I’m in my office facing a husband, a wife and their eleven-year-old daughter. Two of them – the grown-up pair – are giving off the kind of warmth that even a snowman would find cold. Arms folded, lips pursed, eyes anywhere but looking at me. You’d think I’d killed their cat.
I’m used to a little more respect, to be honest. Admittedly, some people go overboard on the reverence. I’m not looking for that. I’d just appreciate people being prepared to listen to me. You know, considering they’re the ones who’ve got the sick child.
I’ve seen their sort before, of course. Maybe not to this degree. But there are plenty who have crossed my doors who are either unreasonable in their expectations of the service I could provide or who just wanted things to happen immediately at their behest. The fact that I would have had at least another ten people to see, some of whom in more urgent need of treatment, mattered not one jot: ‘Why can’t you do the scan now? Why can’t you operate now? I’ve got her pyjamas. Why would you delay it? You’re playing roulette with our child’s life.’
They’re tricky to deal with. With most people I can say, ‘I know you are anxious, I know you are worried, but I have dozens of other patients. Your child is safe – there is nothing that will happen suddenly and waiting will not make their condition worse. There are, unfortunately, some patients who cannot wait, and so are in your position but have been waiting for some time already. I have to prioritize. Try to look at it this way – it’s always better not to be the patient that cannot wait because you are so sick … you want to be the patient that can wait.’ That’s usually the end of it.
But some people don’t want to hear that. They shout, they rail, they threaten. You wonder what they do in their day-to-day lives. Are they bullies with everyone or just NHS staff? When your patient count is in four digits you get a sense of people, so I know what concerned parents look like. Shouting the odds doesn’t prove a thing.
The truth is, scans aren’t like Polaroids. Waiting lists for them can be approximately four-to-ten weeks, even longer for a scan under anaesthetic, which some people just cannot accept. I get that they love their child, but that doesn’t make them experts in medicine and hospital procedure or more important than the parents in the next room or the room next door to that.
In this particular case, I sit across from them, waiting for one of them to break their pouty silence with something more than a curt ‘yes’ or ‘no’. They had come to me for a second opinion from a very good colleague in another unit.
‘Perhaps you can tell me why you decided to leave your previous hospital and come here?’ I say. ‘Your old doctor is probably one of the leading experts in this field.’
‘He’s a charlatan,’ Mum replies. ‘A fraud. A quack. A con man.’
Wow. ‘Okay, why would you say that?’
‘For a start, he said there’s nothing wrong with our girl.’
‘Interesting. And why do you disagree?’
‘We googled it. She’s got Chiari malformation. We demand treatment or we’ll go somewhere else.’
Charming … Here is the rub. The notes from the previous hospital indicate there is a small Chiari malformation on the scan, but nothing serious. Certainly nothing that strongly correlates to the patient’s symptoms. She’s been sick and vomiting, but also angry and disturbed. There have been lots of behavioural issues. And yet I can’t take things for granted. I need to start with a clean slate …
‘Can I clarify that you were advised that Chiari is unlikely to be the cause of your daughter’s problems?’ I ask.
Mum folds her arms even more tightly and harrumphs. ‘That’s what the last idiot said, yes. He should be struck off.’
There follows five minutes of eviscerating abuse of a guy I know to be pretty solid at his job. Even if he weren’t, he didn’t deserve this abuse. No one would. ‘Anyway …’ I continue, ‘did he tell you that surgery on your daughter is too great a risk for the possible benefits?’
‘He was just making excuses.’
My turn to exhale. ‘The brain is not something you operate on for the fun of it. Complications can occur, and these can be serious, rarely even life threatening. You really don’t want to go there unless you have to.’
‘Well, we think you do have to. And the customer is always right.’
‘In a restaurant maybe, but in this room I’m the expert. You came here for my opinion about your daughter. You know her best, but I know what’s best as far as the condition is concerned.’
‘We don’t think you do. We don’t think you care about our little girl.’
Will it never end? ‘Look,’ I say, ‘I’m not sure what you want to hear. My colleague from the other hospital seems to have conducted a very vigorous investigation. I’ve listened to everything you have said, and examined her top to toe. I’m inclined to agree with him. Your daughter might require an operation at some point in the future if things change, but certainly not now and possibly not ever. Her condition is extremely mild.’
‘Oh yeah?’ Dad responds, aggressively. ‘So how do you explain the other problems?’
