The Crippen Diaries 2006 (Week 1)

Not quite Tannochbrae

Sunday 1st January 2006

Perfect way to start a work diary. I'm not at work and I'm not on call. Same tomorrow. It was my turn to work the gap between Christmas and New Year, but it was suprisingly quiet. Phew!

Maybe everyone is reading Harry Potter. According to the BMJ that cuts down medical problems.

No-one outside the NHS seems to be working. I think the UK just stops completely for about two weeks over this period. It's not like the USA. The Samaritans will be busy though, they always are at this time of year.

My wife, who is a hospital consultant, is on call this weekend. So we are housebound. She hasn't been called yet, but you are always slightly on edge, and you jump when the phone goes. She has excellent junior staff, so they don't call often. On the other hand, when they do call, it is going to be something serious.

Anyway, a family day.

But it will all be building up for Tuesday.



Monday 2nd January 2006

It’s the New Year. The leaf has turned. Get it right from the beginning. So up early and off to the gym with Mrs Crippen.

It was closed.

How extraordinary. You would have thought that they would have had a whole team of lycra-clad young lovelies putting direct debit forms in front of all the New Year resolutioners. Missed opportunity, I would say.

We both pay £65 a month for the gym membership. I get there occasionally, because I sometimes have a free hour mid-afternoon.

Mrs Crippen likes to go for a swim and a sauna but it’s more difficult for her. She went twice last year.

Hmm. A little mathematics, I think

65 x 12/2 = £390

That’s a bargain, isn’t it?

I wish people would pay £65 a month not to see me. Actually, I think it’s what they do in China. They pay their doctor when they are well, not when they are ill. It’s a thought.

Must drop a line to Patricia Hewitt.




Tuesday 3rd January 2006

Back to the grind.

A busy day. Start at 8.00 a.m. Twenty three patients booked this morning, a couple of extras, half a dozen phone calls, paperwork, two visits, bowl of soup and The Times at home at about 3.00 pm and then a gap.

On Tuesdays I do the late night surgery, for the commuters (or that’s the idea), from 6.00 pm until 8.00 pm. It’s a long day.

Second patient in is waiting for a hernia operation and arrives with a copy of the Daily Mail. The criminally patronising, oleaginous Patricia Hewitt has announced to the media that patients are no longer tied to the local hospital. They can now choose to go to any of four hospitals in the area. He wants to discuss his options.

Sadly, whatever the secretary of state may have told the Daily Mail, she has not yet told me. We have heard nothing. I presume the letter is in the post, to coin a phrase, but at present, I have no mechanism for referring him elsewhere

I phoned my helpful contact at the PCT. She was not happy. I was not the first call of the day. The secretary of state had not told her about the new system yet either.

There is going to be a lot of this. Great.

Tenth patient in, a young man in his late twenties. I could smell the stale beer before he sat down. His eyes were bloodshot. He looked dreadful.

“Sorry to bother you doc; think I overdid it at New Year and last night; feel like shite and I just can’t get into work. Can you do me a certificate?"

Wat Tyler thinks we are a soft touch for certificates. It’s not easy, sometimes.

They are supposed to do their own “self-certificate” for the first five days. He knows that, but “work won’t accept that doc, you know, with the New Year and everything”

To hell with Wat Tyler, I thought.

“How long would you like then”, I said, “a couple of weeks? A month?”

He looked amazed. “Oh no, er...three days should do it, doc.”

“Just three days? Fine. Three days it is then” I said, and gave him the certificate. “Happy New Year!” He smiled and left.

He was back, looking angry, before the next patient arrived. He slammed the certificate down on the desk. “I can’t give my governor this!

“Why not?”

"You’ve put “bad hangover". If I give him that, I’ll get the sack."

“Better go to work then, eh!”

I felt better for that.



Thursday 5rd January 2006

A mean day today.

Phone call from a 57 year old woman. She has run out of carbimazole. We don’t like to do repeat prescriptions over the phone, too many mistakes, but the line of least resistance is quicker when you are busy.

“Could you post it to me doctor, I can’t get down today, my husband is away and I don’t drive.”

OK. I will. I have to pay for the stamp personally, but it seems mean to mention it.

