Expecting the unexpected, by Dr Sarah Woodhouse, Cheshire
I sat in a meeting one quiet weekday lunchtime, the only thought troubling me being whether to try the fruit tart or the chocolate eclair from the drug rep's buffet.
Life as a GP registrar in a pleasant semi-rural practice had advantages over my last job. Being an SHO in inner city hospitals had been like working in a war zone. General practice was a walk in the park by comparison.
A late call came in. It was a mum whose 14-year-old daughter had been constipated for a few days and was now rolling round the bed in agony.
In those days I found home visits a pain. An inefficient use of my time, I would try anything to avoid them. So I reached for the prescription pad and was just about to write 'Lactulose' when David gave me a funny look.
David was one of the older partners in the practice and a proper Dr Finlay type. Slow and painstakingly thorough, his surgeries always ran late.
Our consulting styles were at opposite ends of a spectrum. I used to pride myself on a brisk no-nonsense style, non-directive and with the emphasis on the patient taking personal responsibility for most things.
David on the other hand would listen endlessly to patients' problems and deliver moral guidance, especially advising co-habiting couples to get married. I didn't approve.
David grabbed his on-call bag and said urgently: 'Let's go.' I wondered what all the fuss was about but thought 'typical', put down my sandwich grudgingly and followed.
David didn't say much on the journey. I was still wondering what the fuss was about when we arrived to a scene of chaos and a cast of what seemed like thousands of agitated relatives.
As soon as we were inside we could hear the healthy cries of a newborn baby. David shot upstairs with me following behind, slowly realising what he must have suspected all along.
He wasted no time in cutting the cord, delivering the afterbirth and ushering everyone out of the room. I dithered uselessly, feeling overwhelmed and not sure what to do.
Mum was crying hysterically outside, while Dad paced the house vowing to kill whoever was responsible.
The young girl looked shocked and scared.
Then came the bit that stays with me 15 years later. David handed the wrapped up baby to the girl and sat on the edge of her bed. He took her hand in both of his and smiled at her. 'Well done, you've a beautiful baby,' he said, 'and she's very lucky, because you're going to be a wonderful mum and everything's going to be fine.'
The girl's panicked look vanished and she started to smile. I got something in my eye and had to fumble for a hanky. Then sirens wailed and an ambulance arrived.
I learned several lessons that day. In general practice we're faced with many situations that aren't ideal.
Life often isn't ideal. It's our job to deal with the technical side of these situations as expertly as possible, whether it's someone old with dementia, someone with a limited prognosis or a scared 14-year-old with a concealed pregnancy.
But there's so much more to it than that. We have to see the humanity in the situation and give people hope, even when things seem hopeless. In fact, especially when things seem hopeless.
Dr Woodhouse wins a cash prize of £400
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Mrs K, by Dr Antonio Munno, Bedfordshire
I fill the silence by watching the repeated movement of her hands as she weaves her fingers to a ball and then straightens them to a steeple. A simple rhythm, like her breathing or her heartbeat.
'Thank you for coming back to see me.'
Without looking up, she separates her hands and rests them on her knees.
'I know you've been through a lot in the past few weeks, and I thought it would be a good time to see how things are.'
The hem of her black skirt flickers as her fingers grip her thighs.
'The news must have been quite a shock for you.'
'Yes, it's been very hard'.
Her hands come together and again she starts to weave and straighten her fingers. When she squeezes her knuckles, the tips of her fingers go red.
I saw Mrs K three weeks ago and sent her for tests. She has metastatic cancer. There is no treatment and she will die in a few weeks.
'I wanted to talk to you about some of the things we can do to help you.'
'Thank you,' she says, as she lifts her head and meets my eyes. Her skin is dark and her face is lined, like a walnut or the bark of a tree. She repeats the thank-you, this time with a small nod. Her gaze settles in the distance, over my shoulder.
When I had seen the letter from outpatients confirming her condition I had to put the rest of that day's correspondence to one side. I opened my door, left my room and walked through the waiting-area towards the kitchen, so I could feel part of the movement of staff and patients.
'Mrs K, we want to make sure that you are as comfortable as possible. It's important that we are able to respond to your needs as your situation changes. We will help with any pain or sickness; we'll make sure that your house is properly equipped and that you are seen regularly by the nurses.'
