The Monthly (Australia) - - CONTENTS - by Karen Hitch­cock

The minute I was ac­cepted into med­i­cal school I be­came, in the eyes of my friends and fam­ily, a pro­fes­sor of ev­ery clin­i­cal spe­cialty, with a side­line in ve­teri­nary medicine. The calls started al­most im­me­di­ately. Overnight, I trans­formed into that re­spected (if oc­ca­sion­ally lethal) per­son in the me­dieval vil­lage who had no train­ing but was some­how the one ev­ery­body went to for treat­ment and coun­sel. I had a new author­ity I hadn’t earned, didn’t want and (de­spite anxious protes­ta­tion) couldn’t negate. Af­ter I grad­u­ated it be­came harder to cry com­plete ig­no­rance. Say­ing I didn’t know turned me into an ob­ject of con­tempt. It’s dif­fi­cult to know and harder to be right about a clin­i­cal sce­nario re­lated by email. A few years ago a par­tic­u­larly hypochon­dri­a­cal fam­ily mem­ber (who only calls when she has a med­i­cal con­cern, usu­ally a sin­gle episode of di­ar­rhoea) thought she’d bro­ken her lit­tle toe. Ter­ri­fied, she told me the story and symp­toms. I said it prob­a­bly wasn’t bro­ken, but even if it was she wouldn’t score a cast, and that she should just be gen­tle with it and it’d get bet­ter by it­self. She sounded doubt­ful. I re­as­sured her. Her doubt es­ca­lated. “Well, if you’re wor­ried,” I said, “maybe go see your doc­tor?” Later that day I re­ceived an SMS – no words, just a photo – of an X-ray of her foot with a big red ar­row point­ing to a tiny cracked bone. I could feel it so sharply, her con­tempt. When my sib­lings had chil­dren my task was to ad­vise, from in­ter­state, over the phone, about the need or not for their infant to be hos­pi­talised. I’d lis­ten to long, ram­bling sto­ries about mu­cus and vomit and what might be a rash and some­one they knew who knew some­one whose kid was just like this and was re­as­sured by their doc­tor and the kid ended up in in­ten­sive care, al­most dead. For a very ju­nior doc­tor who’d never laid eyes on a sick child, th­ese calls were a source of great dis­tress. I’d lis­ten, my mind scream­ing un­speak­able words, words like meningo­coc­cal menin­gi­tis, acute lym­phoblas­tic leukaemia and os­teosar­coma. I’d say, “Does he have a fever?” They’d say, “Hold on,” and come back and tell me his fore­head felt hot. Ev­ery­one’s fore­head feels hot. Ev­ery­one’s throat looks red. How else would we score days off school? I bought elec­tronic ther­mome­ters for all my fam­ily mem­bers and told them not to call me with­out a read­out. I com­pletely un­der­stood their im­pulse to call me and prob­a­bly would’ve done the same. I do do the same, to my friend Mike, a very ex­pe­ri­enced physi­cian in his late six­ties. In the past few months he’s talked me down from a self-di­ag­no­sis of im­mi­nent di­a­betes (be­cause I found a tiny skin tag) and melanoma (that was a blood blis­ter), and he stopped me get­ting an MRI for my achy, post-work-out knee. If you’re plan­ning on hav­ing a doc­tor in the fam­ily I rec­om­mend a gen­eral prac­ti­tioner. One of their great­est skills is the abil­ity to triage the mourn­ful from the sick. And the sick from the sick-sick. With­out a full set of obs, a bat­tery of blood tests and an X-ray or two, hos­pi­tal doc­tors like me aren’t very good at that, es­pe­cially not early in our ca­reers. Pick­ing the sick from the sick-sick is the most use­ful skill a fam­ily-mem­ber-doc­tor around the din­ner ta­ble or on the end of a phone can have. Quiet, febrile, floppy and anuric (not pass­ing urine) is emer­gency-depart­ment bad. Scream­ing and snotty is prob­a­bly a-trial-of-parac­eta­mol bad. I know that th­ese phone calls and cor­ri­dor con­sults are not rec­om­mended prac­tice. And I sup­pose that tech­ni­cally my ev­ery re­sponse should be “go see the GP”, but rules and rec­om­men­da­tions of­ten get bent and bro­ken for good rea­son. My brother, for in­stance, lives on a farm a few hours’ drive from af­ter-hours ser­vices and has a son prone to asthma. Ad­vis­ing him and his fam­ily to drive to the city and wait half the night in the busy emer­gency depart­ment each time he called would be an out­right aban­don­ment of my sis­terly duty. I know him. I know the kid. He finds run­ning it all by me to be help­ful. Un­like my fam­ily, my friends and ac­quain­tances al­ways apol­o­gise pro­fusely be­fore they ask me any­thing med­i­cal. And af­ter­wards they are grate­ful to a de­gree I never de­serve. Some­times they just need to know what kind of doc­tor they should call, what the word on the street is about or­thopaedic sur­geon Mr Such-and-Such, whether want­ing a sec­ond opin­ion sounds neu­rotic, if I know a good geri­a­tri­cian north of the river. I’m usu­ally of no ma­te­rial help at all. I’ve faxed the oc­ca­sional re­fer­ral, writ­ten a script or two. It is the very rare oc­ca­sion where my knowl­edge, con­nec­tions and my friends’ needs align. Strangers men­tion their aches, pains and trou­bles obliquely, or in tiny flick­ers, all the time. They’d quite like to tell a sym­pa­thetic ear, and I can’t help my­self, I love it. Yes­ter­day the su­per­mar­ket cashier had sore and poorly heal­ing teeth with CPAP mask com­pli­ca­tions, the el­derly man next to me in the queue at the post of­fice had a sick wife (long story) and cat­a­strophic house fire (longer story), my daugh­ter called me from camp with a headache (pres­sure from the snorkel mask she’d had on all day), and her best friend needed ad­vice about dress­ing her cut foot. A med­i­cal de­gree doesn’t con­fer author­ity so much as dis­solve the line be­tween a po­lite story and what my daugh­ters would call “TMI”. Get a med­i­cal de­gree and noth­ing is ever again Too Much In­for­ma­tion. The apolo­gies are un­nec­es­sary. None of it is oner­ous or bur­den­some: to lis­ten, even with­out all the an­swers. I in­vite it – of­ten quite lit­er­ally. It’s the po­si­tion I’ve adopted, how I feel part of the world. I’ve been in­sa­tiably cu­ri­ous about sen­tience since child­hood but now my “please, go on” face isn’t weird and creepy and strangely over-freck­led, it’s some­thing ap­proach­ing trust­wor­thy. Doc­torly, if you will?

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