Peter Dorward - The Human Kind: A Doctor’s Stories From the Heart of Medicine

For Morrison Dorward, 19282017

Moving, compassionate and beautifully written this book illuminates general practice the way Henry Marsh has illuminated neurosurgery. Dorwards stories from his practice are subtle, eloquent and told with great integrity. He doesnt shy away from confronting some of the most difficult challenges in medicine: refractory pain, chronic fatigue syndrome, maintaining empathy, complex functional illness. But he carries the reader through with verve, imagination, and great humanity. I loved it.

Gavin Francis, author of the Sunday Times bestseller Adventures in Human Being.

www.gavinfrancis.com
@gavinfranc

Please note that the stories in this book are based on my experience as a doctor. However, many details in the pages that follow have been changed to ensure that the identities of real people are so disguised as to become unrecognisable. In some cases the stories and the people within them come from different experiences and different times. This is to ensure that the confidentiality of any individuals is protected.

Narcotics cannot still the tooth that nibbles at the soul

Emily Dickinson

CONTENTS

To never have to feel as tired as this again

To never have to feel so wretched

Oh

A young doctor sits with his head in his hands at a trestle table in the staff canteen of a district general hospital in Northern England. He wears an old-style white coat: stained and crumpled with use, a stethoscope in one pocket, a book jammed in the other, two bleeps in the breast pocket, one marked with peeling red duct tape. Its half past seven in the morning and still dark outside. Its 1989, and its been raining for years. He has a mug of tea sitting cupped between his hands, getting cold now. Work started the previous morning at half past eight. He will get home again at eight that evening.

Hes thinking: I never want to have to feel this tired again. I never want to feel this wretched.

Bad night?

Someone sits opposite him.

Shelley. Hi.

He is unenthusiastic to see her. Shelley is a year or two older than he is. Shes from Zim , Rhodesia, as she sometimes says, by mistake. Shes thin, has cropped dark hair, intense blue eyes. She is remarkably impervious to strain. She, too, has been up all night: she, if anything, has had it harder, because its Sunday morning, and there is no place harder than the casualty department of that hospital, in that town, on a Saturday night. But Shelley is fresh and manicured: clean white coat, clean blouse. Somewhere, somehow, she has found a place to shower. She doesnt have that up-all-night-in-casualty smell on her that special alcohol/sick/blood combo we all so know and her eye make-up is this mornings, not last nights, you can tell. She has brought two cups of tea, one for herself, the other fresh, hot, for him. Tiny acts of kindness go far in this bleak world. He makes an effort to wake.

You look terrible.

Thanks!

How did Mr Foster do?

Died.

Bad?

Not great

Then, from nowhere, a great surge of emotion, a welling up, intimations of a sob. A bellyful of something hot, rising in his throat, threatens to explode. He swallows hard: Down! Keep these rebel feelings DOWN!

Shelley, who was standing, about to leave, sits down again, waits a mo.

Actually, really really crap

Sob. Swallow.

12 hours earlier.

Feeling great Ward under control, set fair for a quiet-ish night, lots of energy still in the tank, might even get some sleep when his bleep goes off. Its Shelley calling from casualty:

Gerald Fosters back again. Haematemesis. Vitals are stable but he looks a little grey. Bloods are all gone off and hes got a unit of O neg up, but hell be coming your way.

Gerald Foster was what might be called a regular. He had been a very serious alcoholic once. Now in his mid-sixties, he has oesophageal varices, a complication of alcoholic liver disease. Blood, unable to make its way through his rock-like liver, backs up in other places: in his case, in the blood vessels around the bottom of his oesophagus. These varices sit around the mouth of the stomach like over-ripe grapes, ready to rupture. When they do, he bleeds, and when he does, he vomits. Haematemesis.

Young Doctor makes his way down to casualty at a brisk walk. The walls are painted pale green. The corridors are cluttered with patient trolleys and old-style metal drip stands. A porter with a spiderweb tattoo on his neck stands by a lift, surreptitiously smoking. Remember: its 1989.

Ho, Pete! says the porter.

Spider! says Pete, who doesnt much like to be called Pete, but nonetheless likes the human contact, and wishes he could have a cigarette too.

Mr Foster is sitting up in resus., grey indeed, drinking tea and eating a slice of toast. Emaciated man, stick limbs, big belly, white wispy hair, a touch of jaundice, fresh NHS issue paper gown protecting his modesty, his clothes in plastic bags by the trolley; there is blood caked still on his chin and chest.

Good evening, Mr Foster.

Who are you?

Mr Foster crunches on a slice of toast. Butter runs down his chin.

Im Doctor Dorward. Im here to check you out He feels the mans pulse, by way of getting started, although theres a machine doing all that already. He leans over, then leans back and swallows quickly. Butter, blood, tea, vomit, and Mr Foster is unkempt at the best of times. He leans back in again, checks the mans eyes.

Mr Foster: Who are you?

Doesnt matter

He suffers from Korsakoffs Syndrome, a not-so-rare complication of alcoholic brain disease. Its caused by vitamin deficiency and neglect, easily prevented, impossible to cure. It means that Mr Foster has no short-term memory. He doesnt remember a thing, from one moment to the next. The doctor listens to his chest, puts a hand on the abdomen, feels for the liver, feels for tenderness.

Gerroff! Fuckitt! Who are you? Where am I?

Mr Foster doesnt remember, from one moment to the next. In his case thats probably just as well. Mr Foster used to be a small-town bank manager. He had had a house in a nice area, a car and two teenage daughters who attended private school, but he lost all of that. Mr Foster had served a short prison sentence in the late seventies for sexual offences against a child. Upon his release, everything was lost: the job, the house, the car, the family. He didnt want them any more in any case. The alcohol was a kind of slow suicide, now half completed.

Where am I?

Doesnt matter

A nurse has appeared at the bedside, checking observations, marking them on a chart hanging at the bottom of the trolley.

He shouldnt be eating! He should be nil-by-mouth.

No one told us! she says, back now turned, leaving.

This hospital, with its casualty department, is due to close in a year. A few miles down the motorway a new one has been built half the services have been transferred across already. A new building, all steel and glass. There, the nursing staff are young, confident and enthusiastic. There is a central nursing bay for ease of communication. They have an up-to-date telephone system, innovative new computer terminals and training programmes on how to use them. There, the nursing staff wouldnt have to be told that tea and toast were wrong for Mr Foster, they would just know . The new hospital has drained the life from this, the old. This hospital is blighted.