Liam Farrell - The gift that lingers in the handshake

All actions are ultimately self referential, observed Spinoza, and though he wasn't a GP, he knew what he was talking about.

We like to think that gifts from our patients are a symbol of generosity and gratitude, a sign that our relationship is not purely cold and professional, that the care we give to them comes from our hearts. But I have a salutary little parable.

Many years ago, when I was working in a small town in rural North America, a young lad came to see me in some distress.

He was gay, and in a society where cows were considered suspiciously communist, this was a tough cross to bear.

I was young then myself, and desperately trying to avoid becoming cynical like all my senior colleagues (that turned out well). So I listened sympathetically, reassured him that beyond redneck central, feelings such as these were considered perfectly normal, and put him in touch with the appropriate support groups.

I shook his hand as he left, and trying just a bit too hard to be sympathetic (I was young myself, and beautiful), I held on to his hand a fraction too long, and he gave me a rather appraising look.

Despite being very secure about my own sexuality (and I really mean that, I'm straight, definitely, absolutely) I was concerned that I might have given him the wrong impression.

It being a small town, I met him on the street a few days later and had to rather overcompensate by boasting inappropriately about all the women I'd shagged - a pack of lies, of course, we Irish don't do that kind of thing.

I didn't see him for a while, but I heard he'd moved to San Francisco, which seemed a smart move.

But one day he came back to the surgery. He wanted to thank me, he said; before me, no-one had understood him. San Francisco was great, he'd really found himself there, had a lot of friends, and got in touch with his feelings.

He'd become an artist, and had brought me one of his paintings, in appreciation of all my help. I was genuinely touched and thanked him sincerely.

And then he said: 'I can get you a good deal on a frame.'

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