Sarah* was, in many ways, the archetypal lost sheep. Brought up by poor immigrant parents, battered by her father as a girl, she never seemed to have a chance. For years we hardly saw her, hidden, as it were, in a back room by her widowed mother. She was on drugs: heroin, cannabis, anything she could lay her hands on. Then in her thirties she vanished for a long stretch inside one of Her Majesty’s Prisons. She returned more sinister than before, dragging an air of menace through our streets. She befriended and ruthlessly exploited the other drifters and drunks of our small town.
She took to haunting the surgery, demanding drugs. She would bring her sad, battered, tattooed face up close and request diazepam, co-proxamol, tramadol. She demanded treatment for the intolerable pain in her heart. She searched in vain for a cardiologist, a respiratory specialist, for anybody who would agree to further tests. Each consultation was a game of chess; would some new referral, some harmless tablet, get her out of the consulting room before she turned violent? I often thought that might be how I would die; that she would get out her knife and kill me. Yet she was the one who died.
We never barred her from the list. She did not misbehave in the waiting room; her worst crime was once taking away a bunch of flowers. Her presence gave a message to the other patients there. All were welcome. Whatever your troubles, you could come to this surgery.
The last time I saw her, she wished me well for my retirement. A week or two later she was dead. She had died in the local hospital. The day after her death came a fax setting forth all the circumstances of that death. No hospital had done that in 30 years. Something had gone wrong in the hospital; the rank smell of a cover-up hung in the air. I spoke to the police, but they were not interested.
We mourned for her, for the lost sheep has a value for the rest of the flock. She enables the shepherd to act out, to demonstrate his sacrificial care for all. But she also sets limits to that care. For those who do not wish to share the waiting room with the world’s down-and-outs can get up and go. They are free to leave and seek care elsewhere. The shepherd does not exclude them; they exclude themselves.
Footnotes
↵* The name ‘Sarah’ is based on a composite of people and in no way based on an actual person, dead or alive.
- © British Journal of General Practice 2017