The Good Doctor

The Good Doctor

It had been a long and arduous Friday night on the admissions ward, Queens Medical Centre, Nottingham. Doctor Vijay Patel took his horn rimmed black spectacles off to clean them. The heat and humidity and formed a salty steam of condensation on the lenses, tepid sweat sealed his white coat to his back – he yawned, his brow furrowed with overwork and stress the testament to the seventy or so hours he had already slaved this week.

He glanced across to the waiting room – another lost weekend of chaos and pandemonium. It seemed that this country was killing itself slowly, as the end of the century drew closer.
As the sounds of Friday night echoed through the A&E department, it painted the grim portrait of, alcoholism, violence, drug abuse, family breakdown and mental anguish.

Society didn’t exist, as it was once infamously claimed. Like a cancer eating itself from within, the conduits and waterways of the unhappy were overflowing -drowning the weak, the poor and irrelevant. In many ways he could not understand this deep social malaise, his grandfather back in Nepal had always had such reverence for the British. “Civilisation,” he had called it when he had struggled with his shop and terraced house. The home to fifteen altogether - relatives, uncles, aunties and their children back in inner city 1950’s Derby. His reverence even went as far as condemning the independence of the motherland and always proclaiming the wisdom of our English (never British) cousins, despite the regular abuse that he and my extended family bore brunt to.

Of course young Vijay was more inclined to go along with Ghandi who was famously asked what he thought of the great British civilisation and replied, “What civilisation?” But of course he viewed his grandfather though a man of simple pleasures and thoughts - a wise and wonderful man. In family folklore grandaddy Kirit Patel had an almost the veneration of a deity.

Vijay had always been the ‘clever’ one in the family and with the help and financial assistance of family, went on to study, to go to medical school and eventually qualify as a Doctor! He honoured his family deeply and they worshiped him. As Ward 29’s senior house officer he had achieved the dreams and aspirations, the grail his grandfather had worked so hard for his offspring to have. Dr. Patel also had a certain respect within the hospital for his humanity, meekness and kindly nature – he was going to make a very young consultant psychiatrist, or so most people said. When he looked at the state of the nation he sometimes ascribed the problems to the reasoning that the very strong bonds of family, of respect and culture that had nurtured him were not present in Britain, or had atrophied – gone rotten and sour.

Aside from this Dr. Patel was not judgmental or jaded like many of the colleagues he encountered. His job was to care for the sick; he was a Doctor - not a God sitting upon the throne of judgement. This did not stop him feeling a deep sorrow though for what had gone wrong with life on this earth.

In the waiting room, there had been another incident – one of the many that typified weekends on the Admissions ward. People watched as the police dragged off handcuffed and quite fairly admonished a few necessary slaps to the violent drunk, who had spat in the reception woman’s face fifteen minutes earlier. An older guy carelessly intervened; he was looking after his disabled daughter.
“You can’t, be doing that, I fought in…” he said.
Before his words were out a bottle of spirits had been smashed over his head, one eye, hanging off what looked like a string, with a mess of blood, skin and vomit splayed over his daughters face. Security got in fast, six men to the drunken mauler, knocking him down then trying to hold him as he spat, struggled and swore. The receptionist called the police and the old man was taken to the emergency room with grateful swiftness. The daughter’s screams did not subside for what seemed like hours.

Dr. Patel was busy now and had thankfully not been distracted by the appalling situation that had just gone on. Of course he heard the commotion but he was focused on the task in hand. Tiredness and a slight nagging depression had been dragging against him, but with his professionalism he fought back, he had to be in control. He sat politely beside the young man who was crying on the bed beside him. Tears were rolling down the man’s face and he was in great distress. Patel asked questions, trying to ascertain the man’s state of mind.

He jotted a few notes – certainly this guy was lucid. No history of drug or alcohol abuse, no organic pathology in terms of brain disease. The patients GP had prescribed fluoxetine (more commonly known as Prozac) quite recently. Dr. Patel did not really approve, it seemed that too many GP’s had written scripts for this drug which had been of course heralded as the centuries remedy for anything that wasn’t easily diagnosable to something specific. It seemed that Elly Lily the drug’s manufacturers had marketed this expensive, over-rated and fashionable drug to all and sundry like depression was a social trend. Dr. Patel did not think that it was not a useful tool, in fact it may have saved some of his patient’s lives, but the millions of prescriptions written for the drug just seemed so wrong, where non pharmacological therapy would have been more appropriate. There were also the unwanted side effects, the most serious one being a high prevalence of suicide in those previously not seen to be in serious risk.

