Dennis was in the fourth bed on the left. When I joined the firm he had already been there some while. Every ward round, the collective morale of the team would sink when we came to his bed. After weeks we still didn’t know what was wrong with him. From his pillow, Dennis regarded us with truculent challenge.
Every week his long frame was a little thinner, his look a little more withering. He seemed to be willing himself to deny us the satisfaction of a diagnosis and the reward of seeing him recover.
One afternoon the cardiac arrest bleep went off. Fourth bed on the left.
We were uncomfortable. We didn’t know what he had died of. His family didn’t seem that bothered, but we were. A post mortem was agreed. But the mortuary technician was in Benidorm and the hospital couldn’t do any autopsies. The pathologist at St Elsewhere’s would perform a coroner’s post-mortem and provide specimens for his colleague at our hospital.
As the junior member of the team, I was chosen to attend the post mortem and transport the specimens. The pathologist at St Elsewhere’s gave a jolly running commentary. He sliced chunks off various organs and offered them to me with the flourish of a waiter at a carvery. With a sweet jar full of bits of my former patient, I set off on the return journey. The roads were busy, the day was hot, the formalin was leaking from the jar. If I were stopped by the police, would they believe me? If I had an accident, how would I explain? “Don’t worry” the SHO had said, “I’m sure they will be able to tell which bits are you and which are Dennis.”
We reached home, I in one piece and Dennis in a dozen. The pathologist’s report, when it came, was not enlightening. It told us some things we knew and nothing that we did not know. We still had no insight into what Dennis had lived with and died of.
I have come to terms with not knowing how Dennis died. Medicine is not an exact science and though 21st century imaging, 20th century biochemistry and 19th century pathology can shed light on many conundrums, none is guaranteed to provide all the answers. Knowing as much as we do, it may be harder for us to accept being denied knowledge, but if we are wise we accept that sometimes we are not going to know. Primitive people can wish themselves to death, and we recognise the part the psyche plays in the time and manner of death in many patients in our technological world. Whether Dennis willed his own demise and whether he wanted to humble us, I cannot know. But remembering that unsettling journey with the sweet jar, I can hear Dennis laughing the last laugh.
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. Her charity, Cuba Medical Link, enables medical students to go to Cuba for their electives.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…