He had an agenda, he wanted others who read the story of his day to see the joy and satisfaction that can be derived from a life in General Practice, through the passage of 24 hours in his life he wanted to inspire and sustain, to draw in new people and affirm those who had chosen this life.
He knew this to be an impossible task, every day has it’s pleasure and it’s pain, there would be nothing believable about a perfect day in General Practice, just as no-one would accept that driving a train or being an astronaut was a daily round of bountiful excitement.
But he had been asked to write his story. One day in his life, “in detail” she had said, everything.
3.00am
He woke, not in his usual state – bladder full – but this time hunted by a giant silver ball in his head – anxious about the task ahead.
The French philosopher Montaigne wrote, amongst his serious contemplations of the mysteries of life, a detailed account of his thoughts and actions, of his nagging wife, of his bowel habits and boredom, surely she did not want that detail ?
Maybe more like Samuel Pepys’ reports of his appointments and visits to important people sometimes distressingly bland of detail. But even he spattered the texts with a love of the theatre and ‘pretty things’, being caught in flagrante delicto and heavy drinking – would she want to know everything..really ?
Solzhenitsyn’s Ivan Denisovitch had also woken feeling sick on his day. A day in the gulag had more than a fair share of pain, but by the end of it even there, he had found satisfaction, even pleasure; in his fellow man, and in finding the necessities of life.
Perhaps it would not be so hard, to inspire and sustain, inform and entertain with the tale of a day in the life of a rural GP.
4.00am.
He checked his emails..six..none for Viagra or penis enlargement – the spam filter was working well .. one from a patient telling him about the latest specialist appointment and the surprise offer of further shoulder surgery.
He read between the lines. This man was telling him off, he should have been prepared, the months of waiting, the physio, the pain and suffering had been wasted, he could have been fixed so much sooner if only his GP had been a better diagnostician and decided to refer him sooner.
Shuffling off self-recrimination, he replied all “jolly hockey sticks”, it never paid to read between the lines of an e-mail, face value communications at best – the modern equivalent of tipping one’s cap from a passing carriage “hale fellow – well met.” At least the mail would show he was doing this in the early hours.
Another .. a paper had been rejected from another journal – this work was supposed to be fun. That weekend it had been – talking to the practice nurse conference “From Maids to Masters” about standing orders. He had left in all the jokes and taken out all the graphs, a good move given that they had put him on first thing Sunday morning after “the Maids” had had a heavy conference dinner and danced all night.
He believed standing orders would help expand patient services and could help practice team development, it was important to spread the word, enthuse people and provide good tools for their use.
His brother in law was researching a cure for AIDS and TB in Kenya – he tried not to live a comparative life, but it was hard sometimes.
The dog needed walking, an hour’s stroll along the beach whilst the sun rose, listening to his iPod. His playlist compiled as he “walkied” a rather ambitious blend of Hamish and Andy – two loveable Ozzie lads – BBC Friday Night Comedy, Scientific American and The Archers – an ancient UK radio soap opera about the lives of people in the small fictional town of Ambridge – the local stately home estate is planning a horse race, scandal !
Podcasting was his entertainment life, iTunes fired up whenever his computer booted and updated each of his 51 chosen programmes. These self selected radio shows and educational broadcasts made up his listening diet whenever he was alone. He wore huge hearing protectors over his ear pieces whilst he mowed the lawns, so the noise of the machine did not drown out the “Best of Today” or “Health Matters.” NASA, National Geographic, TED talks and New Yorker Cartoons entertained him in waiting rooms, on flights and in the bath.
Reading was confined to bedtime Harry Potter with his daughter – the final book, the final chapters, the final daughter, a whole lifetime of bath, books, bed.
During breaks in work he would dip into BPAC, NZ Doctor, Obs and Gynae Journal, JPHC and NZMJ and BJGP- but probably not enough.