Dr. Patel was courteous and kindly, Luke Harrison – the patient in question seemed amiable and although very upset, was not impaired in terms of mental functioning. It seemed that there had been a break up with his girlfriend, that had been a prolonged and bitter fallout, it was a disheartening tale but it didn’t strike him as being enough to warrant a major episode of depression or for him to be as suicidal as this patient claimed. He made some cursory notes; circumstantial: no previous family history of mental illness. Grandfather - breakdown in WWII, mother on Valium, etc. Then he jotted - presents as controlled, no impulsive behaviours, polite, has insight.

As Dr. Patel patiently questioned him he did empathise with Luke’s pain. He must have really been in love with this girl he thought. However he tried to rationalise with Luke. This guy still had things going for him – young - at university studying law – attractive physically, possessed with social skills, good manners all endearing qualities. Patel almost immediately liked Luke, but his distress seemed exaggerated and unnecessary. At one point he even had to stop him self saying, “Come on young man. There’s plenty more fish in the sea…..”

Fortunately he stopped himself from indulging in such a gruesome cliché’, as he perversely realised that most of the fish were becoming extinct, growing extra eyes and heads and changing sex from oestrogen pollution.

Patel went to collect his review cards and decided to prescribe a sleeping pill and a minor tranquilliser. As he jotted down his notes, he was startled by a cry. It was a sob, but not one like he had heard before – even in all his experience. It was the sound similar to the Alsatian he had run over four years ago. As it lay bleeding, he found its howls so disturbing he injected the poor animal with a lethal dose of diamorphine.

That was worse than seeing people on the wards dying of liver failure. He rushed back and just saw Luke sobbing, disturbing - almost primal. He wanted to hug the poor guy, but when Luke saw him he stopped, suddenly - like a fly hitting a windscreen.
“S-Sorry Dr. Patel,” he stammered. He was shaking, the tears running down his face. The good doctor administered a sedative and considered that perhaps this was just the stress of Luke talking about the break-up. The unfamiliarity of the hospital perhaps, but – he knew this guy was going to be OK. His evaluation, a sensitive chap, likeable, caring – perhaps she had been his first love. Patel remembered his own misery at age 21 with Nicia.

Luke calmed down and then spoke to Dr. Patel articulately with apparent serenity. The edgy tiredness suddenly struck the doctor more severely than at any time in the evening.
“I’m sorry Doctor. I’ve been wasting your time. It was only a girl after all. To be honest I loved her so much I thought she was the only one I’ll ever find that loves me. I realise now what’s real and what’s not. I know what I have to do, it’s simple – how could I have been so foolish to come in like this, it’s pathetic when things are so straightforward. I apologise…….”

Vijay Patel was relieved. His patient had suffered a shock, but the lad had come to his senses. Luke was almost smiling now; he looked like a man reborn. He was so tired and the shift was about to end, thank the gods.
“You have a bright future ahead of you Luke. You are a likeable, intelligent lad. To be honest, you should see some of the poor souls I have on the ward downstairs. You can become a lawyer and then you will have women falling at your feet…”
Dr. Patel once again contorted at his insensitivity of remark, which in his profession could have more sinister repercussions.
“Thanks Dr.”
“Don’t mention it, honestly…”
Vijay then finished up writing his report, collected the medication from the pharmacy and handed it over to Luke. Naggingly he still felt strange about the way Luke had cried – he flashbacked to the dying dog in the road.
Luke’s whole persona seemed transformed. The two even shared a joke. It now seemed to Patel that the two had known each other for a lifetime.
Dr. Patel looked at his watch - 10minutes and he could get some well earned shut eye.

He felt privileged to have met Luke; this had been such a different encounter from the usual suspects; the abusive alcoholics, the irretrievably mad schizophrenics, the bizarre psychotics deep in space or the maudlin depressives devoid of life. Perhaps just by talking, the old therapeutic value of someone listening had helped Luke turn around his negative thoughts and had worked for once. Who needs Prozac? On reflection, Patel wished he had more time to spend with his patients.

