Sitting there

I had a marvellous time at the weekend. We went back to my university town and met up with the five lads I shared a house with over thirty years ago. It was good to meet them again, and some of their wives and families. We wandered around our old haunts, had a superb meal at the hotel in the evening and stayed up chatting until the wee small hours. The hotel was delightful but reminded me of an Agatha Christie novel, so I was relieved not to find a dead body in the library. In some ways my friends were unchanged, and conversation was just as it was in the 1970s. But none of us have been left unscathed by the passage of time and small scratches revealed a wealth of experience beneath the surface, not all of it pleasant. Perhaps not surprisingly it was the women who spoke more openly of these matters. It was good to see that friendships can endure and we must meet again before too long, for we shall not all survive another three decades. The other medic in our group reminded me that at least five of the original hundred medical graduates from our year have already died: one accident, one suicide, and three from disease.

Another of my ex-housemates now lives in Worthing, a town on the costa geriatrica of Sussex. As a young boy I would visit my elderly godmother who lived there and it seemed to me that the whole town was inhabited by little old ladies. My friend confirmed that this is still the case. “People go to Worthing to die” he reported, “and then forget what they came for.”

The first few days of this week have not been so pleasant. Perhaps the contrast was inevitable. I didn't manage to catch up on lost sleep, I have been feeling weary and have again been troubled by annoying toothache. By nature I am grumpy, irritable and selfish, and I have to work hard to be consistently kind, thoughtful and helpful. Yes it is an act, and some may feel I don't work hard enough at it! But over the past few days it has sometimes been hard to maintain when my jaw throbs while people rabbit on about their problems. Or, I should say, explain in detail and at length their difficulties which it is my privilege and duty to rectify.

Please don't take these comments too seriously. I have soldiered on, gone to bed early, taken paracetamol and made an appointment to see the dentist (which almost always relieves the pain straight away) and am feeling rather better now. I don't want to wallow too much in self pity. But it has illustrated the demanding nature of the job, which takes a number of forms. Firstly the relentless series of calls for your professional attention throughout the day, during which you must try to foresee and guard against every possible bad outcome. Secondly transference, where you risk picking up some of the patients' emotional misery. Thirdly the need to adapt constantly to each patient's different understanding and outlook. Normally I do all this without a second thought, but fatigue and pain expose what is going on beneath the surface.

And of course there are rewards too. Since starting to write this blog I have become more aware of how patients show their opinion of me. News has got out about my partner's impending retirement, and several patients have expressed the hope that I am not thinking of retiring as well. Then I saw a man who has been troubled by insomnia for years. We have explored many options including the sleep clinic which he did not find helpful. He did not consider himself depressed and certainly did not want to try antidepressants. With his intractable problem he was in danger of becoming a “heartsink”. But recently I suggested that he try some fluoxetine: not for depression but to increase the serotonin levels in his brain. When I saw him this week he reported an immense improvement in both his sleep and the quality of his life, and was delighted. Such success is gratifying for both doctor and patient. This morning I saw an elderly man who looked at me and smiled and said “just sitting there, you give me every confidence!”

So I shall continue to sit there for a little longer.