2 December 2021

Letter from GOD: Lost in a web of self-delusion

Grumpy Old Doctor RedHerring

Dear Julia,

The subject of mercury came up when I checked a retired farmer’s blood pressure with a manual machine last week.

“Don’t use mercury in those things any more, doc?” Bob asked. 

“No, banned because of health and safety concerns. 

“Funny how things change, we used to play with it as kids. The old miners around Bendigo used mercury to recover specks of gold from soil. We called it ‘quicksilver’, the only metal that’s a liquid at room temperature you know. Kept some in one of my dad’s tobacco tins. Liked to give it a poke to break it into little balls then tilt the tin this way and that to make it reassemble itself. Hours of fun. Health and safety problems, you said?”

“Spillage from a broken machine could pose a risk to patients. Mercury is a heavy metal and toxic to humans.”

“Well, it’s not toxic to ducks, goes straight through ’em. Left the lid off the tin once and an inquisitive Indian Runner ate the lot. Shat it out in 10 seconds flat; got it all back as clean as a whistle. Dentists still use it for fillings, don’t they?”

“They do. Those of us raised on fluoride-free tank water often end up with a mouth full of mercury.”

“There you go! And didn’t you blokes use it to treat syphilis before penicillin came along?”

“We did, but no one believes in such quackery now; modern medicine is based on scientific evidence.” 

Or is it? I ventured to a larger regional town last week to try my hand in a SUPERCLINIC; a high-throughput practice where the patients expect labels for their problems and “antis” to fix them. Antibiotics, anti-inflammatories, antipsychotics, antihypertensives, antidepressants, anticonvulsants, anti-reflux medication and anti-obesity drugs. 

Like a priest handing out hail Marys and Our Fathers on a busy day in the confessional, I was soon dishing out antis to the faithful with alacrity, if not sincerity.

I don’t share my patients’ belief in the omnipotence of antis.

Antibiotics do not cure colds, not even when the snot is green. Antidepressants sometimes help with depression. They do not fix bad marriages or shitty lives. Anti-reflux medications work but are addictive. Prescribe Nexium once and your patient will keep coming back for more and never change their diet.

Anti-obesity drugs.  “Just to get me started, doc. My cousin’s been on Duromine for six months and dropped 30kg!” And will get it all back, with interest.

Antihypertensives are effective some of the time in some patients, but we can’t be sure which ones. They don’t work if not taken regularly. If you do take them as directed, but still have a stroke or heart attack, a specialist will prescribe another one, or three, for you.

Antipsychotics are great for psychosis but more commonly used for anger management and bad personalities, for which they don’t work. Nothing cures the incurable.

Anticonvulsants. These little darlings are prescribed for the same indications as anti-psychotics, with similar results. Also a popular panacea for bad backs, bulging discs and sciatica; no-one would believe me when told that Lyrica was made to treat epilepsy.

Many of my prescriptions made the use of mercury for syphilis seem quite plausible.  

By Tuesday lunchtime, what little faith I had in antis at the start of the week was completely shot, though that of my patients remained unshakeable and illogical. 

I was not surprised when a morbidly-obese-depressed-hypertensive-arthritic-smoker on the full complement of antis, plus multiple over the counter vitamins and supplements, revealed herself as an anti-vaxxer. “Covid vaccines are unproven and dangerous you know, doctor.”

Really!? I didn’t know that; but after 40 years in this business, what do I know? 

I know that most people have no idea how the human body works. 

Jolene has her own blood pressure machine and never fails to take her antihypertensives. 

“I don’t want to end up like my brother, he had high blood pressure and diabetes. Wouldn’t take his pills. Had three toes amputated and then a heart attack while I was visiting him in the hospital after the op. The nurses did CPR and every time they pressed on his chest, blood spurted from his foot. Blood pressure was too high, bled to death.”

I know that most patients don’t mean to lie or deceive. Their honesty just gets lost in a web of self-delusion. 

Marko’s emphysema has nothing to do with decades of hard smoking. “A clumsy Croation dentist dropped a piece of tooth in my lungs in 1947. My breathing has never been any good since.”

Michelle has lost her appetite but is still gaining weight. “I can’t remember the last time I was hungry, but I can’t stop eating. There never seems to be any food in the house.”

Mason left his bad habits behind when he escaped from the city in search of a healthier lifestyle. “I grow all my own vegetables and I’m off all drugs! Went cold turkey yesterday! No alcohol, no dope, no cigarettes; only home-grown, organic dope.”

At least Mick doesn’t underplay his alcohol consumption. “I drink two bottles of red wine every night, (anything reasonably priced, I’m not fussy) purely for the antioxidant benefits.”

With no faith in my prescriptions and unable to trust what my patients tell me, what is there left to believe in? 

A 40-year-old and his elderly mother provided the answer. 

Malcolm came looking for a cocktail of antis, some Endone and a Centrelink certificate.

“I’m having a bad run. My mum has terminal cancer. The wife has an acquired brain injury (the Seroquel is for her). I’ve got four prolapsed discs pressing on my spine and we’re living in a car because the house burnt down.”

Tragic. And untrue. 

Malcolm lives alone in a tidy cottage 10 kilometres out of town. I met his mother, Lola, yesterday; her only terminal disease is an unbreakable belief in her boy.

“Nobody ever believes poor Malcolm. He’s been on Job Search for six years because Centrelink won’t give him a pension. Even I can look at the X-rays of his back and see what’s wrong with him.”

Endless, illogical, forgiving and blind. More powerful than a handful of antis. A mother’s love can fix anything. A mother’s love will never let you down. 

Believe me, I know.

Love,

Dad.

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

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