Just when you think there are only so many years of Medicine you can do before cynicism sets in, something happens that makes you remember why you chose to stick with it in the first place. Cynicism has many tactful medical labels; my personal favourite being, “I’d say the prognosis is guarded” (weasel words delivered with an inward grimace). A friend prefers “cautious optimism”. All of which are polite euphemisms for anything ranging from “You just might get better”, to “I don’t know”. At worst, both expressions implicitly mean, “You’re fucked, mate, but I don’t know how to tell you”.
And then someone walks in, all of 17, bright and vivacious and with laughing eyes and fiercely intelligent and a bit wary because she’s going to tell you that she’s stopped her meds. Before she sits down, you already know. You look at her, shrug inwardly, grin and ask, ‘You stopped ‘em, didn’t you?’ She can’t stop grinning, ‘How did you knooowww?!!!’
‘It’s obvious, you look a lot happier for a start. And they aren’t the best things to make you feel alert and bright, are they? And you are happy.’
Her mother, anxious about the whole situation and worried that I am going to say something dire, says hesitantly, ‘She just wouldn’t listen to me. She stopped it soon after she saw you last, but she tapered it over 3 weeks.’
I am about to throw up my hands and shrug, but then think otherwise. ‘That’s fine, you are the best judge of what’s good for you, and you’re fine without it and that’s all there’s to it, really. But no weed, okay?’
The relief’s obvious on their faces, ‘It wasn’t just weed, there was speed, LSD and MDMA, but I am never going there again’, she shakes her head, suddenly grave.
This is news to me, and a bit worrying. But her intent and determination are unmistakable. “You do LSD, you’re screwed; you know that, don’t you? Not everybody reacts badly to all this, but unfortunately, you do. We’ve already talked about it, yeah?”
She shakes her head several times, “No, never again, I should have learnt that in Ibiza, the first time”.
I believe her. But she has more up her sleeve, this one, “I am starting a job, at the school in ……”.
“Oh, great, fantastic, that’s good news”, I am already looking at the nurse from the specialist team, ready to wind up and hand over. They’ll keep an eye on her in the community for the next two years, just to make sure she’s fine.
“….and I’ve got a place at University, in Cambridge, and I’m starting in September, so the job’s only until then”.
I am startled, then astonished, then admiring, then very proud, “Wooooowwww! Coooool” I gawp at her. I am aware that I don’t sound like a doctor anymore.
She beams at me, shaking her head happily.
I digest the implications, and they are staggering. She’s mixed-race and working class, her mother brought her up alone, and she grew up between the inner-city and the rusting post-industrial end of the commuter belt. Both can be soul-destroying places. She had the worst kind of illness an ambitious and driven teenager could have, twice, for no other fault than experimenting with the usual stuff teenagers do in Ibiza and Brixton. But they had steel, these two, that much was obvious from the start. And that's part of the reason why I've stubbornly refused to label her with a stigmatizing diagnosis.
And now, this. Suddenly, I am happy being a doctor. A regular, jobbing, salary-drawing, non-paper-publishing, non-ambitious, non-academically-wheeling-dealing, not-sought-after, not-changing-the-world, will-shove-my-hand-in-and-unblock-the toilet-if-that's what's going to make the patient better doctor.
Just. A. Fucking. Doctor. It feels good.
