6 September 2019

Believe it or not! Tall tales and true

Clinical General Practice Grumpy Old Doctor

Of all the things patients tell me, the one I most dread is: “Panadol just doesn’t work for me, doc”.

Seven words, presented by a young and well-looking person, either as an irrefutable fact or a pleading entreaty, get me every time. My guts tighten and shoulders hunch. I feel the “flight or fight” response kick in – but a locum cannot run from a consultation.

What follows is 20 minutes of tense disputation. A mutually unsatisfactory compromise is reached and the patient departs (without Endone).

My relief is short-lived. Next patient is a crotchety old biddy who resents not being seen on time and announces: “Doctors can’t fix me. I’m sick of doctors.” There is still no medical cure for unhappiness, thus it takes only five minutes to verify these assertions.

She is gone, leaving the way clear for a farmer with a question to take the floor. “Guess what I heard on the wireless this morning, doc?”

The opinion of a GP, especially one who has just blown into town and will be gone in three weeks, can never trump that of a newsreader, journalist, morning television host or blogger, so I follow the line of least resistance, respond with a polite “Tell me”, murmur the odd “Really!” or “Mmm” and the minefield is safely crossed.

Just when it seems that you have heard it all before, a patient will test you with a really curly one.

I struggled for a suitable response to the older lady who greeted me with: “Good morning doctor! I’ve had smelly water all year!” And then there was the mature, well-dressed woman who announced that: “My vagina has changed shape.”

At other times I would appreciate more detail. Pressed for a description of his chest pain, George offered the illuminating: “It’s a funny pain. Not sore, just really giving me the shits.” Or Harry, only wanting a repeat prescription:  “It’s a blood pressure tablet. It’s white. It’s called something.”

Sometimes it’s the incidental conversation – between the medical bits – that offer the most interesting and surprising insights.

Roger cheerfully announced: “I drink far too much and I fly gyrocopters and ultralights.” He acknowledged my concern that alcohol and aviation might not be a wise mix – and then generously invited me to “a little gathering for a few drinks and bit of a bullshit” in his hangar Friday night. Simultaneous worship of Dionysus and Icarus will end in tears; I think I’ll stay away.

And sometimes these insights serve to remind me what a fortunate life I lead. Helen had moved to a country town from Zimbabwe not so long ago. She “Couldn’t believe how much food there is on the supermarket shelves.” She found it even harder to credit how much food we waste.

And how tough do seasonal workers get it? A potato digger works 12 hours a day in an open paddock confronted by an endless conveyer belt of spuds. A 30-minute break for lunch and two 15-minute “smokos”, if the boss is in a good mood.

“Working in the shed grading onions is easier”, but no less mind-numbing. The pay’s the same, $24 an hour for the “casuals” (European backpackers) and $19 for the “permanents”. Which means that Rhonda, who is going on “the trip of a lifetime” to Fiji and came to see me about travel vaccinations, earns $220 a day.

I am paid multiples of that to listen to stories, dispense advice and write prescriptions. Education is a good investment. I bulk-billed Rhonda.

Some things are almost too painful to hear. Everyone in town knows Debbie and the sorry details of her life. Once a beautiful young woman but now a ravaged, relapsing drunk, Debbie repeatedly crashes and burns. Her hard won periods of sobriety ending as her latest romance begins.

She was living on cigarettes and nightmares when I met her, the smokes taking most of her money and the nightmares what’s left of her soul. Brutally abused by a family member at the age of 16, the memory of the savage theft of innocence resurfaces as soon as her head hits the pillow.

When sleep does come she is visited by her ex-husband. In her dream, he walks in with a shotgun while she is doing the dishes and threatens to shoot her if she doesn’t dry the teaspoons properly. She calls out, tries to run but falls and hurts her shoulder. It’s “just a nightmare,” but the ache in her shoulder will stay all day.

Stories like Debbie’s are too painful not to be true.

Patients are not deliberately dishonest, even when what they are saying is rubbish. It would be easy to be cynical when a patient says: “My pain is 12 out of 10” or: “I always stick to my diet”, but they genuinely believe it to be true.

Men with angle grinders are an exception, however. I have extracted four pieces of steel from the eyes of four farmers this week. All claimed to have been wearing safety goggles. I stopped believing that fairytale long ago.

And then there’s the stuff that patients tell you that’s just … stuff. A Vietnam veteran told me that: “A Caterpillar diesel motor will only work for 85 hours in a tank in the jungle”.  Another bloke informed that he: “Cleaned out a deceased relative’s house yesterday and took a ute load of books to the tip.”

There is no bookshop in town and the tip is open on Sunday morning, so that’s part of my weekend sorted.

You can believe most of what you are told.

Love, Dad

Dr Max Higgs is a former country GP, a current rural and remote locum, and a collector of stories