On not being Ashley

Lucy O’Hagan

It’s 5 April, 2020. The country is in lockdown. Waiting. The pandemic hasn’t quite reached our shores but I feel a need to rise to the occasion, offer my services at the front line instead of faffing around as I have been, writing a book about being a doctor while doing little of it, and teaching others how to do it while wondering if I still have that sharpness in me, that quick pattern recognition, that diagnostic edge, that confidence that I know what I don’t know, drug doses at my fingertips, that glorious feeling that I can do all of this and simultaneously manage the unexpected, the macabre, the lost and the uncertain.

I had imagined myself as a pandemic doctor giving unction to the dying in virus-infested houses, but in reality I have spent the week doing telephone consultations at my kitchen table in my socks.

I want to be heroic, as doctors are meant to be, but actually I’m terrified at the idea of exposing myself to a lethal viral load while tending to those coughing and hoiking and drooling. Me, with no mask and no drugs. I have read the grueling stories of doctors in Italy and New York. But this is New Zealand and already some good keen bloke is in his shed making plastic face shields with his 3D printer and attaching these to small helmets and delivering them free to doctors around the country. I have one and I feel safer.

I love my country, a small string of islands in the south-west Pacific. I love blokes in sheds. I love that we have a female Prime Minister who is simultaneously toilet training her toddler and fending off a pandemic of catastrophic human and economic proportions. Every day I tune in at 1pm for the Ashley Bloomfield Show, the weeks-old reality TV slot starring the nation’s director-general of health. Today, Ashley tells us, we have 89 new cases. If it were 89½, we know we can rely on Ashley to tell us and explain the half.

We love him. He is the best of doctors. Calm and unruffled in a crisis, he spreads orderliness over the dizzying daily influx of numbers and graphs. There is no arrogance or condescension in him, none of the worst of medicine. He is kind. He’s prepared to be wrong but seldom is because his world is not black and white; we are in an evolving situation. He gets across that our trust in numbers should always be provisional. He looks tired, as we would expect a doctor to look in a pandemic, and a national cheer goes up when we are told he is to have a day off. But he doesn’t let himself slip. He wears a suit at every appearance and we can be sure he has washed his hands meticulously.

We trust him. Ashley Bloomfield couldn’t tell a lie to save himself. The worst he might do is save some critical information for tomorrow’s show, so that he has more of a handle on its implications.

I’d like to be the Ashley Bloomfield kind of doctor but I’m not. I’ve got bits of Ashley in me but I have a different job from him. I’m not sure how he would go delivering flu vaccines and good cheer in overheated council flats that smell of urine and mutton fat, as I do; checking a patient is not overmedicated even though the floor is littered with a month’s unopened blister packs; wanting to get away before the patient’s son walks in the door because I suspect he is a criminal and selling his mother’s morphine.

Ashley is great but my situation requires another sort of doctor.

I think it is easiest to explain with a story. I confess I often call my patients love or lovely, as I do my friends and students (and sometimes my colleagues – though probably not Ashley). I feel I need to explain myself.

I like lovely’s softness. You can’t say it unless you mean it. Sometimes it’s different and I call them Sir or Mate, but seldom Dear, although they are all dear to me in one way or another, even the man chucking grump down the phone at me, holding me responsible for his prescription problems – when I know he had the sound off on his cellphone yesterday as I tried calling him four times, and didn’t he know that almost overnight the nation’s GPs had converted to 80 percent phone consultations so grumps like him wouldn’t have to sit in waiting rooms spraying viruses across the shabby spaces between plastic chairs? Didn’t he think we docs were great the way we had done that, like magic? Couldn’t he have just obliged and made sure the volume was up on his cellphone? And no, I’m not interested in his plans to complain to the Government about something I missed because I was momentarily distracted by thinking about the strangeness of telephone consultations, and how he is in a supermarket picking up some smokes for the missus and I am in my kitchen looking at the tiled floor hoping a cleaner will be allowed to come soon and noticing my fingernails are a bit dirty, and realizing that somehow this is still medicine, all the while trying to divert him from his rant to the topic at hand, his script, that he declares is urgent even though he hasn’t needed it for the past six months. I notice my teeth squeeze together as he has one more go at nasty and I get an unfamiliar feeling of real irritation with the patient. It doesn’t happen to me often but we are both under a pandemic cloud and there is a squeezing tension in all of us.