Then the housing officer calls. She wants a report on a patient with severe mental health problems who is requesting re-housing. Mentally ill or not, I will not do the report without the patient’s written consent. Housing officer thinks I am being difficult. I’m not. The mentally ill have rights as well.

The patient has complicated problems. It will need care and will take time. I warn her there will be a professional charge for the report.

“Oh, we don’t pay for doctor’s reports”

“Then I will not be able to do it!

“Well, doctor, if we don’t have the report, we will not be able to find her appropriate housing.”

She is pleased with that. She has got me, and she knows it. So I do the report. It takes me half an hour. I’m pathetic. I should put my foot down. I pay the secretarial costs out of my own pocket. Wish solicitors did free reports.

Mid-morning, when I was with a patient, the phone goes. The receptionists do not interrupt us unless it is urgent. This is. It is the coroner’s officer.

GPs dread calls from the coroner’s officer. It only ever means one thing. There has been an unexpected death, and they need information. The immediate feeling is always fear and guilt. Have I missed something? Have I done something wrong.

This is about Julia. I have not seen her for two months. A forty-two year old with severe Rheumatoid Arthritis. Single. Lives alone. Parents dead. I have known her since she was a teenager. Highly intelligent. Virtually house bound. Voracious reader. Just done an Open University degree in English. She drinks far too much. Often two bottles of wine a day. I nag her about it. She just smiles at me.

“I havn’t got much, doc”

Then we usually talk about what we are each reading. We like the same writers.

The police had to break into her house early this morning as the neighbours were worried that they hadn’t seen her for two days. She was dead in a pool of vomit. I bet she had got onto the third bottle of wine, vomited and inhaled.

I feel dreadful. I don’t have “favourite patients” but Julia was one of them. I shall miss her. Could I have done more? I don’t know.

Hate this job sometimes.



Friday 6th January 2006

School run and then straight into a duty-doctor day.

Twenty three patients booked for the morning, then a couple of extras. Repeat prescriptions, dictating, quick coffee followed by three visits.

Then the hard work starts. We are all fully booked for the day except me. I have nothing scheduled, but I take all the calls from patients who have a problem that cannot wait until the next day or, in this case, until after the weekend. Twenty-eight phone calls. Some nonsense, some minor, some not. As always one or two serious medical problems. The art is to get it right. I advise seventeen on the phone, ask eight to come in, mostly hot children. And three visits, resulting in two hospital admissions; a gut haemorrhage and pneumonia.

What stands out from the day?

The second patient of the morning was Trevor. 32 years old. Hopeless alcoholic. Disturbed childhood. Physically and sexually abused.

He is dishevelled. He stinks of yesterday’s alcohol. He is shaking. Not yet had the first drink of the day. During the consultation he vomits and, before I can get a bowl in front of him, he catches it is cap.

He refuses admission to hospital.

“They aren’t interested, the just want to get you out as quickly as possible.”

I don’t say anything. It’s true. Most of the medical profession avert their eyes, literally and metaphorically, when an alcoholic turns up. The local psychiatrists are not much help. They will not take a direct referral. Instead, they write to the patient telling them that if they want to be seen, they must contact the department themselves. A test of “commitment” they call it. It’s a hurdle. A lot fall at it. Trevor always has.

I give him a large dose of diazepam to take for the next few days and make him an appointment for Monday. I do not know what else to do. He probably will not turn up. He will die soon. I don’t know how to help him.

Two babies with bronchiolitis. Always time consuming. There is not much treatment, other than steam and fluids, the parent usually expect antibiosis and it takes time and patience to talk them though it.

The highlight of the day?

A delightful, elderly lady who has bequeathed her body to medical science. Braver than me. I was a medical student once.

She asks, “If I sign this form, when I become ill, what happens?

I am puzzled. She looks embarrassed. “What I mean is, if I am ill, as I am leaving my body to medical science, would I, I mean I would I, well… still get all the same treatment as anyone else?”

It clicks. What a delicious thought! I reassure her that no one will come for her body until she has finished with it.

Fifty seven patient contacts, fifty seven decisions, some minor, some not. A hard day. And my children wonder why I am ratty when I get home.



Drs Finlay, Cameron & Janet from: The BBC