Confessions of a GP

Strokes are unpredictable and some people recover all of their function, others none and most something in between. For the first few weeks, Betty had intensive specialist physio and speech therapist input, but it soon became clear that she wasn’t going to recover much of her movement. Previously independent, this was very difficult for Betty to accept. It was sensitively suggested by the consultant that she would need to go to a nursing home to be looked after. Betty’s speech was poor but she made it crystal clear where he could stick his nursing home idea. ‘I’m going home!’ she would shout as best she could. ‘I want to see my cat.’ Betty’s mind was as sharp as ever. She wasn’t confused about her diagnosis, she just hadn’t accepted it. If her disabilities had been more manageable, she could have gone home with carers visiting regularly. Unfortunately, Betty needed 24-hour nursing care because of her swallowing problems and severe paralysis.

Betty was taking up a hospital bed on an acute medical ward. It was a complete waste of resources as we were doing nothing for her, but she refused point blank to go to a nursing home and so what could we do? With intact marbles, we couldn’t ship her out against her will so we were stuck. Each morning we would do our ward round leaving Betty to last. Doctors hate feeling helpless so none of us really wanted to go in to see her. As the most junior member of the team, I was usually thrown in to say hello. My attempt at a friendly ‘good morning’ was always greeted with a stoical ‘I want to go home’ and invariably an ‘I want to see my cat.’ Betty had never married and had no children. She had painfully few visitors and we often heard her crying to herself as we hurried past her room. It was a miserable situation but one that seemed impossible to solve.

It was decided between the junior doctors and nurses that we were going to bring in her cat for a visit. We knew that if the consultant or, worse still, the infection control nurse found out, we would all be for the high jump, but after so many months of feeling so incapable of helping Betty, we decided we were finally going to do something for her. It was agreed we would sneak the cat in on her birthday. Like a military operation, the cat was picked up from Betty’s neighbour and smuggled on to the ward. The cat was a miserable old moggy with clumps of missing fur and she hissed at anyone who came close. We couldn’t believe that this was the precious creature that had been so desperately missed. Betty was, however, over the moon. ‘My cat, my cat!’ she cried. The cat herself seemed less than overwhelmed by the reunion but did at least allow Betty to hold her for a few minutes and even seemed to let out the odd token purr.

It would be nice to finish the story with Betty making a miracle recovery because of the amazing healing power of feline friendship, but that didn’t happen. Betty was still paralysed and eventually, after many reluctant months, did have to go to a nursing home. Betty’s case sticks in my mind because it shows how despite all the wonderful facilities that modern hospitals contain, it was a mangy cat that made one woman’s suffering lessen for a short period at least.

Vaccines

Sebastian was three years old and looking fairly miserable. He was very sweet and, despite being a bit unhappy and feverish, he was keen to tell me that he had a stethoscope like mine at home. His mum had brought him in as she was worried about his rash. He was covered in spots. ‘Has he had all his jabs?’ I asked casually as I took a closer look. ‘No, we don’t believe in vaccines,’ Mum replied matter-of-factly. I was shocked. I had mostly worked as a GP in working-class areas and never come across anyone who didn’t vaccinate their children. This day I was working in a leafy north London suburb and discovered it was almost the norm here. A lot of what we do as doctors is patch people up and keep them going for a few extra years. There is a lot of listening to people’s general health grumbles, giving a bit of reassurance and sending them out of the door with a pretty ineffectual tablet. Medicine is better than it was a hundred years ago but the main reason people live longer and only very rarely die in childhood is due to improved sanitation and nutrition. Clean running water and an abundance of food have saved far more lives than doctors and our medicines. Having said that, I believe the one great achievement of modern medicine is the widespread vaccination of children. Vaccines are cheap, safe and have saved millions of lives both here and all over the world. Measles used to be a major killer in the UK and it has now become a disease that I had only ever read about in textbooks. Despite working as a paediatric doctor both in England and Africa, I had never seen a real life case of measles.