The cat scarpers. The door opens. As I enter I'm thinking: is she ready to talk yet about dying? My palliative care pocket-book is warm in my pocket.
‘Hi!’ I greet her cheerfully. ‘How are you getting on?’ Nice open question and all that. I spot the abandoned high-energy drink congealing beside her but quickly avert my gaze from there.
‘Much better thanks!’ She looks grey but I focus on her eyes. ‘Dr Daisy was lovely.’
And sometime around now a heavy feeling fills my guts. I slump on the end of her bed and daydream…
‘Now then Mrs Wiggins,’ I imagine Dr Daisy greets her. ‘How are you managing with your catastrophic cancer?’
‘Cancer?’ Mrs Wiggins shrieks, not even yet seated. ‘My doctor at home told me it was only growths.’
‘Well yes – yes, that is true,’ Dr Daisy hurriedly answers, her smile still fixed warmly at the edges of her mouth, ‘but those growths are growing growths rather than not-growing growths.’
Mrs Wiggins looks uncertain now. She hovers beside the chair as though to move those last few inches and sit on it might expose her to mortal danger.
‘So,’ she stutters after a pause, ‘it is growths after all then?’
Dr Daisy still beams warmly up at her patient. She is a picture of sympathetic and comforting professionalism. There is no outward sign that she has absorbed her patient’s need for a distinction to be made explicit but she has. ‘Sorry,’ she apologises smoothly, ‘I did not start off very clearly did I?’
‘Perhaps I just didn’t hear you right..?’
‘No,’ Dr Daisy confirms with conviction. ‘My fault. Now then – do sit down.’ There is a pause as Mrs Wiggins finally takes the plunge. Air is expelled from the wipe-clean seat cushion like breath no longer being held. ‘Your doctor has found growths and sent you to me so I can shrink them,’ Dr Daisy carefully states.
‘Oh,’ says Mrs Wiggins with relief, her pale face and shrunken cheeks catching shadows as she lowers them momentarily. She looks up again shortly after, mentally re-gathered. ‘I’ve been ever so worried you might say there is nothing that can be done.’
Dr Daisy nods towards the door. Standing there quietly until now, a nurse comes forward and places a soothing arm around the bony shoulders of this once large woman. The nurse says nothing, just looks encouragingly into the patient’s rheumy eyes.
‘So what will it be?’ Mrs Wiggins eventually asks, looking from the nurse, whose cheek almost touches hers, to Dr Daisy. Dr Daisy’s tender smirk plays across her face, undimmed. ‘Five cycles of chemo plus some radiotherapy afterwards.’
‘Thank goodness!’ Mrs Wiggins’ relief is complete. ‘I have friends who have had those. They told me to be strong because you would let me try them.’
For the first time, Dr Daisy is not smiling. ‘You do understand,’ she says. ‘That shrinking those growths in this way will make you feel peaky?’
‘Yes, doctor, I have some vitamin pills ready to help me through that.’
‘Good. Excellent. Well, you are free to go now. We will be in touch soon to get you started.’
‘I hope you don’t mind me asking: have you any idea how long that might be?’
Dr Daisy glances at the nurse who is back by the door. She motions with a thumbs down. ‘Four weeks I think. About then anyway.’
‘Oh,’ says Mrs Wiggins, sounding a little disappointed. ‘What will the growths do in the meantime?’
‘They’ll be okay,’ Dr Daisy urges as the nurse opens the door and ushers the patient towards it.
‘Last thing!’ Dr Daisy has looked back from her computer now.
Mrs Wiggins is at the door: she pauses and turns too, the nurse’s hand on her arm.
‘Yes?’ she asks.
‘My letter. I’ll say you know the score and just stick to the positives. Okay?’
…‘Doctor?’ Mrs Wiggins is asking.
‘Oh yes, sorry, I was just thinking,’ I say hurriedly, a little embarrassed to have drifted off during a consultation like this.
‘Anyway,’ I say, ‘yes, feeding you up will help you cope with the treatment better.’
- © British Journal of General Practice, 2010.
