Further Confessions of a GP

However, just occasionally, I do have the very satisfying opportunity to respond to an enquiry with a definitive answer.

One such question is: ‘Am I going to die, Doctor?’ This is one of the rare questions to which I can be 100 per cent sure of giving the correct answer: ‘Yes, you are definitely going to die. We are all going to die.’ I appreciate that the patient is usually asking whether they are going to die in the immediate future, but the reality is that as soon as we try adding that sort of clarity to the answer, we start moving back into that very unsatisfactory grey area again.

‘Is there a bug going around, Doctor?’ is perhaps the only other question I am commonly asked that I can always answer yes to. Unfortunately there is always a bug going around. It’s how bugs roll. If they stopped going around they’d die out, which sounds appealing, but according to microbiologists would result in disaster. I’ll take their word on that.

A less common question asked by a patient recently was whether it was okay for him to have sex with his partner via her colostomy. Now, I really don’t consider myself to be particularly prudish – patients tell me about all sorts of slightly alternative sexual behaviours and I rarely raise an eyebrow. Even if I wouldn’t necessarily choose to partake in all of the said activities, anything that takes place between two consenting adults in the privacy of their own home is okay with me. Not colostomy sex, though. That’s a straightforward no.

David

I don’t think it will be a great surprise to any of you to hear that a reasonably high number of the patients who come in to see me leave my room without receiving a definite or immediate diagnosis from me. The great advantage I have in general practice is that time is by and large on my side. The patient in front of me is usually not severely unwell. They may well be in discomfort, worried and upset, but they are very rarely just about to expire before my eyes. This means that there is a bit more time for me to work out what is causing the aching legs, funny rash or tiredness that my poor patient might be suffering from.

However, working in the emergency department, time is often at more of a premium.

When the paramedics brought in David, barely conscious and with slow breathing, I really needed to work out quite quickly what was going on. I couldn’t rouse him enough for him to tell me anything, so I was left with the tricky task of trying to deduce the cause of his comatose state from hundreds of possible causes.

The best place to start was with the information that the paramedics already had at hand. They told me that David was 31 years old with no past medical history of note. He had been looking after his two-year-old daughter while his wife was working her shift as a nurse. He was absolutely fine when she left for work, but when she arrived home she found David lying unconscious on the sofa. Fortunately their daughter was unharmed and happily watching CBeebies, apparently unaware of her father’s poor health.

Why had a young, previously healthy man suddenly gone into a stupor? I started trying to work through some of the more common causes. I began with diabetes, but his blood sugar was normal. There were no signs of infection and no signs of a head injury that might have knocked him unconscious. His breathing was slow, but his lungs seemed clear. I was hedging my bets that something was going on in his brain and so was sure that the CT head scan I had just ordered was going to throw up some answers. Top of my list of suspicions was that an aneurysm in his brain had popped, causing a type of stroke. We managed to get the CT scan done pretty quickly, but to my surprise it came back completely normal.

Nearly 45 minutes had now passed and I still had absolutely no idea why David was unconscious. He was stable, but although he wasn’t getting any worse, he definitely wasn’t waking up. His wife had managed to find someone to look after their daughter, so was at his side, looking understandably upset and worried. I felt under huge pressure to work out what was going on. What was I missing? Barry the charge nurse wandered back from his break and took a glance at David. ‘Sure he’s not overdosed on something?’ he asked.

‘He doesn’t look like a drug user,’ I responded.

Barry gave me a sideways look. ‘Come on, Ben, you’ve been doing this job long enough to know that doesn’t mean a thing. He’s a youngish bloke, unconscious with slow breathing. We both know the most common cause of that.’