Monday, Jan 21

 

5.10 a.m.:        He commences his workday burnout prevention ritual. Stretching. Aerobic exercise. Resistance exercise. Stretching. Qigong. Mindfulness meditation.  Reflective writing.

8.25 a.m.:        He rides his bicycle to the medical centre where he has worked as a family doctor for the last 31 years. It is his first day back at work after his annual family summer break at the Brooms Head beach shack.

9.05 a.m.:        He is seeing his first patient of the day. Jackson is a five-year-old boy coming back for review after starting some simple treatments for dust mite allergy a month ago. “We’ve got our boy back, thanks to you,” beams his mum. “I can’t believe what a difference the treatment made. Jax is sleeping all night, he’s stopped snoring and his bed doesn’t look like a disaster zone when he wakes up. He’s so much happier. It’s like a miracle. You’ve become our family superhero, Hilton!”

5.45 p.m.:        He is seeing his 28th patient for the day. There are two more people in the waiting room. How could the post-holiday glow vanish so quickly? This patient has had months of chronic, unrelenting neck pain. Just like he does. She wakes up in pain dozens of times each night. Just like he does. All the treatments she has tried have failed. Just like his have. She is at a loss about what to do next. Just like he is. How am I going to learn to live with this?

Monday, Jan 28

7.35 a.m.:        He is on his way to a home visit. He has had to curtail his morning burnout prevention ritual to do the visit before starting work at the medical centre. Why don’t I ever learn to schedule these visits during normal working hours rather than trying to fit them in before or after work?

7.50 a.m.:        He pulls up in the driveway of his patient’s home. She has advanced ovarian cancer. Just like his mother did before she died last year. The first home visit with a person who has cancer usually means the beginning of the end. It was like that for Mum. But maybe Gretta’s experience will be different. I hope so.

7.53 a.m.:        He is greeted at the door by Alice. She is a home care worker, helping Gretta and her partner with household chores. Alice is a patient of his too. Her husband had also been his patient until he died from cancer a few months earlier. Shit, I wasn’t expecting to see Alice. I wonder what it’s like for her being in the home of someone dying from cancer so soon after Davo’s death?

8.13 a.m.:        He has listened to Gretta’s story of increasing abdominal pain and nausea. He has examined her distended abdomen. Her belly is full of cancerous fluid. Just like his mother’s was before she died. “I think you need to be admitted to hospital to get that fluid drained from your tummy. It will help you feel more comfortable. You’ll only need to be there for a couple of days. Are you okay with that?” Mum never got out of hospital when this happened for her. But maybe Gretta’s experience will be different. I hope so.

Wednesday, Jan 30

1.55 p.m.:        He is having his regular lunch time debrief with his colleague Pete. They are sitting on a park bench overlooking Seven Mile Beach. “I don’t know what I was thinking when I decided to do an extra afternoon’s work at the clinic. I hoped it might ease the waiting time for people to get in to see me. That lasted about a week! Now the backlog is just as bad as ever, and I’m not getting an afternoon off! What a stupid idea that was!” His colleague sits back and nods.  Don’t give me that fucking “I told you so” look, mate!

“Bloody hell, is that the time already? We better start heading back. Wind me up, and point me in the right direction, will you, Pete.”

2.00 p.m.:        He is at the reception desk collecting the patient files for the afternoon. He overhears one of his patients talking in the waiting room. Ruby is three years old. He was present at her birth. An older woman is asking her why she has come to the doctor today. Ruby replies, “I’ve come to see Hilton because he loves me!” He smiles as he hears this. Because he loves me! Not, because I’m sick. Or, because he’ll make me better. But, because he loves me! Such wise words from a young soul. I’m so happy she knows that I care about her.

Thursday, Jan 31

10.35 a.m.:      He is seeing one of his long-term depressed patients. Their conversation has just started when the phone on his desk rings. His reception staff has been trained to only put a call through if it’s urgent. He interrupts his patient and takes the call. His receptionist tells him that the police want to speak with him. What’s it going to be this time? “It’s Constable Pierce here, doctor. Your patient Reginald Smith has been found dead in his home. We need you to come down and identify the body as soon as you can.”

