Further Confessions of a GP

I had never met Danni’s children, but I had read her notes. They had been with her for a few years before being taken into care and from what I could gather being taken away from Danni was the best thing that had ever happened to them. They were thriving with a new foster family who were hoping to adopt them. They were settled in a new school and flourishing in an environment of security and stability that Danni could never offer them.

‘To be fair, Danni, how many times have you promised that you’re coming off the drugs before? You can see why the social workers might be dubious.’

‘It’s different this time. I love those kids. They’re mine. They had no right to take them away. Why won’t anyone believe me when I tell them that I love them?’

‘But it’s not enough just to love them, Danni.’

Danni was silent and I regretted my words.

‘So you think I’m a shit mum as well?’

‘It’s not that, I know you love your children, but kids need more than just to be loved. They need to grow up feeling safe and secure. They need routine and adults they can always rely on. I’m not saying that you won’t be able to offer them that one day, but I’m not sure you could right now.’

Danni looked really hurt. Filling up with tears she looked at me with venom.

‘I thought you were different, Dr Daniels, but you’re just like them. Judging me and making decisions about my life you’ve got no right to make.’

With that Danni was gone.

Danni was my patient and my duty of care was with her, but I couldn’t support her trying to take her children back. How I could I write a letter suggesting that they should leave their settled and happy life and be thrown back into the chaos that was Danni’s? Those children had a golden opportunity to break free from the cycle of misery that had engulfed Danni and I couldn’t endanger that. Maybe Danni could break free too. Maybe this time was different and she would turn her life around. Perhaps I’d got things completely wrong and Danni could become a fantastic mother? It was a risk I was going to have to take and although Danni feels let down by me right now, I hope that someday she’ll agree it was the right decision.

Funny X-ray

It was another chaotic morning in A&E and my first patient was being wheeled into the department on a specially reinforced trolley. Like other 999 services, our local paramedics had invested in some reinforced equipment in order to cater for the ever-increasing size and weight of the local population. The woman being wheeled in was huge, and we needed to transfer her from the special strong-and-wide trolley to a strong-and-wide hospital bed.

The paramedics told me that the woman had collapsed at home, and by the exhausted looks on their faces I could imagine it had been quite an effort to get her up off the floor. How they managed it I don’t know, but they certainly deserved the cup of tea that was waiting for them in the staff room. There wasn’t much more the paramedic crew could tell me about their patient, so I tried to ask her a few questions. Unfortunately she was confused and drowsy and only mumbled a few nonsensical remarks, so I soon gave up.

There are numerous reasons why a patient might be admitted confused and if there is no background history to help point us in the right direction, the obvious next step is to examine the patient. Sometimes examination findings alone can give us all the clues we need, but when a patient is as large as the lady in front of me was, most of the clues potentially gained from the physical examination are hidden under layers of fat. I tried to listen to her lungs, but as I endeavoured to find somewhere on her back to lay my stethoscope, I was met with so many rolls of fat that it was tricky to find a flat surface on which to place it. I tried in vain to listen to lung sounds, but the lungs were separated from my stethoscope by so many inches of fatty tissue that the sound couldn’t be transmitted and I heard nothing. Examining the abdomen was no easier. As I pressed my hand on to her tummy, I knew that there was no way that I would be able to glean any useful information about the organs buried deep below. I could just about feel a pulse in her wrist and so I knew she had a heartbeat but unfortunately, again, I couldn’t hear it. The ECG machine, blood pressure monitor and oxygen probe were struggling as much as I was, and after 10 minutes I realised that I was absolutely none the wiser as to why this lady was unwell.