She raises her hand to her face and traces the line from her cheek to her chin. She stretches her neck and drags her fingers over the gold chain that threads its way inside the collar of her black cotton jumper. She finds the crucifix and rubs it between her thumb and finger.
In the kitchen, I waited for a colleague to join me because I needed to share the story and lift it off the page of the clinic letter. The words I used were those of the traditional medical history - the presentation of a 78-year-old woman with abdominal swelling - but woven silently between the phrases was my lost sadness.
'I know there is a lot to take in, but I want to make sure you understand that we want to make things as comfortable as we can for you.'
'I understand.' She pauses and then, as she grips the seat of the chair and straightens her shoulders she asks: 'Do you know what the most difficult thing is?'
I sit back and shake my head.
'The most difficult thing is that I cannot pray. For 70 years I have, and now I can no longer pray.'
The muscles around her eyes tighten, as if she is squinting into the sun. She is looking in my direction, but her focus is a long way from me. I understand. I have hijacked her story.
Mrs K's problem isn't pain or nausea or bowel care or nursing support.
Those were my concerns, not hers and the talk of putting them right was about comforting me, not her. I placed myself in her story and measured her experience from my own position. I thought I had a privileged view, but I was looking the wrong way.
I look down at my hands. I stop talking and I start to listen.
Dr Munno wins a cash prize of £250
Home visit horror, by Dr Sabha Mohsin, Essex
I was in my second month as a GP registrar. After finishing morning surgery that day, I looked on the computer for my designated home visit. I had been assigned a 71-year-old gentleman who had phoned earlier that morning complaining of backache following a fall, and had requested a GP to visit him at home after midday.
On a normal day, I would have phoned the patient prior to leaving, taken a short history to know what to expect when I got there, and told the patient when to expect me. That day was different, because I did not call.
I arrived at a detached house in a suburban cul-de-sac. I approached the door and noted that the key was in the door. I did not think much of this; I had visited patients with limited mobility before, who had on occasions left the door ajar to allow me to enter the house. I rang the doorbell several times but there was no answer. So I used my mobile to phone his land line to see if there was a response. There was not.
After deliberating for a short while, I decided I would use the key to enter the house. It was dark and creepy in the hallway. The lights were off and the curtains were drawn. There was an eerie feel about the place.
The door for the downstairs WC was open, so that I faced it as I entered. On it was stuck a letter with a sticky note, which read: 'Enter only if you are the visiting doctor'.
I took the letter off the door and opened it. In it was a letter which read something along the lines of: 'Dear Doctor. Thank you for attending to me today. The reason for your visit is to certify my death.'
He continued to write about his long suffering with prostate cancer and incontinence following treatment. He wrote of how despondent he was at being told there was nothing more that could be done for him. He had no family or friends and left a number for the executor of his will. He then pointed me to further letters including one for the medical services and one for the police.
His final paragraph was something like this: 'Please could you discreetly remove my body, so as not to disturb my neighbours. There is a pulley system upstairs next to the trap door in the loft, for you to lower my body, and a hacksaw to cut me down.'
I then twigged what was in store for me upstairs. I was petrified and numb. I ran from the house. I managed to contact a colleague who alerted my trainer. My trainer arrived and asked if I was alright. Together we then plucked up the courage to approach the door, both visibly trembling. My trainer opened the door and asked me to wait outside. She entered and made her way across the hallway and up about ten stairs.
As she looked up from the landing, she realised what the shadowy image in front of her was: the body of a man with a plastic bag over his head, suspended by a cord coming from the loft.
This experience, so early on in my career as a GP, has confirmed how unpredictable our work can be. This scenario is hopefully one which most doctors will never face. However, as doctors we may feel obliged to place ourselves in situations where we feel uncomfortable or unsafe. I think it is essential to consider our own safety first and call for assistance when we find ourselves feeling that way.
Also, the pre-planning involved in this suicide and the fact that the steps I would take had been mapped out by somebody else made me feel disconcerted. This patient probably had no idea what effect his actions had on the lives of the doctors involved. Perhaps he thought it was 'all in a day's work'.
Dr Mohsin wins a cash prize of £150.