As far as I was concerned I was always fit and well. Only the fine and magical arts of various of my other colleagues showed that my slowly advancing oesophageal cancer couldn't be removed without sacrificing my larynx and much of the anatomy of my neck as well. As most of my art consisted of cosy 'there, there,' chats to my well-known patients, the lack of a voice would obviously present insuperable problems.
The diagnosis of squamous cell carcinoma of the very upper reaches of the oesophagus was reached on Monday evening. I worked normally through the week without telling all but two of my patients and friends, and retired at 7.00 on Friday evening. To say that the practice staff were devastated would be an understatement. These dear girls (girls of, er, mature years perhaps) had been my saviours, my calmers-down in between 'difficult' patients, for many a year. They were so much a part of my life that in between taking them entirely for granted and thinking that they never really noticed me at all, I often tended to neglect their unique input into the 'spirit' of the practice.
A considerable part of the local world was being completely overturned. Judging by comment on the hundreds and hundreds of letters and cards I received when the letter from the Family Health Authority reached them, many people had lost not just 'their doctor' but also a large part of their lives as well.
What can I say? I had lived with these families for nearly 30 years. Some of them I had brought into the world myself and were now into the second generation. Many of them I had seen through unpublishable crises of hair-raising awfulness which most of the world 'out there' never come into contact with. It is, in a way, unfortunate that G.P.s just cannot write about most of the problems with which we are faced every day. In recent years most of the problems are not even medical. Many of them could have been at least put in their place in the realms of the problems of life by some other 'wise' adviser: the vicar; the rabbi; some member of any number of other religions whose theology, at ground level, deals with these problems. But it seems that the only easily accessible adviser these days is the G.P.
Do I miss it all? I have to confess that I don't miss Monday mornings: but I do miss the children: my children, who see me as some sort of benign uncle-figure I suppose. Quite the most touching card I received - amongst many hand drawn 'thank-you' notes from the children - was one which just said, rather than messages of thanks and sympathy, "Have a good time..."
And I miss my young mums: those I had seen grow up, and who had put their trust in me during their teens and eventual pregnancies of their own.
And of course, the more elderly: those I first met when they were perhaps 50 or so, who looked at a young doctor with some degree of suspicion no doubt, but who - I can say with certainty - grew into a relationship of mutual understanding and trust... now in their 80s and friends as well as 'patients'. How can I be replaced? Without any sense of boastfulness, I know that I will never be replaced. They have lost as much as I have.
Those that died under my care, I like to think had happy deaths. With the prescience of my mortal hours now become manifest, I can look back with increased interest on all the various sorts of life-endings that nature may spring upon us. It became something of a standard joke amongst my receptionists that when we consulted my notes after an unexpected death, as often as not my last entry was "...very well." I liked to think of my patients to have died 'well'.
There were tragic deaths; early and untimely deaths; and 'organised' deaths with the patient surrounded by the hospice nurses and apparatus of pain-killing and relief of suffering.
"Dear God..." said a letter in childish handwriting beside Grandad's bed as he lay wasting away with carcinomatosis. "When he comes to see you, just ask him to remember the Teddy bear he gave me when I was only five."
I wonder if the family now remembers that note.
I, as their G.P. will never forget it. That is what it all means...
Dr Alan G. Gray