Month: May 2018

The Miss, episode 2/7 – Patient and husband

“I wish I’d been there with you love,” said Mr Valtrey, when his wife returned from the oncology clinic. He rarely left the house, due to Parkinson’s disease. But Elizabeth, who largely cared for him, was strong enough. They spoke about the coming weeks and months. The oncologist was actually quite positive about the chance of a response. If the tumours in the bowel and the liver shrank well, there was even a chance for an operation to clear everything out. A chance.

“Funny thing though,” said Elizabeth. “She looked at my records on the screen and asked me how long I’d been anaemic. I said I don’t know, a year, more. She raised an eyebrow.”

“What did that mean?”

“I got the impression something was amiss. In the blood tests.”

“Amiss how?”

“Well, anaemia, which I had, is a sign of bowel cancer. And I remember our GP, Dr Atwal, saying that I was mildly anaemic she sent me to see Dr Elliot in the first place. But Dr Elliot didn’t mention any anaemia. I’m wondering if I should have had a colonoscopy back then, basically.”

“What do you want to do?”

“I’ll go and see Dr Atwal, see what she says.”

“You think that doctor missed something?”

”I doubt it. I mean, it’s all on the system, isn’t it?”

 

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The Miss, episode 1/7 – Doctor and Patient

A new experiment for this blog. In 7 short daily episodes follow the thoughts and feelings of Dr Patrick Elliot and his patient Elizabeth Valtrey. Patrick has made a mistake; Elizabeth’s bowel cancer went undetected, despite an obvious clue, and is now inoperable.

The scenario is entirely fictional, but it allows an exploration of the reflections and evolving rationale behind a doctor’s decision to be transparent, or to let error go unremarked. We will hear conversations between doctor and patient, patient and husband, doctor and partner, patient and specialist nurse, doctor and conscience, and finally doctor and patient once again. This format owes much to that literary cubist, William Faulkner, who described the death of Addie Bundren through 15 characters.

A new episode will appear at midday for the next 7 days.

Welcome to ‘The Miss.’

***

Dr Patrick Elliot flipped through the notes on his next clinic patient – Elizabeth Valtrey, recent colonoscopy done to investigate rectal bleeding, large polyp found, biopsies taken. He keyed in her details on the results system – Biopsy: Adenocarcinoma. Had she had a scan yet? Yes; the endoscopist was suspicious enough about possible cancer to have requested one straight away. CT scan result: tumour spreading from wall of the large bowel to adjacent structures. A spot on the liver, query metastasis. Oh.

He called Elizabeth in. She was 64 years old. She took her seat. Patrick used his years of experience to address the diagnosis, mixing clarity with kindness, hope with realism. This was incurable disease.

Toward the end Elizabeth surprised him; “Actually doctor, I think I saw you last year… my GP referred me with tummy pain. You recommended a camera test into the stomach… but it was fine.”

Patrick leafed back through the notes. A sweat had risen on his skin. He found his clinic note, and the corresponding letter. ‘Dyspepsia, no red flag/suspicious features. Plan: Bloods, endoscopy, if normal –> discharge.’ Now he looked back to the result screen. The bloods. Haemoglobin 10.1 g/dl. She was anaemic 9 months ago! She should have been referred for a colonoscopy then. The tumour would have been found, smaller, operable.

He had overlooked the result.

“What is it, doctor?”

“I err… I was just looking at some old results…”

“And?”

“Nothing. Nothing Mrs Valtrey. Right… we need to make some arrangements for you. Your case will need to be discussed in something called a multi-disciplinary meeting…” and he laid out the near future for her. As she left he reflected that he might not see her again. Her care would now be taken on by surgeons and oncologists.

 

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Unfinished

Dickens’s Dream by RW Buss. Depicting his imagination and many of his characters, it was left unfinished on the artist’s death.

 

By the feel of the tumour and the extent of its spread on the scan, I could tell it would not take long. First the liver failed, then the kidneys. On the third day, having spoken frankly with her about the inevitability of dying, I noticed the book on the bedside table. It lay spine up with its pages splayed at the place she was up to. She was about halfway through. We spoke briefly about the author, long dead. I remembered where I was and what I was doing when I read it (on holiday, in the country where it is set). To explore her response to the story, to have a general ‘chat’ about it, did not seem appropriate. There were larger, more pressing matters to discuss. But the book (the images within, the journey described) was a point of intersection. A tiny patch of common ground shared by patient and doctor, complete strangers until now. It seemed unfair that her version of those images would collapse the moment she died.

The illness progressed, as it had to. The day before she died I saw the book closed on her bedside table. A bookmark jutted out, just past the halfway mark. The energy required to take in words and turn them into meaning had been taken from her. In the secondary world that all readers carry with them, darkness was falling.

I suspect it was one of very few books she failed to finish.

***