“Okay, I’ll just finish what I am doing here and head on over.” He turns back to his patient. “There’s an emergency I’ve got to attend to. Tell the receptionists to fit you in with me this afternoon or tomorrow. Sorry about this. Can’t be helped.”

He asks his receptionist to reschedule the rest of the morning’s patients. He grabs his bag and exits the back door to avoid his full waiting room.

10.45 a.m.:      He pulls up outside Reggy’s home. He has cared for Reggy for 15 years, and his wife, Jill, who has dementia. And their daughter Janet who he guided through IVF. And Janet’s husband, Steve, who fractured his spine in a workplace accident. He has known Reggy’s two granddaughters since they were each a + sign on Janet’s pregnancy test strips. Here we go again. Entering another house of grief. How is it that fresh grief has such a pungent odor?

10.47 a.m.:      He is greeted at the front door by Janet. “Sorry for your loss, Janet.”

“Thanks, Hilton, and thanks for coming around so quickly. We think Dad died a couple of days ago. Mum didn’t realize what had happened. She thought he was having a long session at the pub. Her dementia is that bad now. Dad’s in the bedroom on the floor beside his bed. Mum didn’t realize he was there.”

He enters the house. Nods sympathetic greetings to Jill and Steve. Shares a Well this is fucked, isn’t it, why do we do this bloody job? look with the police officers. He enters Reggy’s bedroom, finds him face down on the floor.  Reggy is wearing his usual attire—tracksuit pants and old flannelette shirt. His skin is a maze of mottled purple with blotches of indigo blue. I don’t think I’ve ever seen anyone look so very, very dead. Not going to need to listen for heart sounds to certify poor old Reggy!

12.15 p.m.:      He is back at the medical centre. He opens the death certificate pad. He approaches the completion of a death certificate with reverence. It is his final task in the care of a patient. No matter where a life journeys, what it’s seen or experienced, this is the final punctuation mark on a person’s medical narrative.

12.25 p.m.:      He signs off the certificate. He looks up and speaks aloud to his empty room. “Bye, Reggy. I’ll miss you.” He flicks back through the death certificate pad, reading the long list of names recorded in his stilted attempt at neat hand writing. Bloody hell, I wonder who’ll be next? He closes the pad and locks it away in the bottom drawer of his desk.  I hope Pete’s ready for lunch.

Saturday, Feb 2

9.00 a.m.:        He takes possession of a new VW Transporter Frontline camper van. He and his wife are buying it a couple of years earlier than planned, but his wife encourages him. “Don’t wait until you retire. Who knows what might happen? Let’s do it now.”

9.45 a.m.:        He drives home from the dealer. Who would have thought buying a van could make me so happy? 

Friday, Feb 8 

1.30 p.m.:        He heads off in the camper van to Bundjalung National Park.

3.00 p.m.:        He pulls up at the camp site, climbs into the back of the van, unclips four straps and lifts the pop-top.

3.05 p.m.:        He is all set up. I’m set!

Sunday, Feb 10

Dawn:             He wanders down the track to back beach. He is alone, apart from scatterings of kangaroos. Brahminy kites circle overhead. He pauses to photograph the sun coming up behind rock platforms. When was the last time I noticed the world’s tiny details? He reaches the end of the beach, takes off his clothes and swims naked. How long has it been since I last had a skinny dip? He sits on the rocks to dry off. The early morning sun warms his body. How many other important things have I been neglecting? He begins to weep. So this is what it feels like to be alive! I forgot! How could that happen?

Monday, Feb 11

5.10 a.m.:        He commences his workday burnout prevention ritual. Stretching. Aerobic exercise. Resistance exercise. Stretching. Qigong. Mindfulness meditation.  Reflective writing.

7.55 a.m.:        He is in his kitchen finishing breakfast. I was feeling so alive this time yesterday. He begins weeping. “I don’t want to go back to work. It’s killing me,” he says to his wife. She hugs him. He steels himself for work.

9.55 a.m.:        He is seeing his third patient for the morning. Already he is running 20 minutes late. Like all his patients, she is elderly with complex, insoluble problems. Her husband died two weeks ago. She is not coping well on her own. She is in constant pain from arthritis. Her diabetes is out of control but she doesn’t care about that. All she wants to do is to drive 800 kilometres to see her daughter. For the last ten years she hasn’t driven further than the shops because her husband used to do all the driving.

