How To Be Good

It's a long time since I read Nick Hornby's book and I don't remember much of the detail, but it is not surprising that I was drawn to it, given that it is about a GP who is a wife and a mother, who is striving to do her best at being all three.

It is rare enough to meet a doctor who doesn't wake up every morning determined to do better. We are a quare bunch of type A do-gooders, who are bitterly disappointed if we feel we haven't done our best in a given situation. We like to be told we are Good People. We are cut to the core if we are told that we are not. 

We start off our adult lives as the top-scorers, the nerds, the bespectacled swots. We find a way of making this socially acceptable, by turning our 8As into an MB BCh BAO. We compete fiercely with each other, in the only we know how, by being clever. By studying longer. By being the first at the ward round, and the last to leave the operating theatre. By knowing the names of every statin trial ever published, and all the possible causes of hyponatraemia. 

This, I imagine, will be very reassuring for all you non-doctors. This is what you want to hear. "These guys are super-brainy and have super-great memories and know a whole pile of important medical-type stuff. Super."

I was never at the top of the class, and never knew ALL the important medical-type stuff. I shuffled along mid-table, happy out, pretty sure that I could be Good, if not Excellent, and that was Good Enough for me. 

And now I see what truly makes a Good Doctor.

There is no great revelation here, no light-bulb oh-my-god-why-didn't-I-think-of-that-before cleverness.
It's the same thing that comes up over and over and over when you ask for patients' opinions. 
It's not even the first time that the patient happened also to be a doctor (and, therefore, cleverer than most (insert cheeky emoji suggesting false modesty here).)

So I am not breaking any new ground (but then again, who does?)

In the past 26 months I have had multiple interactions with all kinds of nurses, doctors, physios, care assistants, receptionists, cleaners, dietitians, radiographers, accounts people and the nun who hands out the communion.

A good 90% told me their name. Fair play lads. 
I have forgotten most of them, to my shame.

I have had something like a dozen scans, a gazillion blood tests, a few colonoscopies (shudder) and an encounter with a lady on a commode (triple shudder).

What I haven't had much of is what you might call Clinical Skills 101. 

I have rarely given my full medical history to an admitting doctor. They usually just transcribe it from the (exceptionally accurate and detailed) oncology letters in my file. Fair enough, saves time, and is more than likely 100% accurate. 
But what if it isn't? What if there is a recurring error in there that has been repeated hundreds of times in my notes, because no one checks the "facts" by simply asking me to tell my own story? 

I have also been examined an approximate total of twice.
I don't mean sticking an MCQ paper in front of me and asking me to name three causes of hydrocephaly.
I mean physically examined, where the doctor puts his cold hand on my tummy and asks me to breathe in and out while he pokes me under the ribs. 
It seems the "modern" thing to do is to glance in the patient's vague direction while ordering a full-body CT. Sure that'll figure it all out. Who needs to waste precious time checking for rebound tenderness?

The physical examination provides so much more than diagnostic information. 
I am infinitely more aware now, when a patient comes in to me, that the laying of my hands on them is a significant part of the therapeutic process. If a patient leaves my room without my having checked their blood pressure, or held their wrist for a pulse, they will feel like the process is incomplete. They will feel short-changed. 
I never fully appreciated this until I felt the same.

It is easy to be smug about this, and say that GPs are better at the old-fashioned one-on-one medicine than hospital doctors, but the fact that we do not have immediate access to diagnostic equipment does mean that we have to use what's at our disposal. Our selves. And there is an unseen therapeutic value to this that needs to be recognised. 

Getting a patient to tell their own story teaches young doctors to listen rather than just hear. Going methodically through a physical examination creates a moment of silent connection between physician and patient which builds trust, engenders confidence and creates a therapeutic relationship. 
That relationship may only last ten minutes in a frantic Emergency Department, but for the patient it is often the start of their journey into the darkest moments of their lives, and they need the safety of that human connection.


Anybody can type "CT TAP" into a radiology request form. 

A good doctor reaches out their hand to a patient who is sinking into the quicksand of their worst fears. 

Turmeric!!

I forgot the flipping turmeric!!!

One of the few nutrients with an actual evidence base for cancer-defying-ness. 

Delicious with palm-oil-free free-range hand-reared home-popped non-GMO popcorn.

Working Hard

My brain is full of things to do. My patients are waiting. Some of them are grumpy. I am promising haste, but I cannot deliver. I have a fairly constant little voice at the back of my mind saying "there's something I've forgotten to do..."

This is entirely normal for a GP. Every day is spent frantically trying to do more than enough, to keep everyone happy, to allay fears and fill forms that need to be in tomorrow and fix that problem that's been going on for years. 

