Post 60 Belatedly reaching the Correct Diagnosis

Thursday afternoon was the time each week that John set aside for his clerical and administrative work. It was a chance to sit in his room, close the door, and work for a couple of hours, free of interruptions. He started by clearing the requests for repeat prescriptions. It didn’t him take long and was an undemanding task. Then he reviewed the results of the blood tests and x-rays he had requested on his patients. He had to decide who needed to be reviewed and who simply needed to be reassured their test results were normal.

He spent more time on the letters he’d received from hospital consultants, about patients he had referred for a second opinion. They were always informative. Those who had simply been put on a surgical waiting list for a condition such as a rupture or varicose veins, he simply filed, but the ones that particularly interested him, were those where  he had struggled to make sense of a patient’s symptoms or was unsure of the best way to manage their condition. These were an opportunity to see what an expert in the appropriate field had made of the problem; an opportunity to learn.

Next, he moved on to the administrative matters that required his attention; directives from the Ministry of Health, and financial matters relating to the surgery. This was work that he knew was necessary but which he regarded as a chore. He was just thinking how much happier he would be, if medicine was simply a matter of looking after patients when there was a polite knock at the door

‘Come in,’ he called.

It was Mary from the back office.  ‘We were just having a brew, and I thought you would like a cup of tea, Doctor. And I’ve brought you a couple of those chocolate digestives too; I know they’re your favourites.’

‘Thanks, Mary, you’re an angel.’

John lent back in his chair and started to reflect. He enjoyed his life as a General Practitioner and had been happy since he joined the High Melton Medical Centre. He liked the easy, friendly atmosphere in the surgery; he enjoyed a good relationship with the other doctors and, by and large, got on well with his patients. They represented a pleasant cross-section of the population. The practice covered an area on the edge of town, including a large residential area, a small council estate, and one or two houses in the neighbouring countryside, occupied by the ‘well-to-do’, some of whom had joined the practice as private patients. Which reminded him, he’d better get back to these administrative matters, as he had arranged to see Jeanette Hopkins at Melton Manor on his way home. A frown creased his brow; she’d been worrying him; she didn’t look well, and he found her symptoms difficult to assess. Maybe she was someone on whom he ought to be seeking a consultant’s opinion.

John was met at the door by Mrs Hopkins’ cleaner.

‘Mrs Hopkins is upstairs in bed,’ she said, ‘and not for the first time,’ she added, meaningfully. ‘You can find your way, Doctor, can’t you - up the stairs and the first door on the left? It’s the big front bedroom with the bow window and the en-suite.’

John found Mrs Hopkins in bed, a sleeping mask over her eyes and the curtains were drawn. Forty-five years of age, she looked pale and tired.

‘I’m sorry to trouble you like this, Doctor, but I feel tired all the time.’

Inwardly John groaned; they had lots of patients who complained of being ‘Tired All The Time’, – so many in fact that they referred to them as ‘TATTS’. It was a modern epidemic; most of them had nothing wrong with them at all!

‘And I have this awful headache as well,’ Mrs Hopkins continued. ‘It’s been bad for three or four days now, and I don’t seem to be able to shake it off. I couldn’t possibly have come to the surgery to wait with the other patients.’

John took a quick history. The pain was situated just above the eyes and was present most of the time, but there was little to suggest its cause. Her temperature was normal, as was her blood pressure. There was nothing to suggest anything serious was amiss.

‘It may be a bit of a viral infection,’ he said, ‘but stress can often be a factor. Are you under any pressure, or is there perhaps something that’s particularly worrying you at the moment?’

‘No, I don’t think so; well nothing serious anyway. There was a bit of a ‘to do’ at the bridge club recently. Anne Tetley and I had a little disagreement when she made a false bid, and then tried to change it. But we called the adjudicator, and he said I was in the right. She’s been a bit standoffish with me since.’   

John started to gather his things together. ‘Right, I’ll give you something to ease your headache. I’m sure it will pass in a couple of days.’

‘That’s very kind of you, Doctor, I appreciate you visiting me. Will the tablets help my backache too?’

This remark caused John to make a few enquiries about her back pain, and again he found nothing amiss. He became increasingly certain that anxiety and stress were Mrs Hopkins basic problem, and, deciding to play amateur psychologist, he began to probe a little deeper.

‘You say you have no major worries, how are things at home?’

‘No real problems, Doctor, well, no more than other couples, I guess.’

‘And how are things between you and your husband?’ John asked cautiously, aware that he was now moving into personal territory.

‘Well, Doctor, I do get lonely. Arthur works in the city and has to commute to work; he’s off at the crack of dawn each morning, and he doesn’t get home until late in the evening. As a result, I’m on my own a lot. And he’s the secretary of the golf club; that takes up a lot of his time at the weekend. So the truth is, I don’t see a lot of him. But if it’s the matrimonial side of things you’re asking about Doctor, well, no - we don’t often have relations. In fact, I can’t remember the last time we had sex. At night, Arthur gives me a quick peck on the cheek, turns over, and is asleep in two minutes. Then I lie there, tossing and turning, listening to him grunting and snoring. And my legs are restless. I read something recently in the Daily Mail about restless legs, but apparently, there’s not a lot you can do about them. With one thing and another, I find it difficult to get any sleep at all, and then, of course, I’m tired when I wake up in the morning. In fact, Doctor, I was wondering if you could help me with some sleeping pills.’

 John was becoming ever more certain, that all his patient’s troubles were due to stress, and a burned-out marriage.

‘Have you thought of taking a holiday, having a break?’

‘It’s strange that you should say that, Doctor. Arthur’s dad and his new wife have asked us to go with them to Cyprus, but I really don’t think I could go.’

‘It sounds as if it could be a good way of getting to know her, and the sunshine and fresh air would do you good,’ John commented.

‘Oh, I get along with her all right, but the problem is they’re planning to take her son along as well...,’ she hesitated before going on, ‘..... well, I just don’t think it would work.’

‘And this young man, what is his name?’

‘He’s called James.’

‘And don’t you get on with him?’

Mrs Hopkins lips melted into a warm smile. ‘I get on with him very well. He’s lovely, quite the opposite of Arthur. He’s lively, quick-witted, delightful company. I’d like to see much more of him, but that would be a bit awkward.’

‘Do you see him often?’

 ‘Yes, I try to see him whenever Arthur is away.’

John was sure he was now getting to the root of Mrs Hopkins’ problems. She had a guilty secret – she was in love. He wondered how far her romance had progressed, and whether her husband had any suspicions.

‘And you’re fond of him?’

Mrs Hopkins whole attitude changed. She came to life; she was animated; a smile lit up her face. ‘Yes, I adore him. Whenever I’m with him, I want to hold him in my arms, hug him, and feel close to him. He makes me so happy; it makes me realise what I’ve been missing all these years.’

‘And does he love you in return?’

‘Oh y,es, definitely. He’s so sweet. Only the other day, he said he wanted to marry me.’

John wondered if she realised that if, or perhaps when, her husband discovered her infidelity, her life would become even more stressful.

‘Look,’ he said, ‘I’m sure it’s very flattering for a lady of your age to have a sexy young man attracted to you, but you need to think very carefully before you take things too far.  There’s your marriage to think about, your home, your whole lifestyle.’

‘Oh, Doctor, you’ve got it all wrong. James is only six years old. If only it would have been possible for me to have a child of my own.’

John saw the tears well up in his patient’s eyes, as he realised he had finally stumbled on the cause of her unhappiness. He reached out and took her hand.


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