She possibly has a better idea of your medical history."
"Another blood test? I hate those things..."
"I know," I nod sympathetically. Again.
"I feel like I need to keep tabs on everything because, you know, I know so many people who have been the victims of poor medical care." With this parting shot, she leaves.

I lean back in my chair and reflect on that comment. How long will it be before I see myself as I am seen by my patients? Inadequate...the word resounds in my head. I am responsible for treating their diseases; if they are ill, it is my responsibility to fix it and, therefore, it seems that if their health is poor, it is because either me or my pills are not working. I feel my sense of frustration rise. 

The door opens. Tracy, the practice manager, has brought me a complaint.
"You're not very good at this, are you?" she laughs. 
I feel instantly annoyed. I had to jump through so many hoops to finish my training, I want to scream. Where would you people be without us intelligent martyrs? Where did all the respect go?

Apparently, the complaint is the result of a patient not having had her call returned yesterday. Instead of attending to her call, I had spent the entire afternoon trying to find a private bed for a patient who desperately needed to be admitted but refused to occupy an NHS bed. The image of Atlas burdened with the world flashes through my mind. I shrug.

"I will write her a letter of apology," I say, staring at my computer screen and refusing to acknowledge Tracy's presence. She eventually leaves. Part of me wishes they would all leave. I start typing my letter, trying to fight an overwhelming sense of fatigue. Perhaps I need to have some blood tests done.

Someone knocks at the door. This is it, I think. Tracy is getting punched and I am setting fire to my distinguished career as human punchbag a.k.a. general practitioner. 
The door opens and a little old lady with snowy white hair enters. 
"I'm so sorry, I thought I was finished for the day," I say, flushing. I cannot seem to do a single thing right today.
"That's okay, dear. You look exhausted. You should be heading home," she says. I look up, surprised. I cannot remember the last time anybody has started a consultation by considering my well-being. 
"It's okay. I'll go home soon," I say, smiling, naturally this time.
"It's only a prescription, dear. I probably shouldn't be bothering you at this time."
"Oh, of course you should. This is my job," I say.
"And do you like it, dear?" she asks, her eyes twinkling.
I gaze back at her. I feel her kindness radiating across the room to envelope me and a lump begins to grow at the back of my throat. The people really do make this job. 
"Yeah..." I manage to choke the words out. "Yeah, I do."