3 minutes and thirty seconds to read
Sadly this is a totally true story.
It was my early days in rural general practice, trying to do a job I found virtually impossible. I would see over 60 patients per day in my “surgeries” (clinics), we would do sessions at a local prison and at a local hospital for the mentally handicapped, we were on call every second or third night with weekend surgeries, home deliveries, “minor” surgery, terminal care responsibilities and “call-outs” to all kinds of “emergencies”. Couple these with the fact that I had no training for general practice – nil – so the feeling of being totally overwhelmed was perhaps understandable.
Yet the very worst – and most resented part of my work – were the “house calls”; nowadays they call them “home visits” which sounds a lot more patient- friendly, but I spat out the words “house calls” with some venom, as they were nothing at all to do with “real medicine”. In fact a lot of these requests were a hangover from the pre-NHS days when important folks who could afford to do so would “send for the doctor”; naturally patients believed that they would be entitled to this service at the inception of the NHS, whether or not they could have made the trip to the doctor or not. As such the “excuses” for such requests included “no transport” and “not feeling well enough” as if feeling poorly would prevent their travelling to the hospital! The very worst part of all, though, was that I didn’t feel like a proper doctor when I did “house-calls” as I was rarely able to do the examinations and tests that would help to find treatable pathology and arrange for it to be sorted.
Then, one day, I was asked to see an 84-year-old lady – yet again – who, as was her custom, was in bed when I arrived, like a royal personage in her estate.
As always I suppressed my resentment with a false smile, refused her offer of a cup of tea and was about to beat as hasty a retreat as possible when I noticed it: a barely discernible ulcer with a rolled-up edge on her forehead – a classical BCC – a basal cell carcinoma (rodent ulcer) which could be cured easily. For once I felt like I was a “proper” doctor, making an astute early diagnosis and saving a life. I told her that I would refer her to the hospital and that this needed to be dealt with or it would keep on growing until it ate into her skull and brain (my bedside manner was still in its infancy). For once I left her domain feeling I had done something useful.
I didn’t see her for a couple of months; presumably the house call requests had been fielded by my partner. When she did “summon me” once more, I was horrified that the lesion was still sitting there on her forehead.
“Did they not remove it at the hospital?” I asked with some concern.
“I didn’t go to the hospital,” she finally admitted.
“Did you receive the appointment?” I asked, concerned that my referral letter had somehow gone astray.
“Yes, but I don’t want to go to hospital,” she said.
I was dumbstruck: this crazy old woman had refused my advice and my offer of a cure had been spurned.
As usual I suppressed my annoyance with a wry smile, while muttering something about ‘It’s your choice’ and making an exasperated exit.
Over the following years, I saw her many times; on each occasion offering to refer her for surgery should she want it. Each time she demurred, and each time I noticed the skin cancer grow a little bigger. Eventually she had a special “hat” made to cover the huge ulcer which had obeyed my prophesy and was slowly eating into her skull and beyond. By now I was reconciled to her ‘rejection’ and indeed had probably become a little more civil to this very ‘single-minded’ old lady.
Then, one evening as I was about to go home after a particularly challenging evening surgery, she phoned in asking for a “home visit”. As usual there seemed no particular valid reason for the call and I sped off with even more resentment than usual.
The visit went as always, leaving me unable to discern why she had made such a late request for a visit. I was about to leave when she pointed to a rather beautiful china teapot:
“Doctor, I would like you to have this,” she said smiling.
I was desperate to get home and bring the conversation to a speedy end:
“Another time,” I said with my usual false smile.
When I arrived at surgery the next morning I was horrified to learn that the old lady had died during the night. Like all young doctors, I felt an immediate anxiety at the unexpectedness of the death, but of course there would be no repercussions as I could easily complete a death certificate and there would be no problems with the relatives or indeed the coroner as my medical behaviour was beyond reproach.
It was only later, as I reflected on the case and shared it with my wife, that she rather astutely pointed out:
“She just wanted to say goodbye and thank you… you really should have accepted the teapot.”
Over the following months and years I thought many times about the old lady and her teapot, and began to recognise the wisdom of my wife’s comments and indeed began to feel a little guilty. In spite of my ‘brusqueness’, I had been an important person in this lady’s life and I had denied her last request – her last gesture of friendship to me – the gift of the teapot.
I slowly improved with time in general practice by learning from my ‘mistakes’ – yes, of course, on clinical matters, but even more about breaches of ‘kindness’. And it is these latter breaches which hurt the most as I become older; if only I could go back and do things differently…
I never did receive the teapot, by the way: I certainly didn’t deserve it, but the old lady gave me a lot more than a teapot – a painful lesson that will live with me for the rest of my career in medicine.