By the end of the day the grump and I are friends. He did get his overdue chest X-ray, as is always called for six weeks after someone has had pneumonia. It has been three months and he tells me he can’t breathe getting up to the house. I did decline to give him controlled drugs for his pain-of-life in view of his history of addictions, even though he corrected me about his alcoholism, claiming that he now doesn’t drink before lunch. I did ring him back after 6pm when I had poured myself a soothing chardonnay in an elegant glass with a slice of washed-rind cheese on a gluten-free cracker, because the radiologist had found my phone number and told me the man’s left chest was full of fluid, and although part of me wanted to finish that chardonnay and ring him in the morning, I knew it was bad, so I tapped into my inner Ashley Bloomfield and sorted it. Even though he was both scared and feisty, we managed a laugh and he packed his bag and finished his fourth litre of scrumpy for the day and off he went to hospital with his tail wagging.

I don’t like hospitals. The steady strut of young doctors, the flurrying rush of nurses and steely professors waiting to catch me out as a fraud; one look at me tells them I have forgotten how to calculate the creatinine clearance and can’t recite the verses of the Krebs cycle. But that’s what Google is for: I know I can look those things up if I need to, across town in my community clinic with its carpet worn out by the split soles of homeless people.

So it’s hard for me to send someone to hospital with their tail wagging but I seem to be able to do it, I don’t know how. Maybe it’s a mix of sureness, consideration, humor and attention to at least one detail: namely, how will he get there, given what we both know but don’t say, that he is well over the limit and shouldn’t drive.

Maybe it’s down to a mix of concern and reassurance, doubt and hope, or an ability to internalise a complicated situation and make a plan and then bring him along with me so in the end he feels as though it’s his idea. I have listened to the hesitation in a tiny silence on the dark screen of my cell phone, felt my way, adjusted the plan, presented it differently, talked it up while appearing benign, cheer-led him into doing what is medically prudent by harnessing the mate within, oversharing my own frailties, laughing at myself or giving such details as “the specialist agreed if you were our dad we would want you in hospital tonight”.

That is when he softened, the man I have never seen in the flesh, only spoken to three times in one day over the phone, but who I imagine he is a little unkempt and lives in one of those houses in the flood-prone suburb that has a warm kitchen and a dreary hall and a shower with rising damp. But, all the same, I imagine he might have looked in the mirror and done his hair before picking up his bag, a comb-over type of look, and the bag a well-used giveaway from the super liquor store, and maybe it holds pyjamas from the back of his cupboard from a more dignified stage of his life, but probably it is my wishful thinking that there had been such a time and he in fact packed an old T-shirt and what my nephew calls fat pants.

I imagine he might have felt good: a man with a bag in a taxi with his hair slicked down. But then I worry that he might have felt small as he was delivered to the emergency department, because during our second call he had agitatedly told me how his father had whipped him with a belt every day and sometimes he had cried and then he had been beaten more. He had PTSD — didn’t I know? — and I said, “Yes, I had read something about that in his notes.” It had been just down the list after emphysema and dyspepsia and fractured metacarpals and hepatitis C, but I had felt it in him anyway, and later I hoped he wasn’t gruff when he walked into ED because the health system can give a whipping to those who are unkempt and ungracious and wounded, even if they have combed over.

And I called him lovely and I said I would ring him next week to see how he is doing, and I think I will.

---

Lucy O’Hagan is a GP in Dunedin, and teacher and mentor to GPs in training. She is a regular columnist for New Zealand Doctor magazine and is working on a manuscript of short pieces of creative writing and personal essays on being a doctor.

Explore these themes further on Corpus in articles like  Suffering Patient, Suffering Doctor and A Rhinestone Cowboy in the Waiting Room