Oh, I wish you hadn’t asked that. I have in front of me a ton of notes from psychology interviews conducted with the parents and the daughter. The key factor in all of it is that Mum and Dad are recently separated. Not that you could tell from the united front they’re presenting against the old doctor and now against me, but I suppose the enemy of my enemy is my friend, etc.
The conditions they’re complaining about started since news of the separation broke. What’s more, the daughter’s ‘illness’ seems to be quite virulent on weekends and holidays but absent when she’s at school. It also appears to be quieter during time spent with Dad. Even I can see a pattern. Daughter blames Mum for the break-up, kicks off whenever she’s in her orbit and relaxes a bit when she’s not. Elementary, my dear Watson.
Except … Except there are physical complaints. Weakness, balance problems, headaches, swallowing difficulties, chewing issues, speech problems, double vision. She had reported all of them. Which is what, I suspect, has sent a series of doctors chasing golden geese.
Just for completeness, I order my own scans, which buys me a little time. In actual fact, I’m perfectly happy looking at a set taken by the previous hospital. They confirm mild abnormalities. Nothing, I would wager, that should result in the responses the daughter is reporting.
The last thing I want to do is throw this eleven-year-old girl in front of the bus. Especially a bus driven by her parents. But here’s the thing: when children with functional problems are asked the same questions by different people at different times, they will often start to assimilate the inferences from the questions into their answers.
‘Are you cold?’
‘No.’
‘Are you cold?’
‘Are you cold?’
‘No.’
‘Are you cold?’
‘No.’
‘How are you?’
‘I’m cold.’
It’s not necessarily misleading. It’s just kids telling adults what they think they want to hear. I’ve seen a dozen patients who have parroted their symptoms straight from either the NHS online website or, more frighteningly, from Wikipedia. To be fair, Wikipedia sometimes has clearer definitions. Either way, it’s a sad state of affairs when I have to check those particular sites before I meet a new patient in clinic.
The more I speak to the patient, the more contradictory her answers appear. I notice that she’s taking prompts from Mum. Not only in the tricky stuff, but also quite straightforward questions like when I ask her when she first developed her symptoms. I see what’s going on. I don’t want to interfere. But I do want to help them.
Before I’m finished talking, the parents start chipping in with questions. A lot of them are irrelevant and nothing to do with me. Then, when they realize I’ve made my mind up, the questions become accusations: ‘Why did we bother coming here? What a waste of time. You were supposed to help us. You’re not a doctor, you’re just a charlatan.’
It doesn’t matter how many times I tell them their daughter is fine. Or that she doesn’t need an operation. They won’t listen. They don’t want to. Dad launches into Mum, saying how the daughter should live permanently with him as she’s clearly not happy with her. Then Mum tells Dad where to go, informing him how he’s failed them both and how if he were a real man he’d sort me out.
Suddenly, Dad is up on his feet, towering over my desk. He’s pointing at my face. Screaming at me. They both are. The door opens. A colleague looks shocked to see this man mountain aggressively gesturing at me. He mouths the words, ‘Should I call … ?’
‘It’s okay,’ I say. ‘I’m fine.’ But for how long?
I stand up. Possibly the wrong move. I’m more than 6 foot. He’s a good few inches taller. Wider. And he’s furious. His face is so close I can feel his breath. Flecks of spittle bombard my skin. He’s shouting the odds. Swearing. Telling me what he’s going to do to me if I don’t help his daughter.
I’m sure this tactic has worked on many people in the past. If I weren’t quite so tall and not used to fairly aggressive behaviour in my social life, then I would feel quite worried. Maybe I’m too stupid to recognize the danger I’m facing. Or maybe it’s because I survived Glasgow unscathed. You can be hit by anyone, of course. His wife is as likely to strike out as he is. Right now, he’s my priority. I need to watch his fists carefully.
This isn’t my first rodeo. Not my first threat of violence. I work in a very pressurized industry. I can normally talk them down. Bring them back from the brink of violence. I believe I can this time, but I don’t get the chance to try. Mum suddenly decides she’s had enough. She marches to the door and, dragging her daughter, demands that her ex follows suit. When they open the door, I see my colleague with two burly security guards. They step aside as the family storms past.
I never saw the family again. I pray they never found a surgeon willing to operate. Perhaps in years to come, that young lady will require surgery. But all she needed then was psychological help and parents who didn’t want to kill each other, with her caught in the crossfire. Funnily enough, that wasn’t mentioned in the letter of complaint they sent to the hospital …