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The Truth

July 16, 2013

I wrote for the BMA News Writing Competition 2013. And got nowhere with it. Ah, well.

This is a completely fictionalised encounter between a GP and their patient.

I check the list on the computer to see who my next patient is, and with a silent groan, I see it’s you. The screen throws up your personal nosology; obesity, hypertension, diabetes, all poorly controlled, and of course, the chronic liver disease, the booze and the cirrhosis. Morbidly impressive for a man not much older than myself, not yet fifty. Will you even see fifty?

What is it this time? Electronic scans of discharge summaries ping up into my vision. Today is a follow-up for a recent hospital admission with delirium tremens. I’m surprised but not shocked. After reviewing a few blood tests – your LFTs are beyond deranged – I rise to call you from the waiting area. A palpable miasma of stale beer follows me back into my office.

“How’s it going, doc?” You ask jovially, light-hearted as ever. I stare at my computer screen, pretending to read, as I compose myself. I feel the weight of that permanent cheeky grin of yours on me.

“Good, Michael.” I reply curtly, “I see you were in hospital a little while ago. Can you tell me about that?”

“That? Oh, well, there’s not much to tell.” You shrug, fiddling with your sausage-like fingers. There’s a tan-line around your ring finger. I assume that wedding band has finally become too tight for you. “I had a few too many one night, then a few too little the next night. Felt awful, I did.”

Awful is one way of putting it. Rushed into A&E, feverish and seizing is another, more accurate way.

“You know why this happened, don’t you, Michael?” I asked, trying to pitch my voice at the right blend of sympathy and concern, “It’s the alcohol. More than just the shakes; your liver, your blood pressure, your weight. It all comes down to the alcohol. If you could stop, or at least cut down, you would do yourself a world of good.”

You are silent after that and for a moment, I dare to hope that I’ve gotten through to you. “You’re right.” You nod soberly. But that cheeky grin is quick to reassert itself. “But the way I see it, doc, I’ve just got this one life so I might as well enjoy it. Besides, I’m mainly a social drinker. I don’t think I’ve got a serious problem.”

Your body has volumes of evidence to the contrary.

“Could you just try to drink one less beer a day?” I scramble for a compromise. I don’t want this consultation to be another wasted ten minutes.

“Alright, for you, doc.” You wink at me, as if it’s a favour you’re doing for me. You make to rise from your chair, a disorganised displacement of adipose.

It wasn’t always like this, I reflect. You were one of my first patients, when I was newly qualified. You had a bit of a paunch and liked a drink back then too but no more than the next man. I gave you advice, on diet and exercise, and I think you genuinely tried to follow it for a time. Then your weight began to creep up, and your blood pressure followed. I remember asking, for the first time in months, how much you drank and being left speechless by the answer. That was when you came to me for reflux. That was when I first noticed, took note, of your decline away from health.

Yet the more your health deteriorated, the less you seemed to care. That dopey grin you always wear grew from a boyish smirk into a rictus, mocking me. Whenever I tried to help you, explain how bad things could get, my eyes would flicker to the otoscope as I wondered how many of my words would fall on deaf ears.

Why is it that the less you cared, the more I cared? Why, when you leave the clinic room, am I the one shouldered with the obesity and hypertension and all the other risk factors? Why am I going grey in despair for you? Why is it that your bad decisions keep me up at night while you sleep soundly? Why do you make me feel guilty?

Perhaps, before you go, I should explain things one more time. You’ve had the lectures before, and every scrap of advice I know, but I’ve never given you the whole truth. How would you react if I told you that your problems were not just your burden? What would you do differently if I said that your drinking affected not just your heart but mine too, my peace of mind as well as your liver?

Who am I kidding? That kind of heartfelt emotional plea might get you to cut down by two beers a day, for a week at the most. La belle indifference est invincible.

You’re nearly at the door when my reverie evaporates. Something on the computer screen, previously unseen, catches my eye.

“Michael, it says here you’re single. What happened with Janet?” I inquire with concern. Your hand on the door handle, you hesitate and turn.

“Divorced. A few months ago, actually, but I’ve only just got the details changed at reception.” You shrug, that grin of yours slipping. “She couldn’t stand me drinking all the time. Said either the booze had to go, or she would.” You chew your bottom lip and look at me, “Guess you know what I picked.”

“I’m sorry to hear that.” I reply, “Why didn’t you tell me? I could’ve helped you.”

“I didn’t want to worry you, doc.”

I want to laugh but stop myself. If only you knew! I gesture at the empty chair between us. This consultation isn’t over yet. You seem to agree as you return to your seat.

“How have you been coping?”

“You want the truth, doc? Lately, it’s been hard on me…”

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