Confabulations

Dr Joe Baker

Con-fab-u-la-tions: – chats; discussions; – replacements  of memory gaps with imaginary imperfect, distorted or misinterpreted memories consistently believed to be true.

A busy over-booked morning clinic  and a consequential shortened lunch break. The paperwork can wait. There is just enough time for a quick visit to the local coffee shop to relax and dip into my new  John Berger book.

I order a coffee, turn, and am truly delighted to see Bruce, a former patient who is revisiting the area. We talk at length about all things non-medical. While I can remember his Paisley-lined collar shirts I have completely forgotten why he used to visit me. I have always had the ability to forget patients’ problems when they leave the practice; I think this may be some psychological protective device.

But truth be told, patients don’t even have to have left the practice before I forget their ills. Last week, for example:

“Ah Simon, nice to see you. The computers are down today so I don’t have your records. Just remind me, when did we see you last?”

“Yesterday.”

“Ah… yes that’s right. Pain in your knee wasn’t it?”

“No. Headaches. You were worried and said you wanted to see me again today.”

“Yes that’s right, headaches. I’m so sorry. We do rely on the computer so much – there is a lot to remember.”

“Could it be early  dementia?”

“No, you’re far too young and dementia doesn’t usually present with headaches.”

“I meant you. Might you have dementia?”

Very sobering medical advice from a patient, advice that will later trouble me.

Bruce and I drink our coffees.

Bruce looks at my book. “Reading Berger eh?  He writes about  art stuff doesn’t he? I didn’t think doctors did art stuff. Although having said that, I do remember you were quite artistic. You were pretty good at making things up. How many times did you tell me I must have a virus? I bet you didn’t really have a clue.”

He is being friendly  but the joke’s on me. Fair game, there is some truth in what he says.

Time to return to work.

“Nice weather!”

“Yes it is, Philippa,” I reply matter-of-factly.

“Although we had a heavy dew on our lawn this morning.”

I am keen to cut to the chase but we are taught to let patients talk.

“Did you?”

A smile. “Yes we did.”

A pause. A bigger smile. “ I said, Rabbi Jacobson what are you doing on our lawn?”

My mind works overtime. What is she talking about? Oh I get it: dew/Jew. There was a heavy Jew on her lawn. But is she making a Jewish joke? Is it offensive?  Probably not – it’s simple word play. I can smile.

“And then I said, Rabbi, I see you haven’t kicked your ten bagels a day habit.”

More analysis. Another play. This time on the word heavy. I think it is OK to smile but I am not sure. Anyway, I have never been taught how to confront patients who proffer inappropriate comments. I decide to smile; she is paying to see me after all.

Then, later than afternoon: “I blame Hitler and his crew.”

I could leave it at this and carry on, but that would be bordering on the surreal and Tim clearly  wants to tell me more.

“Yes I blame the Nazis.”

“What for Tim?” I decide to partake in his joke.

“For my weight issues.”

My mind works even faster than before. I’m not sure I can anticipate the punchline and surely making light of Nazis is never appropriate. Maybe he’s going to say something about Goebbeling up all his food but that seems too left field, or in this case too right field.

“Do go on Tim.”

I learn Tim has constructed a theory not only for his weight issues but for many of our weight issues based on the idea that rationing in the Second World War led to the war-ravaged population eating everything available to them and this cultural meme spread through the generations leading to our current obesity epidemic. What can I say?

“A very interesting theory Tim.” We can’t really do much about Hitler now, is what I think.

That evening I am reading my Berger. I remember there is a packet of chips left over from the previous evening. I’m not hungry. Maybe Tim is right. And it’s good to be able to blame someone else, especially if it is Hitler. But I’m not  sure where I put them. Perhaps I have eaten them already.

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Dr Joe Baker: Joe Baker is a GP in Dunedin, New Zealand.