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Every doctor has patients and families – or types of patients and families – they find particularly tricky to work with.
Some struggle with the medical-school-drop-out nephew who insists on a level of medical detail he clearly can’t follow; some are flummoxed by the submissive older person who insists on saying, ‘whatever you advise, doctor’, regardless of the question; some get wound up by assertive people who know their rights and demand them loudly in all circumstances.
To balance this, though, some kinds of people are a particular pleasure to work with – and, like pet hates, this varies very much from doctor to doctor.
My personal favourite variety of family member are those who are totally un-medical but are trained in some quantitative, technical discipline which makes them ready to understand how medical treatment works – or sometimes doesn’t. Physicists and engineers are good for this, but so too are plumbers and electricians.
There’s one disadvantage with these people, though; sometimes a clear understanding of what’s happening isn’t an unmixed blessing. We’re no longer allowed to withhold information for someone’s ‘own good’, but many doctors still try to soften or at least pace the information they’re giving when it is particularly devastating. If the patient or relative is ahead of you, this is impossible.
I recall a father – an analytical chemist – whose two-year-old daughter developed a degenerative condition. It took us some months to diagnose her but long before we did, it was clear that her outlook was very bad indeed. This father had drawn a graph to keep track of how his daughter’s condition changed over time.
The x axis showed months; the y axis showed abilities: walking, standing, crawling. The line showing the little girl’s progress wavered to begin with but as time went on it trended inexorably down. The father had had to add new milestones on the lowest part of the y axis: reaching out. Raising head. Swallowing.
If you did history at school, you’ll probably have seen the famous picture of Guy Fawkes’s signatures, before and after he was tortured into confessing to the Gunpowder Plot. The first signature is in a firm, looping hand; the second is so tremulous and fragmented as to be barely recognisable.
This father’s writing, neat and technical to begin with, in the newest, lowest parts of his graph became scarcely legible. Handwriting, as with Guy Fawkes’s, distorted by pain.
When we eventually came to break the news of the child’s diagnosis, it was clear that he was only waiting for us to put a name to his fears.
A lack of false hopes and self-deception on the part of relatives may possibly make the clinicians’ lives easier, but does it make the relatives’ own lives harder?
By the Secret Doctor