Confessions of a GP

Over the next two and a half years, Kieran proceeded to have several courses of radiotherapy and chemotherapy for his cancer. He had periods of remission but, unfortunately, they were always followed by a relapse. Our worlds had always been very similar, but now they seemed far apart. I would sit in lectures learning about the side effects of chemotherapy and just a few floors above me Kieran was lying in a hospital bed losing his hair and vomiting his guts up. I used to pop in to see him between lectures and even wheeled him, drip in tow, into our student union bar to watch a few of the big England games during the 1998 World Cup.

Kieran came from a big Irish family. During my teenage years, I had spent a lot of time at his house and I knew his parents well. There was no one medical in his family and during Kieran’s treatment his parents clung to me as a source of medical knowledge and as someone to translate the jargon into real English. I didn’t really want this role. I was only a couple of years into medical school and hadn’t even heard of non-Hodgkin’s lymphoma when Kieran told me he had it. I wanted to be there simply as Kieran’s friend and wasn’t ready to play the role of doctor during this awful illness.

As I progressed through medical school, Kieran’s cancer spread and worsened. I learnt more medicine and did begin to gain a limited understanding about some of the medical components of his illness and treatment. Eventually, the cancer spread to his brain and although Kieran and the rest of the family seemed to view this as only a minor setback, my basic medical knowledge was sufficient to know that the prognosis was now very poor. Just after Christmas 1999, Kieran declared that he had been given the all clear. He hired out a bar and threw a big party to celebrate. Kieran still looked terrible but told everyone it was simply the aftereffects of his chemotherapy. Deep down I knew that something wasn’t right but I so wanted him to be cured that I let myself believe that he was. While his friends got drunk and partied, Kieran sneaked off home and took a massive overdose. He had been told earlier that week that his cancer was now untreatable but he clearly didn’t feel able to tell us this. He wanted to have a big party and then go out with a bang. I guess he needed to take back some control over his life that had been ruled by the cancer for so long.

Kieran’s overdose was unsuccessful and he had two more precious weeks before he died peacefully at home. He had the opportunity to say goodbye to family and friends, plan his funeral and decide where he wanted his ashes to be scattered. We were all grateful for those last weeks and I hope Kieran was, too. At his funeral I remember his mum hugging me and, as we both wept she said to me, ‘This will make you a better doctor.’ An amazing thing to be said by a woman who had just lost her 22-year-old son. I just hope she was right.

Peter

‘’Allo, Doc. We’ve got a right one for you’ere. Mad as a box of frogs. We found ’im running down the middle of the dual carriageway completely starkers and shouting in gobbledygook.’

It was 3 a.m. on a cold February night and I was on call for psychiatry. The police had picked up my latest patient and, after diagnosing him with being ‘as mad as a box of frogs’, a common police diagnosis, they kindly dropped him off at the psychiatric ward for me to assess. The man, who we later found out was called Peter, was in his early twenties and looked fairly frightened. He was shouting in an unfamiliar language and was miming being attacked and chased. He gave the policemen each a hug (very much unappreciated) and they left him in my less than capable hands. Peter was wrapped in a blanket kindly donated by the local constabulary and given how cold it was outside, I wondered quite how he had survived any length of time being completely nude out on the dual carriageway in the middle of nowhere.

The most likely diagnoses going through my mind were some form of paranoid psychosis, possibly drug induced or maybe schizophrenia. He may have been having some form of manic episode but without him seeming to understand a word of English, the assessment was very difficult. We sat in a quiet room and I tried in vain to communicate, as did he, but we got nowhere. He had no clothes, no wallet and absolutely nothing to identify himself with. I admitted him to the psychiatric ward. What else could I do?