Innocence revisited – 5

Putting the patient at ease

On a cold winter’s night…

It is important to be courteous and gentle with patients, for most of them come equipped with burdens enough. We all have our own technique for achieving a state of relaxation within our clientele but in the end we are likely to fall into the trap of the friendly throw-away remark. Then our troubles begin. Come and see where Dr Pelmore landed himself.

It was a typical winter’s night in the Channel Islands. The wind and rain vied for the windowpanes like shoppers in a sale queue. I was doing my medical residency job, eleven thirty at night, on the women’s geriatric ward. A tiny old woman wearing a fading shawl beckoned me over.

‘I pressed the buzzer and nobody came.’

‘The nurses have been really busy – what did you want? Perhaps I could help?’

Long pause. ‘I can’t remember’, she faltered.

‘Perhaps you’d like a handsome young man to come and give you lots of money?’, I joked.

She leaned forward, rather breathless, and whispered, ‘Never mind about the money’.

A tattoo or two…

One’s special interests and hobbies can catch one out, too. Here is Dr Pelmore again, this time at St Thomas’.

Tattoos fascinate me. Through the years, both at home and abroad, I have tried to be a Samuel Pepys of the tattoo world. Colours vary from country to country – all major ports have their specialists. These dermal effigies abound in variety and humour – biceps adorned with a buxom trollop’s bust and the words ‘Miss Behave’; a pair of pigs copulating labelled ‘Making Bacon’; and a wizened old gardener from Brittany with ‘The Fountain of Love’ tattooed down the shaft of his personalised implement (in French, of course).

My favourite tattoo encounter was on the wards of St Thomas’ Hospital. A wily old Cockney, wearing only a pair of loosely-tied pyjama trousers, was headed towards me. A gallery of tattoos covered his body. I noticed his appendage eyeing the world through his gaping trousers. As I hastened forward to tell him to ‘cover up’, I noticed a small tattoo on the offending organ.

‘What’s that?’, I asked.

He led me to the safety of the bedside locker, looked furtively about him, and showed me. ‘It’s a monkey’, he said, ‘but sometimes it’s a bloody gorilla!’.

Touché…

Just as carefully selected remarks may be used to augment the morale and esteem of patients who suffer from a deficiency of these things, so also may they diminish the colleague who has them to excess.

Dr Primus remembers a fine example.

During my junior residency a young man from the country was admitted under the care of the senior orthopaedic surgeon. He had a serious shotgun blast injury to his forearm and hand, involving fractures, major blood and skin loss, as well as damage to muscles, tendons and nerves. After being suitably resuscitated and having his fracture treated, the senior plastic surgeon was asked to see him, to see what could be offered in the way of restoring some useful function and appearance to the young man’s arm.

This plastic surgeon was very talented and artistic, and a perfect craftsman when it came to reconstructive surgery. For this reason he was greatly respected and admired. He was also inclined to be verbose, and would let his imagination go wild when it came to solving problems such as our young man’s. At other times he could be a veritable ogre, and would reduce the hardiest and staunchest theatre and ward staff to tears with his sarcasm and tantrums if his instructions were not carried out to the letter, or if he happened to be given the wrong instrument by an unwary or novice theatre nurse. In fact, nurses would draw lots to avoid having to scrub with him. He saw our young man and gave his opinion.

Our team’s grand ward rounds were always a sight to behold. There was the senior orthopaedic surgeon – a large, formidable man, followed by two more junior orthopaedic surgeons, registrar, senior and junior residents, several physiotherapists and the ward sister.

We came to our young man, and our leader picked up the patient’s file to ascertain the plastic surgeon’s opinion. As he read out to us the voluminous notes on how the plastic surgeon was going to carry out the reconstruction – how he was going to raise flaps and abdominal skin folds, carry them over and attach them to the injured parts as a ‘kangaroo graft’, then leave the pedicle…and so on, going into great details, a big grin broadened across our leader’s face. He picked up his pen and scrawled across the bottom of the page in large letters, ‘WE THINK YOU’RE WONDERFUL TOO’.