Doctors; let’s get naked……

One of the unwritten rules of general practice runs thus; the longer it takes for a patient to disrobe, the less likely there is to be any significant clinical finding.

There is obviously a huge cost implication for the NHS here. Instead of sitting there twiddling our thumbs or daydreaming or idly Googling to see what Britney Spears is up to, while Mrs O’Toole laboriously removes corset number four with a hammer and chisel, we could be doing something useful.

But I have a solution; some might consider it rather extreme, but at a stroke it would rectify this drain on scarce resources; we should all get naked. And not only patients; to maintain a balance in the doctor-patient relationship, doctors would have to get naked as well.

It’s not really such a revolutionary step. By this stage, nearly everybody has appeared naked in a fundraising calendar, and being honest, we know fundraising is just a handy excuse, some people just like getting their kit off in public

OK, OK, I hear you say, some of it won’t be pretty, have we not suffered enough?

But think of all the time we’d save. No need to worry any more about what suit to wear, whether our trousers are pressed, which tie goes with which shirt – a major source of stress would be history.There would also be less tangible, more spiritual rewards. Clothes have lost their traditional purpose – to keep us warm and dry – instead, our culture has become so trivial that clothes have become a statement, a status symbol.
Getting naked would liberate us from these pretensions, get us closer to the truth of who we really are; here I am, we’d say, this is me, I am a child of the universe, peace, love and rock’n’roll, this is my glorious naked body, no longer fettered by fashion and convention, and of which I am not ashamed, look on my works, Ozymandias, King of Kings, and despair.

The rest of society would also benefit. Going through security at airports would be a breeze; no more being herded into long queues like sheep, no more having to take off shoes and coats and belts, we’d be straight in there to the duty free and the free samples of expensive aftershave. Terrorists would have nowhere to hide their paraphernalia; well, maybe there’s one place, so a lot more rectals would be needed, but they’re not that bad, and can even be quite pleasant.

If performed by an attractive person, that is.

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Rubber gloves are the new black….

I was at a local Gaelic football match recently. These can be ferocious; the honour of the parish is at stake, the rivalry is ancient and atavistic as the peat, and we suffer none of the false bonhomie of rugby, i.e fighting during the match but best of buddies afterwards.

If we fight during the match, we fight after the match and at the next match and at the match after that and our cousins fight with their cousins (or marry them) and the feud goes on and on, gathering pace through seed, breed and generation even when the original cause of the dispute has long been lost in the mists of antiquity. If any of our neighbouring clubs were playing the flesh-eating monsters from outer space, we’d be cheering on the aliens.

‘More substance in our enmities/Than in our love,’ wrote WB Yeats, who in between talking to the fairies and pouring out his unrequited love for Maud Gonne, had obviously been at a match or two in his time.

During the match a player went down with an injury. My cronies looked at me expectantly, hoping I might provide a diverting and potentially hilarious spectacle by sprinting onto the pitch to provide succour; they always enjoy a bit of drama. But my sprinting days are long over.

‘He’s fine,’ I said to them, ‘he’s still moving.’

They were visibly disappointed, but having to Break Bad News is just another part of the great tapestry of general practice.

The team physio (or bagman or trainer or waterboy) rushed out onto the field, stopping only to pull on a pair of rubber gloves although he had some difficulty with the thumbs. This was all rather theatrical, I felt, but then rubber gloves are quite the fashion accessory.

The actual risk of a clean-limbed young gossoon from the bogs of Ireland having AIDS or hepatitis B, and also having an open wound, and the physio/bagman also having an open wound and thus the pair inadvertently sharing body fluids must be incredibly small, but hey, he’d seen it on TV so it must be right.

Has there ever been a reported case of a physio/bagman picking up a serious infectious disease from a player during a match?

'Uh-Oh!'Rubber gloves, it seems, are the new black.

Beware of the rabbit……

This world is a dangerous place, red with tooth and claw, and none of us will leave it alive. It’s a jungle out there, a pasture for monsters and savage beasts, though often peril comes from the most unexpected sources, like the early scenes in Casualty, when someone is gardening and you know that one of those seemingly innocent garden tools is going to become an instrument of torture.

