Enjoying an occasional tipple of premium whisky recalls fond memories of a remarkable patient, writes Dr Leon Piterman
Doctors commonly receive gifts from their patients at Christmas time, very often in the form of an alcoholic beverage.
When I was in full-time practice these bottles, usually of wine, generously stocked my cellar. Sadly, a large proportion of them were lost when the cellar flooded. My wife had kept telling me there was a bad smell in the vicinity of the cellar. When I finally explored it, the cellar was under three feet of mud.
For 10 years or so each Christmas morning, as I opened my front door at home, I discovered a bottle of Dimple Whisky on my doorstep. Each year, I determined to unravel the mystery of my secret admirer and resolved to wake early to identify the source of this generous gift.
Finally it happened. She was sprung. It was Mary, one of my regular patients, who lived about 10km away. She was embarrassed and uncomfortable. I was surprised and relieved, but somewhat guilt-ridden also.
Mary proceeded to tell me how grateful she was because I had saved her life. Some 10 years earlier, Mary noticed abdominal swelling and weight gain. This was slow and progressive, and had been brushed off by her usual GP as obesity.
Mary was aged 60 at the time. She had not changed her diet or exercise pattern and had maintained the same weight for 30 years until the recent weight gain over the past six to 12 months.
When I examined Mary, I discovered what I thought was a large ovarian cyst. This was confirmed on ultrasound and CT scan. Of course, it was not until this 10kg cyst was removed that its benign nature was established.
The regular Christmas Dimple continued after my detective work, only this time it was presented to me at the clinic – much to the chagrin of my colleagues, who could only boast the odd bottle of wine.
In her 70s, Mary developed a range of minor illnesses, including hypertension, osteoporosis and osteoarthritis. But none of these stopped her from winning bowling tournaments, caring for her husband, who had severe COPD and cardiac failure, and caring for her demented mother, who, at the age of 96, was placed in an aged-care facility.
When her husband died, Mary was 75 and took over the management of his share portfolio. She took great pride in boasting of her success in this arena, frequently giving me advice on which shares I should purchase.
By the time Mary turned 80, I had been looking after her and various family members for 20 years.
Much Dimple had been consumed over these two decades.
In her early 80s Mary informed me that she was becoming demented. I asked her what evidence she had for this and she explained that she kept forgetting where she put things. But more importantly, she was proving to be far less adept at picking winners on the stockmarket.
I undertook a mini mental examination and she comfortably scored 28 out of 30. I arranged a number of blood tests, all of which were normal.
She repeatedly told me that she did not wish to go the same way as her mother, who lived for 12 years with progressive dementia and died aged 98.
She insisted that I make it clear in her medical records that she did not wish to be resuscitated if she had a stroke or became demented. I agreed to this and arranged for her to sign an advanced- care directive.
At the age of 84, Mary fell during a game of bowls and fractured her right hip. Hip replacement and rehabilitation were successful and she was back at home after four weeks and driving her car after three months.
Over the next 12 months, I received three bottles of Dimple. I pointed out to Mary that while I was happy to receive her traditional Christmas Dimple, presenting me with Scotch more frequently was both unnecessary and inappropriate.
She told me that she could not remember giving me so much whisky, adding: “You see doctor? I told you I was getting dementia.”
I took this remark seriously when, a month later, a further Dimple arrived with her next routine visit. I repeated the mini mental. This time the score was only 20 out of 30.
A CT scan showed signs of cerebral atrophy and a visit to a geriatrician confirmed Mary’s worst fears. She had Alzheimer’s dementia. Did the hip fracture and the general anaesthetic accelerate the process? Who knows?
Some four months later, I returned from four weeks leave to the news that Mary had suffered a CVA and died in hospital. She did not wish to end life like her mother and this wish was granted.
I still have surplus stocks of Dimple and I am reminded of Mary each time I pour a glass.
Dr Leon Piterman is Professor of General Practice at Monash University and has been in clinical practice for almost 40 years
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