‘My nose is dripping,’ he says, seating his slim frame on the plastic chair.
‘Fill that,’ I say, handing him a bucket. ‘Then I can get it checked, rule out TB: that sort of thing.’
But he knows about Time As A Diagnostic Tool. ‘Don't fob me off,’ he protests. ‘It'll take me months to fill that! Anyway, my wife says I snore like a walrus.’
‘Too much oily fish then?’ I venture, trying to picture Mrs Walrus.
‘No,’ he answers irritably, not getting the joke at all. ‘It's polyps. I've had six operations for them already and this time they're worse than they've ever been.’
‘What do you do?’ I ask suspiciously, pleased to ease in some Social History so early in the piece. Perhaps he is a rape seed salesman?
‘I'm an Agent of Reform,’ he answers, leaning forwards conspiratorially so that droplets fall uncomfortably close to my trousered knee. Polyps ooze forwards from his nostrils like some alien trying to burst out. I recall an old black-and-white Quatermass film and colour in the green bits myself.
To my relief, he sits back. ‘I have worked for the FHSA, the health authority, the PCG, PCT, the amalgamated PCT, and am currently waiting till what comes next stays still for long enough that I can jump on board that too.’
‘Oh!’ I exclaim. Although I knew that in the last 15 years no organisation above practice level had remained for as long as 3 years, I am surprised by his boldness.
‘We Agents of Reform must be willing continually to be reformed ourselves in order to prove we are the rightful agents of disorder to those lower down the food chain than ourselves,’ he adds helpfully.
There is a sea-calm pause. Like a lone herring, I swim uncertainly across his gaze.
‘So?’ he says, his eyebrows raised like facial flippers.
‘Well,’ I sigh, ‘you are an outlier, a budget-breaker We are currently trying to reduce our ENT referrals — targets, you understand …’
He gets my drift but won't be beaten too easily. ‘This is the era of Choice,’ he points out. ‘I helped waste millions on an ocean of leaflets …’
‘New government!’ I reply, trying to keep the triumphalism out of my voice.
‘I'm prepared to wait.’
‘Ah, so you know waiting lists are back?’ I shake my head. ‘No good though, it'd still count.’
‘I'll complain if you won't help at all!’ He means it too. I can tell he'd Put It In Writing.
‘Alright!’ I concede. ‘There is no need to panic — you can buy a nasal spray that will help.’
‘I couldn't insert the nozzle.’ And he demonstrates this horribly, with my pen.
I hold out my hands in impotent apology. ‘It'll have to be oral steroids then. Big doses.’
‘I thought as much,’ he answers acceptingly, popping the pen back in my palms. ‘They're not subject to targets or budgets, being cheap and plentiful.’
It is a few months later when he returns.
He waddles in breathlessly, a fleshy catalogue of side effects.
‘The polyps are much better!’ he says cheerfully, almost missing the plastic chair as he crosses the room. ‘My vision's shocking though. Gone right down since I've been on these pills.’
‘Cataracts,’ I explain, easing the grip on my pen.
‘Will you do anything about those?’ he asks cautiously. ‘I'm prepared to wait.’
‘No need!’ I exclaim. ‘There's a special target on that for diabetics!’
- © British Journal of General Practice 2011
