Further Confessions of a GP

Maggie clearly needed to see a specialist and have a scan. She didn’t really need to be admitted to hospital that morning, but then it wasn’t appropriate to make her wait two weeks for an outpatient appointment either. When stuck with this sort of quandary, I generally default to the ‘What would I want if it was me?’ option. This turned the decision into a bit of a no-brainer and I phoned the medical consultant on call who agreed that she should go straight up to the hospital.

Sometimes it’s really satisfying to get a diagnosis right, but I took no pleasure in having my suspicions confirmed this time. Maggie’s leg symptoms were due to her breast cancer returning. It had already spread extensively and it was lesions in the brain that were causing her leg symptoms. After being told the result of the scan she was discharged with some steroids.

Maggie had still been in a state of shock when they’d given her the diagnosis in hospital, so she made an appointment with me to go over a few things. First of all she wanted to know how the cancer had lain dormant for all those years before coming back. I would like to have been able to answer that question, but the truth was I just didn’t know. It wasn’t something she’d done wrong; it was just one of those awful facts about cancer. Sometimes we think we have beaten it, yet somehow this horrible disease has a dirty habit of reappearing. Maggie hadn’t even noticed a breast lump, but by the time she had her scan there were cancerous lesions in her liver, bones and brain. The cancer specialist offered her some chemotherapy that might temporarily shrink the tumours, but he made it very clear that he could offer her no cure.

‘What now?’ was her next question.

Again, this was a hard one to answer. ‘We’ll get the palliative care nurses involved and will always make sure that you’re never in pain or distress with the symptoms. You might remain stable and fairly well for some time…’

‘But basically I’m going to die.’

I thought about trying to counter that remark with something upbeat and positive, but in reality Maggie was right. She was going to die and I couldn’t say anything that would change that fact. I stayed quiet, handed her a tissue and put my hand on her hand. We sat in silence for a few moments while she sobbed. After she left, I made myself a quick cup of tea, splashed some cold water on my face and pulled myself together enough to see my next patient.

Brian and Deidre

Every couple of months or so the surgery shuts for an afternoon and we have some sort of educational session. It’s an attempt to keep us up to date and make us better doctors. The most recent education afternoon was on the topic of sexual health. A lady with a colourful silk scarf and ethnic sandals was talking to us about the importance of sexual identity.

‘How often do you see your patients as sexual beings?’ she asked. ‘How often do you consider how the medications you prescribe might affect the sexuality of your patients?’ I had to admit that the answer to both of these questions was ‘never’. I knew that some medications could affect libido and erections, but I tended to avoid discussing it with patients if I could. This was all going to change from now on, though, I decided. The sex therapist lady was right. There was no point lowering a patient’s blood pressure if I was going to ruin his relationship because my drugs were inhibiting his erections.

The first chance to demonstrate my newfound sensitivity came the very next day. Brian had come in for a review of his blood pressure medication. I know it’s wrong to pigeonhole, but I always felt like Brian looked like the perfect stereotype of a bus driver: mid-50s, with mutton-chop sideburns and an ever-expanding beer belly. His faded white shirt always had large yellow sweat patches in his armpits and was open at the neck to reveal a big gold chain that matched his sovereign rings. Brian was accompanied by his wife Deidre, and although they always came to see me together, I had the impression that their relationship was often strained. With my new approach, perhaps I could help?

‘Brian, some men find that beta-blocker medication like the one you’re taking for your blood pressure can affect their ability to have erections. Do you ever find this to be a problem?’

‘Well, funny you should say that, Doctor. Me and the wife here have been struggling to manage in the bedroom department for some time. When we’re alone together I just can’t seem to get the little fella to stand to attention these days.’

Wow, I think to myself. What a breakthrough. The nice sex therapist lady was right. We do need to talk more about sex with our patients. Perhaps I can make a real difference to Brian and Deidre’s relationship. Perhaps the sexual frustration is the reason why they’re always bickering.

‘Mind you, I do still get erections though, Doctor,’ Brian said, interrupting my thought process.