“I have to tell you, good medicine goes the distance with the living and the dead… The dead don’t care much but they do matter. And your presence with those people for whom they matter … your showing up and pitching in and doing your part, is part of the very best medicine that you’ll ever do.”
Thomas Lynch, Undertaker-poet was speaking to an audience that included many medical professionals at the wonderfully eclectic Dotmed conference in Dublin. His work starts when ours finishes and as he gently reminded us a little overlap might do us all good. His words stuck with me, and were still very much in mind when I got news of John’s death.
At the age of only 29 he died in a motorbike accident just before Christmas. The first thing I did when I found out was to call his sister, Tessa. She was with her mum and they asked if they could come to the surgery, ‘Of course, come as soon as you can’
We met and shared our memories of John and they invited me to say a few words at his funeral. Here is what I said, with some added context and a couple of other memories I didn’t have time to include.
I was John’s GP for 11 years. I work in a practice that has a policy of every patient having their own doctor. Doctors and patients are possessive of, and loyal to each other. I got to know John as a result of asking him to come in for an hour at a time to help teach medical students about eczema. His was pretty severe. But what he taught us was that you can’t really get to know and understand what’s going on with someone’s skin, if you don’t make the effort to get to know and understand what’s going on inside their head. It’s a lesson every doctor with an interest in any organ needs to learn.
I remember the time he came in complaining that he felt ‘weak’. It’s probably the worst thing you can say to a GP because it’s the most common complaint and the least specific. It really isn’t helpful, diagnostically speaking. Inwardly, and sometimes outwardly too, we groan when patients complain of feeling weak. “It’s kind of interfering with my job”, John continued. He was a welder and I imagined him welding panels to the sides of ships. He was thin, but hard and wiry. “OK, OK, I said. Let’s examine you”. I gestured for him to stand up and we stood facing each other. “Now, lift your arms, like this,” I raised my arms out to the sides and above my head. John shrugged his shoulders and with all the strength he could muster, swung his hands up as far as his shoulders. They flopped back down again. ‘oh God,’ I thought, ‘this is terrible’, my fear and frustration came out when I pleaded with him, “Why the hell didn’t you come in sooner, I mean, in what way, exactly is could it possibly not be interfering with your work?!” His understatement had reached an unprecedented level. I called the National Hospital for Neurology there and then, and they said that they could see him in a couple of days. I told him to pack an overnight bag. They kept him in for 2 weeks of intensive investigations and after a couple of years back and forth to their outpatients, eventually he mostly recovered.
Not complaining was typical of John. If he was having a hard time, there was no point asking, ‘how are things?’ because he didn’t like to disappoint you or take up your time. After a while we found our ways of talking about ‘how things were’. Hard as my job is, I suspect it would be a lot harder if more of my patients told me how they were really feeling.
Another thing John taught me was that happiness, good health and self-confidence come from feeling you’re in control. One of the last times we met, he told me he’d been cooking. This was when we were watching Breaking Bad, and I felt a little nervous. I hear a lot of confessions in my line of work but I needn’t have worried, because John had been cooking eczema cream, out of beeswax, olive oil and brine. He had jars of it all over his flat. I tried to coax the recipe out of him, but what he’d really come in to tell me, was that it worked better than anything I’d ever prescribed. As if to prove it he didn’t pick up any of his monthly prescriptions for about six months after that.
What I’ve learned from John has relevance to almost all my teaching and my practice because it is about what it means to be a good doctor: the importance of listening, of not taking what patients say at face value and the importance of being able to manage without doctors.
What I’ve also learned is that the dead do matter and being John’s GP for just a little longer than I had expected was one of the most moving and rewarding things I have ever done.
This is a powerful point well made! One of the most long term consequences of the expected lethal viral pandemic is that there will be no possibility of proper ritual for our dead. We have heard about this at the extreme with Ebola recently – but the infectivity risk is not a problem with those who succumb to influenza. A simple preparation and service would bring comfort to many and lessen the longer term damage in the aftermath is this were to be addressed.
I can concur with the can’t or won’t seek help behaviour syndrome – in the 1980s in operating theatres we came across many examples of those of the generation born in the second and third decades of the C20 with advanced carcinomas who did not want to “be any bother”. My father suffered the symptoms of bowel cancer because he could not talk about it, and took a proprietary painkiller until it was too late.
Ever since I’ve taught that help-seekers are the strong ones.