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At work blog



Brief encounters

‘How many of these will you have to do today?’ she asks.

‘Four,’ I reply.

‘All day?’

‘No, this afternoon I’m going to do a ward round at another hospital.’

‘You see so many patients,’ she mused.

I was excising her mole. It was a 45-minute slot in a morning list, a small part of my working week, a routine procedure. Yet for her it was a much bigger part of her life.

From the other side of the therapeutic relationship, our everyday clinical activities are major events. Every clinic appointment, procedure or conversation is held on to, our words committed to memory, our letters carefully filed.

And from my experience as a patient, I know that I am no different. I replay in my mind interactions that occurred years before: the paediatrician telling me that there were no guarantees that my tiny little baby would be normal.

Or the geriatrician who thought he could keep my grandmother alive for my wedding but that she probably wouldn’t make Christmas; every year, for the next seven years, he received a Christmas card informing him of her continued survival, until she finally passed away two weeks before her 98th Christmas.

And I can still remember our family GP on a home visit to see me when I had the measles. His tall frame filled the doorway of my parents’ living room. Taking one look at me sitting on the sofa, his impulsive reaction was articulated in a single syllable of disgust: ‘Yuck!’

Off the top of my head, I have no idea how many excisions I have done. For the patient, often it’s a one-off, the mole is benign, and we wave them goodbye. If it turns out to be a melanoma, then it’s different and it’s the start of a long-term relationship.

Looking at my patient’s mole today, I don’t think that we’ll be seeing her again. You can never be sure, but I reckon her mole looks OK, somewhere in the spectrum of atypical moles, but I don’t think it’ll turn out to be a melanoma.

As we say goodbye, I’m still thinking about our earlier conversation. I will forget her, but her memory of me, like the scar I have given her today, will be with her for ever.

Susannah George is a specialty trainee 4 in dermatology in Brighton