7.00 am
Home for breakfast, he woke the wife with a coffee, showered and the frantic school preparation began- lunches to make, teeth to brush, clothes to find and shake free of yesterday’s mud – for his daughter not himself – cheque in an envelope – whatever happened to state funded education?
Mobile coffee made, he bundled off to work, a 25 minute drive with Garrison Keillor reciting poems over the car stereo.
8.00am
Check in on his computer and go over results, patients already waiting whilst he greeted the staff with a cheery grunt and lit his oil burner. The washed who came in after the great unwashed appreciated lemongrass and lavender generally.
(One patient had been horrifed “You don’t have that going all day do you ?“ Quack “It’s very dangerous to have lemongrass in such concentration it will give you cancer” Quack.)
Fifty three results and scanned letters to view. For many years he had been building a knowledge of these people, some of course were new to him, but many names triggered brief life histories in his head.
A poor HbA1c- man with a wife and a fishing addiction, overweight and under exercised mentally and physically, in town for years but still hankering after the busy town life that economics had driven them from.
A normal FBC – a busy woman with a family and an unmotivated husband -trialed for years by an illness that was getting better but would take many more months to overcome.
He greeted the GP registrar, shared news of the night on call, a few phone calls from the nurse but nothing major. He settled in to his patient-filled day.
His morning was punctuated with three phone calls. Two from the chemist checking that the prescription he had just written for the medication he had just arranged to give the patient he had just seen was the medication that he intended to give and in that dose.
He had taken to writing “This is deliberate -I know what I am doing” on scripts the week before as this was not in uncommon occurrence. They needed a meeting.
The other call was from the hospital, the Sparky Young House Surgeon transferring Mr Cellulitis back to the cottage hospital, apologetic as the old school consultant had put him on IV Penicillin and Flucloxacillin, a very old school combination, but it had worked, “surprisingly” or so it seemed to Sparky.
Fifteen patients before lunch, another fifteen booked for the afternoon. A full “blue” book. But the day’s “blue” appointments gradually turning “yellow” as extra patients were fitted in…
08.30am Morning:
Mr Diabetes Review. Mr Stop Smoking (day 7.)
Mrs Back Pain Off Work. Miss Infected Eczema.
Messrs Scabies and Lice and Sores and Snotty Nose.
Mr Cough. Miss Buckled Up With Abdominal Pain.
Mrs Medication review. Mr Erectile Dysfunction.
Mrs Discharge Transition Admission For Stroke.
Master Earache. Mr Testicle swelling. Mrs Sprained Ankle. Mr Arthritis.
Mr My life Is Shit, Cough, Cough, Cough, Cough.
Mr Man in A Wheelchair Insurance Form.
Mr Funny Mole On The Ear And My Wife’s Affair.
Did she want him to write the details ?
Roger Neighbour talked about the 2 other people in the room in each consultation: the subconscious doctor and the subconscious patient, searching for what is unsaid.
Listening to those inner voices whilst Earache’s mum talked, revealed anxiety about the MMR vaccine. Testicle swelling had a cancer fear, Infected Eczema feared a DVT.
No-one had only one problem and his own voice needed constant attention to keep it focused:
“When he asks for an off work certificate why does the hair on my neck go stiff ?” “When abdo pain screeches try not to let your face show you think it sounds funny.”
The pleasure and the pain.
He chatted to the GP registrar. Her morning had been much the same, she told him of the exemplary management of all her cases. He felt his contribution was to listen and affirm, to reassure, but was this education?
Teaching theory would talk of apprenticeship learning. His burden was sharing the decision making vicariously. Perhaps a CXR would have been good, maybe think about the unexpressed fear of dementia next time.
12.30pm Lunch.
Half an hour in the local café. Alone with the paper, a bacon wrap and a cup of strong coffee, head down, he avoided eye contact with yesterday’s Chlamydia out of fear of triggering an embarrassed response. He made no decisions.
1.00pm Afternoon.
