If symptoms persist.. .
I SOMETIMES wonder what patients think their insides are made of. Last week, an elderly lady of the mildest appearance informed me that her doctor had diagnosed a hiatus hyaena. I'd heard of the ravening beast within, of course, but this was absurd. What carnivore, red in tooth and claw, would be satisfied with mere antacids? I advised plenty of meat.
My next patient was a man with a plethoric face, who looked as though he spent his spare time writing angry letters to his local newspaper.
`Typical hospital,' he said as he came through the door of my room. `Hundreds of people waiting for hours and nowhere to park your car.'
Having heard on the highest authority that a soft answer turns away wrath, I apologised for any inconvenience, but pointed out that I was seeing him exactly at the time of his appointment.
`Yes,' he said, tut what about my next appointment? More than likely I'll have to wait for hours then.'
This is an example of what is known technically as anticipatory anxiety: wor- rying about something before it has hap- pened. Anxiety, of course, is one of the many ways of giving meaning to life: it fills an existential void. As we know, the void is vast, while matter is but a trifle.
After my clinic I went to the ward where those who have tried to commit suicide, or at least have taken overdoses, are treated. A lady there had swallowed a bottle of pain-killers because her hus- band habitually gambled all their money away, leaving none with which to buy food for their three children or to pay the bills. If she tried to conceal money from him, he beat her. The overdose, however, was a turning point. She was going to divorce her husband and live happily ever after.
`I've realised, doctor,' she said, 'that life's not worth killing yourself for.'
Amen to that.
At lunchtime, there was a meeting with the administrators. I go to such meetings only to pick up the latest man- agement jargon and to savour the wilder flights of fatuity. One of my colleagues complained at the meeting that black bags of rubbish — 17 at the last count had accumulated in the last two weeks outside his ward. The General Services Manager (a janitor in a suit) replied that he was dedicated to providing a high- quality service but was acting under severe financial constraints. The General Manager (Clinical Services) interjected: `Quality doesn't cost anything — and anyway, you can have too much of it.'
In the circumstances, one turns to the medical students for light relief.
Another colleague of mine, a specialist in the new and expanding but somewhat lugubrious field of terminal care, com- plained after the meeting that medical students these days were frivolous and had narrow horizons — unlike us when we were students. 'I asked one of them last week what a hospice was, and do you know what he replied? About four and a half litres, sir. Then I asked a female stu- dent what she thought of euthanasia. Do you know what she replied? She said she wasn't interested in the problems of the Third World.'
Theodore Dalrymple
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