‘Its not what you look at that matters, it's what you see’
Henry David Thoreau.
Potato waffles and baked beans for breakfast. A touch of salt and vinegar and I have a real treat on my hands., A slightly unusual breakfast, some might say, but then again, sometimes unusual is better than usual.
Hmmmm … Delicious! Four minutes later, no more waffles. It's as though they have disappeared. Born out of the freezer, they spent their short lives in my toaster. Both of them. I wonder if they chatted, I wonder if that's the way they had planned their life. Salt and vinegar had rained upon them. And then that was it: my molars came crashing down, and it was the end: they had died. My stomach gives a quick rumble … Maybe they're not dead after all …
It's not what you look at that matters, say wise people, it's what you see.
In any case, my shift starts at 8 am, and it's already a quarter to. I'd better get going.
First patient this morning doesn't even have a name: ‘Baby Harold’ it says on my screen. Only a week since it switched from ‘that other world’, to ours. Proud mum and dad can't decide which of them should hold him:
‘Just been a bit snuffly, doc’, says dad. And yes, they're first time parents.
‘I know it's nothing really, but I just wanted to get him checked out’.
‘Yeah, I know.’ I reply. Because, I know.
It had happened, you see, on 14 July 1979.
My list is starting to build up, better call in the next one.
Six-year-old Tim, crying as soon as he sees me. I think it's the way I do my hair:
‘Don't worry, little man’, I reassure. Although, of course, I fail to reassure. He's having none of this reassurance nonsense.
Dad had taken me to the dentist … floods of tears. At least I had held out until the dentist had taken out his tools. Pashtun men don't cry, and a Pashtun man's son will himself become a man as soon as he is out of nappies. Father was not impressed. I call in the next one.
Fourteen-year-old Ahmed. His nose is hurting. Had a fight, he says. Not broken, but still painful:
‘I beat him up though’. Hmm … tough guy.
‘I think ENT should have a look at this, it's a little too painful for my liking’
‘Is it gonna be ok, doc’?
Ahmed's scared. It's not what you look at that matters, say wise people, it's what you see.
My friend Steve was being bullied in school, so I decided to intervene. My heroics proved unrewarded however. Embroiled in a losing battle, I turned around to look for Steve; the only thing I could see was his back. Treachery. Uh-oh. Trouble. I call in the next one.
Twenty-one year old Jim:
‘These spots are really annoying doc. I'm not even a teenager anymore, and I thought these were teenage spots’. They are teenage spots; they must be on the wrong body …
‘Well, young man, I can either give you just the antibiotic lotion, or the combination one’.
A good bit of negotiation of management. I am impressed with me. Jim's studying pharmacy.
We were all revising for pharmacology in second year medical school, looking through past paper questions. I'll never forget question 4: ‘Aspirin. Discuss’ …
Thirty-five-year old Jack is next; him and his wife will be travelling away. Which jabs will they need, and when? I'm going to have to double check that.
Marriage, how beautiful. I have often wondered what my wife to be is doing right now.
Forty-five-year old Ed, a newly diagnosed hypertensive comes now for a repeat blood pressure check. It's fine, and so are his home readings. We've had to check his kidney function as I had started an ACE inhibitor, and that too is fine. Ed is starting a business. He works as a driving instructor, but wants to branch out.
A change is as good as a rest, they say. I don't expect I'll be doing this all my life. Who knows what the future holds, who knows what tomorrow holds?
‘Bye, Ed.’ I say. ‘And I hope it goes well for you’. Who knows what tomorrow holds?
Fifty-nine-year old Mr Green. Slightly overweight. He's wearing a grey cardigan, and is late, again:
‘My memory's not what it used to be, doc.’
That's since his wife died, I guess. Now he lives alone. Although he still smiles. He refuses to take antidepressants, doesn't ‘believe in them’:
‘You've gotta keep yourself busy, haven't you Doc’.
‘But I do miss her though …. I do miss her.’ And he does miss her.
I guess we really can't change the cards we're dealt, only the way we play the hand.
‘When am I gonna get my new walking stick?’, says 74-year-old Mr Hendry.
‘Good morning to you, young man,’ I reply. They always appreciate that.
‘Have you not heard anything from them then?’
‘No, I bloody ‘aven't’, he replies after a few utterances of the word ‘pardon’ while he adjusted his hearing aid.
‘Well, I'm going to get on the case right away ok’, as I start typing the letter.
‘You do that’, he replies, still with a hint of anger.
‘Bloody nuisance.’ He continues, as he turns away.
I smile.
Eighty-six-year old Mr Farooq can only enter the surgery with the assistance of his family. One son holding his right arm, the other his left. He's just returned from Pakistan. He looks deeply jaundiced:
‘He's been unwell for the past few weeks, doc’
‘How?’
‘Just off his food, staying in bed, not really talking’, as they lift the being who was the source of them onto the examining couch.
‘Has he lost any weight?’
‘Yeah, loads’.
As I examine him, even my non-surgical hands detect a large right-sided abdominal mass. His deep jaundice has worked its way through even his dark skin.
‘He's going to have to go in,’ I explain to one of his sons. And I speak with the on call team.
His sons look as though they know. It's just that look in their eyes; that vague space between wanting and avoiding eye contact. They look as though they know.
Mr Farooq leaves the room, supported by his sons, and sadly, I turn from the view of the empty waiting room, back toward my desk, as I watch them leave the building.
I move slowly towards the wash basin, to clean my hands before attending to my home visits, as I do catching a glimpse of my self in the mirror.
It's not what you look at that matters, say the wise people, it's what you see.
- © British Journal of General Practice 2012