‘Watch out for the pitchfork!’ you want to shout, but it’s too late, and the pitchfork is sticking out of the neighbour’s naval.

‘The pet rabbit bit me,’ Joe complained, with a palpable air of betrayal and injured pride. ‘Et tu, Brute,’ he might have said. ‘What have I ever done to that rabbit, that it should hurt me so?’

I was not impressed; if the abrasion had been any more superficial it would have been a protuberance. Laying on the antiseptic as thick as the sarcasm, I admonished him sternly.

‘Were you teasing it with a stick?’ I asked. ‘Or putting your hand in and out of its mouth to impress your friends?’

Our prehistoric ancestors survived by hunting down small furry creatures, and entertaining though this pastime sounds, rabbit meat is no longer an essential part of our diet. But not wanting to be too flippant, and just in case I had missed something, I Googled rabbit-induced trauma.

Persuading my computer to Google anything other than pictures of Britney Spears is always difficult, but even after all my efforts (downloading the pictures takes up quite a bit of time), the search proved fruitless; apparently, even in a pack, even if reared by wolves, and even if cornered, rabbits will not attack humans, though get in the way of a pack of rabbits and a big feed of juicy carrots and you might be in for a stomping, however accidental.

Like stout Cortez, I could only surmise wildly that the most likely danger might arise from the rabbit’s admirably vegetarian diet; some minerals, vitamins and fibre might have inadvertently leached into the abrasion, thereby causing an unprecedented surge of rude health, which the patient’s sedentary lifestyle and cafeteria diet would be unable to sustain.

And the wise clinician will always explore the past medical history. ‘Has your rabbit ever done this before?’ I asked.

Grief; the Bright Side……

Local funerals, unfortunately, pass right by our health centre, and I have to duck out of sight as the cortege looks over accusingly. If I’m spotted, some Trotskyite agitator is sure to shout: ‘You should have sent him for that X-ray,’ or ‘I told you he needed a strong antibiotic.’

But I understand; emotions run high, we Celts are a volatile people. If I’ve had to forcibly restrain one grieving widow from throwing herself into the grave after the coffin, I’ve had to restrain 20.

And, of course, once one does it everyone has to do it, in case people think they didn’t care.

A few years ago, our cousins insisted on carrying Uncle Paudge the whole way from their home to the graveyard. Our ancient graveyard is picturesquely but inconveniently sited on a hilltop and is one hell of a carry. Previous accepted practice had been to use the hearse for most of the journey, and rely on muscle power for only the last few theatrical yards. But yet again, one family thoughtlessly sets a precedent, and the spectacle of corteges pitifully collapsing in exhaustion half way up the hill has now become commonplace.

 I was strolling along at the back, quite enjoying the walk, when the rate of attrition at the front became too great, I became a leader instead of a follower, and willy-nilly was pressed into service, just as we reached a temporary but steep incline.

Hey,’ I felt like saying, ‘I didn’t like him much.’

I took my place at the rear of the coffin, which turned out to be a tactical error. The pallbearer on the other side was much shorter than me, so all the weight was crushing down on my clavicle. Did I mention it was raining, the wind was against us and Uncle Paudge was a big fat guy?

The pain was excruciating and I almost put the coffin down and admitted, ‘I’m not strong enough, he’s too heavy,’ but this would have shamed my family and its seed, breed and generation, might as well stand up and admit you are only half a man.

However, I didn’t become a doctor by being stupid.

With my free hand, in a clandestine manner, I gradually pushed the coffin sideways, transferring the load on to Shorty’s neck. Soon, strangulating noises were audible and the coffin was listing, ready to topple. The cortege rushed forward in alarm, my burden was relieved and I gilded the lily by ministering with faux concern to Shorty, by now blue in the face.

In medicine, if you can fake sincerity, you’ve got it made. As a senior colleague once said to me: ‘There’s nothing worse than a smiling bastard.’

