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Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 2008 October 1; 58(555): 740.
PMCID: PMC2553547

A patient's diary:

episode 22 — Please doctor, don't leave me now!

I woke up this morning feeling distinctly unwell and not for the first time either. There was a strange metallic taste in my mouth and a lump in my throat when I swallowed, which seemed to correspond to a tender spot just below my Adam's apple on the outside. There were also the usual abdominal gurgles (probably the malfunctioning pancreas, but one can't be sure) and a sort of heaviness in the lower chest as if something was lying in wait. Now I am not the worrying type as a rule and if I do have a health problem, I'm quite sensible about it, make an appointment with one of the doctors and go and have it sorted out. I must say, they are usually very good, provided it is something straightforward and easy for them to understand. Like perhaps, a nosebleed or a few black spots before the eyes. The difficulty comes when the symptoms are subtle and complex, and rather hard to pin down, as mine are at present. I've tried to be helpful by writing everything down in my notebook and taking it along, but that seems to make them restless for some reason. So I end up with a useless prescription or hints that my condition is all due to ‘anxiety’ or ‘stress’.

Yet I know that there is something fundamentally wrong inside that even my operation didn't reveal. I know Mr Cutler had a good look round when he took out my appendix; but did he really check every inch of both the small and the large intestine? Sometimes I can't help wondering whether, brilliant man though he is, he might have put some of it back the wrong way round or with a kink. I mean, how can I tell? I am not an expert.

As I was chewing on these morbid thoughts along with my breakfast muesli, I became aware that Hilda was speaking to me. ‘Norman,’ she said, ‘did you know that Dr Phillips is going to leave the practice?’ It was like a sudden douche of icy water. ‘Leaving?’ I gasped, ‘Where did you hear that?’ ‘Mrs Bishop was telling me,’ Hilda said casually, as if it was of no importance. ‘She said Mrs Knight had told her she'd heard Ivy Flagg say another doctor would be coming to replace her next month.’ I was so upset I could hardly finish my muesli. Of all the doctors at the surgery, Dr Brenda is the most patient and helpful. Besides, I am registered with her; her name is on my medical card. Surely she couldn't just decide to leave without telling me, there must be some mistake. Then I thought, perhaps the strain of worrying about my case for all these years has been too much for her on top of having three children to look after. Quite honestly, I don't think that husband of hers is a lot of help. He's out playing golf most weekends from what I hear, or drinking with his cronies in the bar, more likely. Anyway, I decided I had better go and see Dr Brenda as soon as possible before it was too late. I got on the phone to Mrs Flagg to secure the last appointment for the afternoon surgery.

During the day I was somewhat preoccupied by nagging doubts and fears. How much longer would Dr Brenda be available? Would she have time to really find out what was wrong with me before she left (if she really was leaving). Perhaps it was already too late, the pathological process having by now gone too far to be arrested. She had decided to leave the practice rather than continue the hopeless struggle to save my failing pancreas. In this way the day dragged slowly by. I went through the daily tasks at work purely mechanically and scarcely said a word to anyone. At last it was time to go to the surgery. Would this be the last time, I wondered as I entered the familiar welcoming door. I sat in the waiting room, trying to get all the things I wanted to say in the right order in my mind. When the buzzer sounded for my turn I stepped into the familiar consulting room with its pots of geraniums and pictures of the children — and wondered if it would all be different in a month's time: redecorated in a cold, impersonal style by a new doctor to whom I would be just Another Case.

Dr Brenda greeted me cheerfully and looked no different from usual, which was reassuring. ‘Well, Norman,’ she said, ‘how are you today?’ So I tried to tell her all about my symptoms in proper chronological order just as I'd planned, but somehow it came out all muddled and confused. Why couldn't I make myself clear? I began to panic. This might be my last chance to explain and I was making a mess of it. Suddenly, I ran out of words and could only sit there, breathing heavily and trembling all over. Dr Brenda was silent too for a few moments. Then she said something about was there something upsetting me. I don't know if it was what she said or the way she said it but I got a big lump in my throat and started to feel a bit tearful. I heard myself saying, ‘is it true that you are going to leave next month?’ Then she put a hand on my arm and said gently, ‘No, of course not. It's nurse Sarah who is leaving. Her husband has got in job in London and they are moving house so she is going to work in a practice down there. I am not moving. I shall still be here to look after you, Norman.’ And she gave me a big smile.

I can't remember very clearly what happened after that. I felt that I had made a bit of a fool of myself, but it didn't matter because she seemed to understand and she was so nice about it. And she is not leaving after all, which is a great relief.

I am to have my chest X-rayed and go back to see her next week to get the result and let her know how I am getting on. Of course it's going to take a long time to really get to the bottom of my condition, but I am feeling much more optimistic. The body has great powers of healing and regeneration. Already my intestines are feeling more settled and the bubbling in my pancreas is scarcely noticeable. And, the best thing of all, that terrible, heavy feeling in my chest seems to have lifted completely.


We are grateful to John Salinsky for these extracts from Norman Gland's diary.

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners