Further Confessions of a GP

I’m not against the idea of weight-loss surgery being performed on the NHS. Ideally we would all be slim and healthy due to vigorous diets and abundant exercise, but the reality is not that straightforward. Many people simply can’t manage to control what they eat and so end up overweight. When the weight starts getting to dangerous levels, a gastric band can completely turn someone’s life around. Some might argue that the cost of the procedure should never be fronted by the taxpayer, but successful gastric band operations can often cure expensive diseases such as diabetes and high blood pressure, returning to health and work people who were previously facing a future of illness and disability. The potential savings to the taxpayer are enormous.

Most patients who have a bypass operation simply can’t manage big meals any more. They feel full and sick if they eat too much, and soon learn to lessen their portion sizes. But I guess Donna was finding that old habits die hard.

‘Donna, I don’t think you need to see a surgeon. The gastric band is doing what it’s supposed to do.’

‘But this band makes me feel sick all the time.’

‘No, you will feel sick if you try to eat as much as you did before the operation.’

‘But I never really ate much anyway and now I eat even less.’

Donna looked suitably insincere – so much so that I didn’t feel I needed to mention that I had witnessed her choice of breakfast that morning.

‘Let’s make a deal. I want you to promise that you’ll make a massive effort to eat much smaller portions of food for the next two weeks. If you can do that but find you are still feeling sick I’ll refer you to the surgeons on the NHS.’

Donna nodded with what I took to be genuine earnestness, and, sure enough, she didn’t return. I’m hoping that next time I see her, the nausea will have gone and along with it some of the weight.

Karen’s baby

I like doing antenatal checks; it is one of the few times during my day that a patient isn’t coming to see me because they are unwell. The process of measuring pregnant tummies, listening to foetal heartbeats and having chats about baby preparations is a lovely part of my job. Karen’s appointments had been no exception. She was very excited about the arrival of her first child. The pregnancy had been normal and her antenatal appointments with me had been unremarkable.

I only got wind that something had gone wrong when I received a letter from the hospital. Karen’s waters had broken a few weeks early, and her baby had then started to show signs of distress during the later stages of labour. The hospital team had initially tried to use forceps to get her baby out and then went on to perform an emergency caesarean section. They discovered the umbilical cord was wrapped around his neck. When he was finally delivered, the baby didn’t start breathing. The paediatric team tried to resuscitate him with oxygen, and when he still didn’t breathe he was put on a ventilator and rushed to the neonatal intensive care unit.

It was touch and go for several days, during which Karen barely left his cot side. Her baby son Wesley had been starved of oxygen for too long during the birth, and it had caused some damage to the brain. Ironically, by a mechanism I don’t fully understand, the oxygen that was then given during the resuscitation period to keep him alive went on to cause further brain damage. The brain scans confirmed that quite extensive damage to Wesley’s brain had occurred, but the neonatal specialists explained that only time would tell how severely disabled he really was.

It was several months before I met Wesley for the first time. He had been kept in the special care baby unit for 12 weeks and there were all sorts of ongoing problems. For Wesley to leave hospital he needed to have a mobile oxygen supply and also a special feeding tube that went into his stomach via his nose. I popped in to see how they were getting on on my way home one evening. ‘He’s gorgeous,’ I said, as I peered down at Wesley in his specially modified cot. If I’m completely honest, he wasn’t gorgeous. He was odd looking with a large forehead and bulging eyes. He could sometimes focus on light in the way that a baby a few days old might, but he wasn’t smiling or showing the sort of interest in the world that a normal three-month-old would.

Karen looked down at her son with immense pride, and it really moved me to witness the overwhelming strength of a mother’s love. From the outside all I could see was an abnormal-looking disabled baby, but the maternal bond she had with her son was as strong as any mother’s could be.