I am delighted to back in the thick of it, but I miss those days when I had all the time in the world to sit with a lonely widow, or crack through the steely facade of a scared father. 

I have other work to attend to as well. 

Keeping healthy is not as straightforward as you might think. 

First, there's the compulsory eight hours sleep. 

Then.

Oats (organic, stone-ground).
Berries (boiled to get rid of hepatitis). 
Bananas (not too many, your potassium will go bananas).
Green tea (not too much, it'll suck up all your folic acid).
Coffee (minimum 2, maximum 6 cups a day).
Wholemeal bread. No, sorry, wholegrain. Spelt if you can get it. Feck it, probably best to avoid gluten altogether. 
Vitamin D. Vitamin B. Vitamin C. Definitely Vitamin K. Not Vitamin E though. 
Probiotics. 
Fermented stuff (bound to be some of that in the back of my fridge...).
No red meat.
No processed pig.
No antibiotic-filled poultry.
No waste-filtering shellfish. 
No tuna (mercury).
No cod (non-sustainable. Save the fishies!)
No blue cheese. 
Organic muslin-strained home-knitted yoghurt. Pronounced correctly.
No unpasteurised dairy. 
Heck, what am I saying, no goddamn dairy at all!
A glass of red wine. One, I said. Red, I said. Not fizzy.
No refined sugar. Only common-as-muck stuff.
No salt. 
Wheatgrass. 
Cacao (whatever happened to spelling it cocoa?)
That stuff that turns into frogspawn when you add water. 
Watercress.
Kale. (Kak).
For the love of god, don't cook the vegetables!
Cook it to death! (see Berries above).

Meditate twice a day, 10 minutes minimum. 
Aerobic exercise, 30 minutes a day.
Pilates.
Yoga.
Aromatherapy.
Hydrotherapy.
Psychotherapy. No drugs though. Those pharma companies are evil disease-mongerers. 
Do not even get me started on the vaccines....

Set goals.
Fill a jar with post-it notes.
Talk to yourself in the mirror.
Pray. And mean it. He'll know, you know. 

Write. Sing. Row. Draw. Run. 





Yes, clever clogses. 
You have spotted that this is a preview of my soon-to-be best seller: The Sick Doctor's Guide to Having a Strong Argument with Cancer. 
A compilation of all the other self-help pulp out there, cleverly disguised as Medical Fact.

Happy New Year

I didn't intend to leave such a long gap between posts, and I didn't mean to make a big deal of January 1st by suddenly re-emerging into the blogosphere, but there you go. I guess I am innately melodramatic. 

The main news is that I went to see the Top Man in the posh place in Dublin. 
I was right, my insurance doesn't cover it. 
After sitting in the plush waiting room (for the same length of time I would have in HSEville) with the free coffee, the photocopied crosswords on the tables, the polished leather armchairs, the exceptionally ancient fellow patients, I go into to see The Man. He looks at my scans, says things like "blimey, what's that?" while occasionally glancing at me, tries to make thin banter about the Real Capital, and pronounces that yes indeed he can fix me no bother. 

"Emm but my insurance won't pay for it."
"Of course it will."
"Emm no it won't."
Given that we were right in the middle of Panto season, this could have gone on for some time. 
Thankfully, he is a man in a hurry and with secretaries, so he got them to do the next bout of to-ing and fro-ing. 
And indeed, once again, the getting-a-bit-impatient insurance lady said No.

"Not to worry, we will make you a public patient and the State will pay for you."
"Sure that's fine so."

Some minor protocol-avoiding meant I could toddle home again that evening and get stuck into the Christmas mayhem, and forget about the CyberKnife spongeing that I will be doing in a few weeks.


Outside of all this cancer stuff there was a lot more fun going on. 
I became one of the very few women who is ecstatic to be forty. Couldn't be happier to be getting old and grey.
I had a good party.

The week before, we went to a 50th birthday party. The week after, we went to a 90th. I like the maths of that. 

We had a pathetically wholesome Christmas, with beside-ourselves excitement when Santa came, and a swim in the sea which reaped huge respect despite it being really not that cold at all. I was very tempted to go for the bikini to show off my lovely scar, which would have notched the kudos level up to 11. But I don't like to be a drama queen....

Board games, organised exercise, chats, leaky mince pies, champagne, stinky cheese. We had the lot. 

And inevitably I am here now on the first day of the new year, thinking how grateful I am to be here, how lucky I am to have the people I love in my life, and how wonderful the world is.

Over the top? 

Maybe just a little bit. But it's my party!