Liam Farrell - The story of patients' lives unfolds in their notes

Because I am sometimes a good doctor, I read the occasional specialist article.

It's a bit like watching Fox News USA; we need to know what the enemy is thinking, and it's always nice to have our prejudices confirmed, for example, America is full of illiterate gun-crazy right-wing rednecks whose hobby is shooting Mexicans and who believe that an intelligent black man must be a communist.

One article claimed that in the next millennium diabetes would remain one of the most intellectually satisfying of all illnesses, and that because diabetes involves all organs and ages it gives a 'wonderful' spectrum for the clinician.

He didn't claim that people with diabetes would be better managed, or that they would feel better, or have fewer complications, or live longer and have a better quality of life, but just that his work would be a little more interesting and diverting.

Call me old-fashioned, but I still find patients fascinating, their notes a set of little chapters on the long journey to the tomb. Each life unfolds in leaps and starts, plenty of notes on childhood infections, then a big gap, interrupted for women by the pleasant meadows of fertility and childbearing.

Some people are unlucky to be struck by early illness, asthma, inflammatory bowel disease, or depression, but for most of us the chart remains sketchy till we reach the forties. Then the first pale intimations of mortality start, dim drums throbbing in the hills half heard. Minor harbingers of doom start to appear - hypertension, osteoarthritis, gratuitous counselling - and from then on the entries and reports multiply.

Sickness piles on sickness, cancer piles upon degenerative disease, piles pile upon piles, as this is one storybook that will not have a happy ending and with each page the grave yawns a little wider.

But comprehensive as they may be, the clinical notes tell us little about the real person; they are just a skeleton, and the flesh is absent. In the same vein, Thomas Hardy once referred to the futility of fiction. 'Compared to the dullest human being walking on the earth,' said the great author, 'the most brilliantly drawn character, in any novel, is nothing more than a bag of bones.'

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