To encourage them, to build self worth, to really help them achieve their goals - rather than dole out endless paper cups with pills. The two men shook hands, Luke smiling grasping the Doctors hand firmly. He winked and said, “Thanks, you’ve helped me make the positive decision now. I won’t be seeing psychiatric services again! Take care Dr. Patel and once again thanks.”
As his patient walked away down the endless corridors in the QMC, Dr Patel was ready to sign off and slink to bed in his hospital quarters. Tomorrow was another day; he hoped it would end like today. As he wandered down the halls Nurse Stanley stopped him.
“How did it go with that young guy?...What was his name Luke? He seemed so distressed but he was so polite and nice, compared to the normal drunken fiends we get on psychiatry on a Friday night!”
“Yes, he was quite disturbed initially, but nothing major. Sometimes people just need some advice and care, not just oodles of antidepressants and drugs, eh? We forget that we are all human beings and a hospital isn’t a factory”
“Is he discharged then?”
“Yeah, I sent him home with a few meds to help him sleep and a good old pep talk. He could have a good future. Just a bit of girlfriend trouble, but that can feel like the end of the world when you’re that age. He’s a trainee lawyer to be!”
“Good looking lad too. Must have had a bitch of a girlfriend!”
“I wouldn’t say that. Remember, it’s our job not to make judgements nurse...”
“Yeah right,” she cackled as Dr. Vijay Patel made his way to his quarters, tired yet somehow warm and happy. Perhaps his job wasn’t as fruitless as it appeared.

An early start the next day for our good doctor, washed, shaved, and coffee down his neck for 8.45am.He’d managed a full six and a half hours kip - amazing. Patel greeted McDrove from the emergency room, who grunted back - he looked like a man who’d been going through horrors. Grateful in many ways he’d chose psychiatry as his path, he understood why the surgeons working in intensive care had their messianic complexes. They salvaged the most mangled of bodies, the car crashes, the shattered skulls and vertebrae’s, the heart attacks, malicious and malignant cancers – these guys were dealing the cards of life and death, an occasional ace, kings or queens meant a life saved.

There was certain snobbery in the medical profession towards psychiatrists. They dealt with what the ‘what if’ - the uncertain. The superheroes in intensive care dealt with the real sharp end of life and death. Mental health was the sewer pipe of the NHS. Psychiatry was pseudoscience for psudeoscientist’s a colleague once said. Patel however was not an arrogant man; he had come to help those in the gutter. As said before his hero was Ghandi and back in the motherland his family (though never spoken of now) had come from the class known as the ‘untouchables’.

He got on with his work. A few evaluations here and there as usual were undertaken. He had to interview with a schizophrenic who had forgotten to take his medication who was ranting and rambling that electricity was the work of Satan. The patient was sent back to the acute ward without delay, for a course of depot injections. At 10.30am he bumped into his friend Shelia (or Dr.) Knight, procuring a cup of gut rot cafeteria coffee. She was shaken and looked pasty and pale. She sat with him and he noticed alarmingly the diazepam bottle she produced as she slugged her coffee.
“What’s up Shelia?” he had never seen her look so bad, or disturbed, In fact she looked so bad he could have mistaken her for a patient of his.
“Last night, “she winced and almost went a shade of green. “About 2pm. When did you finish Vijay?”
“At one forty, I think...”
“A guy left the hospital just after you retired. He…” she stumbled. “Sorry….he threw himself under a lorry just outside the gates…at the roundabout. It was deliberate of course. Right under the front wheels.” She gulped more and then eventually continued. “Thing was the driver swerved, I mean he meant to end it – sorry the guy of course Mr. – sorry can’t remember his name now. The wheel just caught his jawbone and fleshy skin at the bottom of his face. It removed the bottom part of his face and practically removed his jaw. Whether you can call it a miracle – his brain and skull remained basically intact, eyes also. The neck was ripped open but he was breathing when the crew got there. The guy had half his head missing. Just these staring eyes without a face. The anaesthetist thought that he would have been unconsciousness, but his brain was totally functional. He’s still alive now………”
“Who was the surgeon on the job?”
“John McDrove”
“Excuse me please Shelia..”
Dr. Patel went over to the nearest nursing station to make a call.
“Hello, intensive care – unit 4. Who’s calling”
“Can I speak to John. McDrove..” There was a long, long silence.
“McDrove”
“Hello - it’s Vijay Patel….”
“And?”
“The accident, the patient his name?”
“Harris”
“Are you…….”
“No sorry, Harrison - Luke”
“Obviously. You interviewed him before his..…he was sent to psych services….”
Vijay felt vomit rising in his throat .
“Yes…..he’s still al..”
“No it seems providence is smiling. He died ten minutes ago. I’ll be faxing this atrocity to your superior. See you at the GMC tribunal.”