Mrs Review The Drugs – Stop The Beta Blocker.
Mr Carpal Tunnel Syndrome And A Funny Mole.
(Discuss new vaccine schedule with nurse.)
Master Heel Pain . Mr Impetigo.
Mr Severe flank pain – admit to hospital.
(Discuss 2 patients with rest home manager.)
Mrs Atrial Fibrillation Counsel About An Operation.
Miss Infective Exacerbation Of Asthma.
Master Epididymal Abscess.
Mrs Review The Drugs And Chase Up Surgery.
Mrs Depressed and Fat For Sickness And Loan Form.
( Telephone from chemist are the rest home scripts right?)
Mr My Wife Says I’m Cold To Her Touch.
Mrs Worried Well Results. Miss Spots and Flu.
Miss Urinary Tract Infection and Medication Review.
He checked his e mails. Twenty Four. None for Viagra or penis enlargement – strange.
Two from the Professor – put the papers to a different journal, apply to a different ethics committee.
One from the DHB – a newsletter from the GP liaison – One from the college asking for volunteers to do a Cornerstone visit, minutes of the PHO Board meeting to approve, PHONZ asking for expressions of interest in a new pilot project, Australian students confirming their elective, Swiss friend asking how goes it, BMJ and NZMJ and NZ Doctor and Medscape, MOH minutes of a Taskforce meeting.
He went through his in tray – insurance forms to complete.
Would he put them off until another day?
Does the pope wear a funny hat ?
ECGs to review, Spirometry results, newsletters from ACC and plastic covered bumpf from the drug companies, he discarded into the rubbish 50 % of the mail after a cursory glance, completed a questionnaire for a university researcher about the elderly, and switched off his computer.
5.30pm.
He chatted to the GP registrar, the afternoon had thrown up a problem, literally in the form of a child who had been vomiting repeatedly and become sufficiently dehydrated to warrant admission, the hospital doctor had been obstructive but she had stuck to her guns, confidence growing, what else could have been done ?
He discussed a planned trip to the local amateur dramatic production for the staff outing.
The receptionist stopped him as he left.
Venison had been left by ‘My Life Is Shit, Cough, Cough, Cough, Cough’ freshly butchered from a newly slaughtered beast.
A bag of beans had been left by Mrs Review the Drugs.
He popped over to the hospital. Mr. Cellulitis was happily settled into the ward, eating what could have been a roast dinner at one time, but was now what could only be called ‘hospital food’ – the amorphous gray green slime collected into pockets on a harshly cleaned plate that always reminded him of the film “Soylent Green.”
He drove home, listening to Stephen Fry, and part of Agatha Christie’s Radio Mysteries.
He stopped to check no-one was hurt at a minor crash, a car spun off the road in the gorge, just around the corner from where he had written off his own car two weeks previously answering his cell phone whilst driving to an out of hours clinic.
6.15pm
He arrived home just after the family and asked his wife “How was your day?” He wandered off the bedroom to change whilst she expounded upon the daily grind of a teacher in a high school. He mistakenly thought she was oblivious to his absence.
A cycle ride, “Health Matters” and “TED Talks” on the iPod, and then tea. Venison steaks and fresh green beans.
Bath, Harry Potter, Bed for the daughter and the Food Channel to numb the brain for his wife before bed.
He wrote it all down.
He wondered about you. Inspired ? Sustained ? Informed ? Entertained ?
He thought “there is joy in each day and that’s not bad.”
He contemplated the list of conditions he had dealt with. The human contact and connections that he had made. The lives he had changed. The people he had helped.
He had not found a cure for AIDS and TB in Kenya, but every day was different, every pain and cough had a unique story, he was making a difference atom by atom, doing what he could.
He loved his work.
He thought of an empty chair in an empty room and fell asleep.
Jo Scott-Jones
(A version of this story appeared in NZ Doctor Magazine in 2008)
Don't Shoot.. 