Liam Farrell: The dark side of being a country doctor

All the world's a stage, and we docs are but poor players. Mrs Dooley had never attended drama school, but had learned acting from the University of Life, and could teach even the most distinguished thespian about the centrality of the initial visual impact.

As GK Chesterton observed, artifice is the ultimate expression of human genius; things that try to look like things often look more like things than the actual things, and no cripple can have the physical dexterity to be as plausibly crippled as an actor pretending to be a cripple.

Other cripples would point at Mrs Dooley in the street and say, 'Look, isn’t she crippled?' She even rather cheered other cripples up – it’s always nice to know there’s somebody worse off than you.

'The DLA doctor is calling tomorrow,' she said, meaningfully, after her weekly wheezy hobble into the surgery.

Real medicine is the process of making decisions amid diverse influences. It involves discussion, calm deliberation, and the capacity to balance valid but competing interests.

South Armagh is an uncertain country, violently necklaced by a ragged border and long deprived of industry and investment. People have had to learn to live by their wits, which may involve schemes such as smuggling whatever is in this week’s hit parade or playing the system like an old Stradivarius.

Mrs Dooley and I had always had a cordial, give-and-take relationship; I gave her what she wanted, and she took it. But this time I was conflicted; there is a Dark Side to being a country doctor. Sometimes we can know our patients a bit too well, and see things we aren’t meant to see.

Only the week before I’d witnessed her scamper, gazelle-like, onto the football field to berate an unfortunate referee whose decisions had displeased her.

Should I confront her, I wondered, weighing up my loyalty to the individual patient against the common good of a resource-depleted healthcare system.

I examined my conscience; 'Your options suck,' it told me, helpful as ever.

As so often in medicine, what’s right and what’s necessary aren’t the same thing. The common good and the individual good were in bed together, but individual good had the hot water bottle.

'No problem,' I said. 'You can borrow a wheelchair.’

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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