This all sounds like a lot of fun, but there is grave purpose afoot. Shedding the grief in one blaze of glory is undoubtedly therapeutic; life must go on, and consequently the aforesaid grieving widows, having had their catharsis, can take a moment to freshen up their mascara, shimmy right out of that black dress, and start flirting with the undertaker.

An unusual approach to Advanced Care Planning

GP  26 July 2017

Joe looked unusually pensive, which cheered me up a bit and added some sparkle to the morning.

Your native hue of resolution / Is sicklied o’er with the pale cast of thought,’ I observed.

‘I was wondering,’ said Joe, ‘if I should get an advance care plan in place.’

I was a bit surprised by such a display of forethought, the first falling leaves of vulnerability; Joe has always been a man who demanded immediate gratification of all his desires, his only forward planning on the lines of how big a steak to eat tonight, or the most likely winner of the 3.30pm at Kilbeggan today.

But I did have sympathy for his request; no one is allowed to die peacefully anymore, instead we get tubes rammed down our throat, multiple needle jabs, our shirts ripped off and electric shocks administered – and all of it a very public spectacle, as an audience has become traditional.

Everyone means well, of course; what could be more meritorious than bringing someone back to life? But as Albert Camus said: ‘Good intentions may do as much harm as malevolence if they lack understanding.’

‘So what would you like in your advance care plan?’ I said. ‘I can give you a form with all the information.’ I love giving out forms, it saves me having to explain every bloody thing myself, like I don’t have, you know, a life.

‘Most important thing,’ he said. ‘I want a big flatscreen TV, with Sky Sports, the Racing Channel and Netflix.’

‘We may have a misunderstanding here,’ I said. ‘An advance care plan is a legal document in which you specify what actions should be taken for your health if you are no longer able to make decisions for yourself. We should all have one signed and filed, to avoid having some big sweaty guy pounding gaily and unnecessarily on our chest. But what it will not specify is having a humungous TV in your room.’

Joe was undeterred by such minor details.

‘When I’m dying,’ he insisted, ‘I want a big TV; pull the plug on me before you pull it on the TV.’

He gripped my hand urgently and looked me straight in the eyes.

‘Can I trust you to do that for me, doc?’ he said. ‘Can I trust you not to pull the plug?’

Dr Livingstone, can I have an antibiotic?

We are never naked, we wear the iron cloak of our esoteric knowledge wherever we go.

‘Dr Livingstone, I presume,’ said Henry Morton Stanley; his indomitable will had driven him headlong across jungle, desert, mountain and river, and he bestrode Africa like a colossus.

But the legend does not tell the whole story, for the legendary adventurer had something further to say: ‘By the way, doc, I have a bit of a cough; could I have some antibiotics? And what about an X-ray, my leg’s giving me jip?’

We can’t escape it, can we? Once a doctor, always a doctor, ours is a high and noble destiny, and I still remember the first time I put on a white coat and hung a stethoscope around my neck; a bit like the first time I had sex, although not as sweaty and with less protection, and with more ridicule from those more experienced; je ne regrette rien, I say, good sex may be great, but bad sex is still good.

But if you buy the farm, you get the Indians, and the same moral code that ordains we stop at road traffic accidents also compels us to listen to strangers on the train recounting how they discovered an ingrowing toenail protruding from their scrotum; we can never entirely lay down our onerous responsibilities.

Once you become a doctor, everyone else in the world immediately falls into the category of ‘patient’. Wherever there are sick people there will always be doctors, with the unfortunate corollary that wherever there are doctors, there will always be sick people.

My Auntie Mary was a simple country woman who earned a living off the land, blackmailing farmers, smuggling cigarettes and ambushing insurance salesmen, and to her, doctors were different from everyone else, a kind of aristocracy.

I remember telling her I was going to become a doctor and that I was off to medical school for six long and hard years; as she was fanatically religious, I was careful to omit the all-night drinking and carousing and rogering that this would entail.

I could see her thinking it over and she went away and came back a while later and said: ‘And can you become a doctor just like that?’