10.10 a.m.:      As he listens to his patient, he finds himself repeatedly rubbing his right cheek. What’s this fucking numbness? This is new. This could be bad. Real bad.

10.18 a.m.:      After seeing off the widow, he tells his colleague about the numbness. Pete responds with what he already knows. “You need to go to Emergency. You need to get scans to make sure you’re not having a stroke.”

10.35 a.m.:      His wife picks him up and takes him to the local hospital. They wait.

3.40 p.m.:        Examinations show no signs of stroke. The numbness has diminished. He is booked for an MRI scan the next morning. His wife takes him home. How embarrassing. Maybe the numbness was all in my head. That’s what the Emergency doctor implied. It’s embarrassing, but better than a stroke.

Tuesday, Feb 12

10.28 a.m.:      He enters the MRI scanner. The radiographer tells him the examination will take 40 minutes. The bed is narrow and hard. His head is clamped in a brace, his arms strapped by his side. The scanner belts around his head.

10.42 a.m.:      This is the most peaceful I have felt on a workday morning for ages. No one can get to me here. His eyes jolt open. If this feels peaceful, tethered to a slab less comfortable than our kitchen table, with a scanner jackhammering in my face, then I’m in big trouble.  

2.15 p.m.:        He is seeing his doctor to get the MRI result. It’s all normal. His doctor asks him how he is doing. “Work is terrible. My patients are all so hard to manage. They are a litany of comorbidities. Guidelines don’t apply to them. Three died on me last month. I agonize about who will be next. I write long lists of things I need to do to keep on top of their care. They’ve infected my dreams. I dread going to work. I never used to be like this. I’ve tried everything to get back on track, but nothing works. I’m terrified that I’m going to kill someone. I haven’t killed anyone in 38 years of doctoring. I could never forgive myself if that happened. I’d hate to end my career like that.”

2.25 p.m.:        His doctor sits back and says with a calm clarity, “You’re done.”

“Done? What do you mean, done?”

“You can’t go back to work. It’s no good for you.”

He takes this in, the news that his body has been trying to give him for months.

“We’re one doctor short for a couple of weeks. How about I work until next Friday and then take some time off?”

“No, you’re done. You need to make that call.”

Wednesday, Feb 13

8.05 a.m.:        He makes the dreaded call to his practice manager. “I can’t come into work. My doctor has advised extended leave. I don’t know when I’ll be able to return.” He cries as he is talking to her. She thanks him for calling and wishes him well.

8.50 a.m.:        He is sharing a coffee with his wife on their back veranda. They haven’t done this together on a Wednesday morning for years. “I can’t believe how much better I feel. The guilt, it seems to be evaporating. I still feel ashamed and embarrassed, but the guilt, it’s feeling better already. I should have listened to you, and done this months ago.”

Friday, Feb 15

11.20 a.m.:      He is doing his other job, writing clinical guidelines for family doctors. He is working on the PTSD guideline. He reads the diagnostic criteria. Holy shit!  That’s me. I tick all those boxes. He reads the recommended treatments.  Maybe I don’t have to feel guilty about needing time off work. The guidelines say avoiding triggers is part of the management of PTSD. He pauses for a moment. Looks up. Gently touches his right cheek where it was numb a few days earlier. Maybe I haven’t just been weak. Maybe this has all been unavoidable. Some people are more prone to PTSD. Maybe I’m one of those people, and it was always going to happen, even with everything that I’ve been doing to try to stay well. PTSD! That feels somehow like a badge of honor. I can live with that.

Sunday, Feb 17

7.45 p.m.:        He is in his kitchen finishing dinner. I was feeling dead inside this time last week. Now it’s just an ordinary night. No dread. No apprehension. I forgot Sundays can be like this. Must be my lucky week!

Hilton Koppe is a family doctor from Lennox Head, a small village on east coast of Australia. He combines clinical work with an active role in education, including reflective and expressive writing workshops for health professionals, people living with serious or chronic illnesses and the general public. Hilton’s writing can be found in Grieve, The Examined Life, Hektoen International, Pulse, Chrysalis, The Universal Doctor, and More Voices. His play, Enduring Witness, has been performed in the USA and Australia. A film version of the play is regularly used in medical education to facilitate end-of-life discussions.

Header Image by Alan Bern