I saw a patient today for his regular certificate, and he told me that he had more or less got over the recent death of both parents. His elderly mother had died first, his father killed himself shortly afterwards. I was reminded of the fate of Sir Albert Morton's wife some 400 years ago:
He first deceased; she for a little tried
To live without him, liked it not, and died.
My patient looked better, but wanted to tell the story of his father's death to me as clerk of the records. He had been found lying upstairs in bed with two pillows covering his head. Under the pillows his father's head was enclosed in a plastic bag. A declaration of love.
Another patient this morning was a Middle-Eastern refugee in his thirties, who came with his support worker. He felt that all his illnesses were getting no better, after a year of treatment. His notes showed that my partners had been assiduously treating several conditions and he was being seen in the Pain Clinic for his back pain. He looked fed up. Dear reader, when a patient in difficult social circumstances tells you he has got no better for a year and looks fed up, what condition do you think of? It didn't take much prompting to find out that he feels depressed and worthless because he can no longer work to support his family. I think his love for his family is making him worse at present, but there seems to be no computer code to record that surmise.
A third patient was a middle-aged single woman. She told me that her sister with Down's syndrome lives in a town many miles away with their elderly mother. The mother can no longer look after herself, let alone her daughter, but she is obdurate and will not accept any help from social services. My patient has decided that she must give up her job and her house here to go and look after her mother and sister. She was clearly stressed and distressed by this, which gave me the grounds to issue a sickness certificate she required to cover her period of notice, but I thought her decision was rational and one that she was competent to make. Writing a certificate seemed a very small token compared to her sacrifice.
It is reassuring that I still seem to be making effective interventions despite speeding up my consultations. This morning they averaged 11.5 minutes each. It is so good for morale when one finishes morning surgery before 2pm!