Further Confessions of a GP. Benjamin Daniels

hungry?’

      ‘Bradley, that boy you’ve been worried about. He’s having tummy aches because he’s hungry. That’s also why he’s stopped growing and losing weight and why he’s had no energy. It was obvious really. I asked Tracey about what he’s been eating and it turns out she’s been having problems with a debt collector and hasn’t been able to afford to buy food. She’s got herself in a right mess with it all and hasn’t told anyone.’

      I had asked Bradley and his mum about every possible symptom and ordered a multitude of medical tests. But I hadn’t even considered asking if there was food in the house. Bradley wasn’t such a medical mystery after all. He was suffering from something unfortunately felt by millions of six-year-olds across the world. There was a famine in Tanzania when I was working out there and I saw hundreds of malnourished, hungry children. It just wasn’t something I was expecting to see in modern Britain. Our brilliant practice nurse Brenda had already put lots of things in place to help. The Citizens Advice team were working on resolving the debt issues and a charity was going to help with food donations until the family’s social worker helped sort out Tracey’s finances.

      Bradley was an example of how easy it can be to give a medical diagnosis for what is actually a social problem. I wonder how many times I have labelled the misery of long-term poverty as clinical depression, and I once nearly diagnosed an old farm worker with eyesight problems, when the real reason he couldn’t read my chart was that he had never been taught to read. I see poverty on a daily basis, but never thought that I would see malnutrition in a six-year-old boy in Britain. We live in one of the richest countries in the world and food here is plentiful. I would like to think that Bradley was a one-off case, but as everyone is becoming increasingly squeezed financially, I fear that he may well not be.

       Glass test

      My first experience of treating children was during my third year at medical school. It is at this time that we are allowed into the hospital to start seeing real-life patients. This is an exciting time for us as medical students, but there is always a fear that we will be asked difficult questions by a scary consultant on the ward round. This was the situation we found ourselves in as we started our first attachment to a paediatric department. Everyone had been very friendly up until now, but we had just started a ward round with Dr Bowskill. He was an odd man, most memorable for his 1970s side parting and very thick glasses with large brown frames. He looked more like an Open University physics lecturer than a doctor who needed to interact with small children and anxious parents.

      My friend Jess and I were on his ward round and shuffled along behind him as he mumbled incoherently to the parents of the various children on the ward. We were mostly ignored until we reached the bed of a young boy with a rash.

      ‘Now medical students, this boy has a rash,’ he declared excitedly and then peered closely at the boy’s skin through his jam jar-sized lenses. ‘Fortunately for him this isn’t a meningitis rash, but what test might we use to see if it was?’

      Dr Bowskill turned to Jess.

      This is easy, I thought. Everyone has heard of the glass test. I was sure Jess would know how to hold a glass against the skin to see if the rash disappeared under pressure. Unfortunately, it was becoming apparent that she hadn’t ever heard of the glass test. Her expression was completely blank and she clearly didn’t have a clue how to answer Dr Bowskill’s question.

      Rather than put Jess out of her misery or turn to me for the answer, Dr Bowskill just kept staring at her in silence. This silence just kept going and going and going, but Jess’s expression continued to remain completely blank. Come on Jess. I was trying to transmit the answer into her brain using telepathy, willing to try anything to end this excruciatingly awkward silence. If she’d just looked up at me I could have mouthed the answer but she just continued to stare vacantly at the small red spots on the boy’s arm.

      After what seemed like an eternity, Dr Bowskill took off his glasses and handed them to Jess with great dramatic intent. ‘Perhaps these might help?’ he suggested in a loud, patronising voice.

      Jess took the pair of glasses in her hand and I was sure she would click that she just had to hold the glass lens of his spectacles against the rash on the boy’s skin and end this whole tortuous affair. But Jess continued to look just as vacuous, holding those glasses in her hand. I could see her getting increasingly desperate.In a final moment of panic she put the spectacles on her nose and peered closely at the boy’s arm. She then looked up, shook her head and said, ‘Nope, still don’t know.’

      At this point I absolutely fell about laughing. The painful awkwardness of the long silence accompanied by the hilarious sight of Jess wearing these ridiculous old-fashioned glasses was just too much for me to bear. Jess started laughing as well, still absolutely clueless of the relevance of the glasses to the whole meningitis diagnosis but aware that putting them on her nose in case she might be able to see the rash better had clearly not been Dr Bowskill’s intention. Particularly as the strength of the lenses meant that she could see practically nothing at all.

       Mr Lorenzo

      By far my least favourite part of being a junior doctor was covering the medical wards at night. As darkness fell, one or two of us would be on duty to cover any potential emergencies that might crop up in any of the many medical wards that were spread over several floors of the hospital. I say emergencies – the reality was that many of the jobs were far more trivial. The nurses wanted us to rewrite a drug card or re-site a drip. Occasionally, though, a call would come through on my bleeper that wasn’t quite so routine.

      ‘I need you to prescribe something for one of our elderly gentlemen,’ the nurse was saying. ‘Something to calm him down sexually.’

      ‘Eh?’

      ‘Is there anything you can prescribe to reduce his testosterone levels or something?’

      ‘What, you want me to chemically castrate one of your patients at 3 a.m. on a Sunday morning. What is he doing?’

      ‘He keeps touching all of the nurses up. He rings his call bell every five minutes and as soon as we come anywhere near his bed, or the one next to him, for that matter, he reaches out his hand and grabs whatever he can.’

      ‘Can’t you tell him not to?’

      ‘He doesn’t understand English.’

      When I arrived at the ward in question, I was greeted by a group of very irate looking nurses who led me over to the gent causing all the problems. Mr Lorenzo looked too frail and decrepit to be creating such a debacle, but as the nurse in charge escorted me over to his bed, sure enough, he made a grab for her behind. Clearly ready for this, the nurse nimbly dodged his flailing hand and gave him a hard stare. Mr Lorenzo looked at me, gave me a wink and then let loose a massive toothless grin and cackle.

      ‘You mustn’t touch the nurses,’ I told him firmly.

      ‘Funnily enough, we’ve tried telling him that. He only speaks Italian.’

      ‘No touchee the nurseees,’ I tried again, this time shouting in English but with a terrible Italian accent.

      In the very unlikely scenario that Mr Lorenzo did understand me, he chose to ignore me and instead continued to give me his toothless grin before this time trying to grab the bosoms of a health-care assistant who had foolishly strayed within his groping range.

      ‘Senore Lorenzo, por favori, no touchee. No touchee!’ I shouted firmly. I then turned around and decided to stride away purposefully as if I had successfully resolved the issue when of course I hadn’t. The nurses didn’t bother waiting for me to be out of earshot before loudly commentating on how bloody useless I was.

      I’d almost forgotten about Mr Lorenzo when about an hour later I got a frantic call from the nurse back on Mr Lorenzo’s ward.

      ‘It’s