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Oh god, I was so fucked last week. As in, right up until last night.
Had a patient come in. Clint Eastwood-looking fellow, albeit a bit yellow. He'd clearly been to Shanghai and had a good time, whereas I only seem to get Shanghai'd into work and am the wrong kind of Asian for it.
He was not in a good mood. When the senior consultant led the ward round, the rest of us tagging along like ducklings who'd imprinted on the wrong mother, he had concerns. Said we should help, that the NHS was clearly failing him. I cannot in good conscience disagree, having extensive evidence on the matter, but we did need a slightly more itemised complaint. Turned out the gentleman in the next bed had wet himself and nobody had come. My patient, who could not reliably tell you the year, had correctly identified a real institutional failure and appointed himself its ombudsman. The consultant was mildly put out at being mistaken for a nurse. She was far too professional to show it to a man in hepatic encephalopathy, and I was the only one who caught it, because spite recognises spite.
Later, I had to put an Adults With Incapacity form in place for him. He couldn't consent, so the job was to consent on his behalf, which is the polite clinical phrasing for deciding things about a man's body in a room he isn't really in. It wasn't urgent enough to skip waiting for the family, so I waited for the family. They came. The wife told me he used to have a sense of humour like mine. I said that probably explained the liver. She laughed, which I'm choosing to log as a therapeutic outcome. I'm sure she was a gorgeous lady once, albeit too old even for me. She was suitably apologetic for her husband getting rather angry when I put on my usual song and dance, and possibly interpreted it as coming onto his wife. Bit late for that bud. He was not amused. He said "don't quit your day job."
How rude. Wasn't planning to, but that is precisely what I would say in his shoes. And I don't even have the loving wife, lovely daughters, and the grandkids. Or the dementia and what is possibly a HPB carcinoma. Win some, lose some.
Here's what they don't put in the GMC curriculum: he was, by every account in the room, a good man. A lawyer who gardened. Combative, his wife said, but never rude to anyone he understood was trying to help, which is a finer distinction than most healthy people manage. Then dementia, then the loss of his legs, then the drink, in roughly that order, each one a door that only opens one way. I wrote the cognitive and alcohol history and I will admit, with the appropriate amount of shame, that I enjoyed writing it, because it was the first time in months the job felt like the one I trained for. My colleagues said I was the right person for it. I suspect this is because I am the only underemployed psychiatry resident in the building, but I'll take the compliment at face value, since I'm short on those and long on face.
What I did not enjoy: watching the poor bastard suffer, and the fact that my replacement NHS ID badge was not handed to me that day as promised, despite an email, an appointment, and a confirmation that very morning. Isn't there something clarifying about being trusted to make life decisions for an incapacitated stranger while the same institution cannot be trusted to hand you back a piece of laminated plastic?
Then, because the week was apparently being written by someone with a heavy hand, I went on a date. Long journey, no sleep, the usual baseline of grey. She seemed nice, but I really wasn't hoping for much. I went on that date because I wanted to do something other than dissociate in my bed that weekend. I was more unhinged than usual, past the point where I come off as charming and confident, and appear slightly delirious myself. We talked for an hour or two, as many drinks. She came back from the loo, told me she wasn't feeling it, didn't want to lead me on, and would rather go home. Which is, I want to stress, the considerate way to do it, the rejection equivalent of a clean surgical margin. I told myself this. It did not take. I'm a psychiatrist; I can narrate my own distress in correct terminology while it ignores me completely.
I won't bore the thread with the bit in the middle. There were mushrooms. There was a bus station, a kebab, an emotional support lesbian* who has so far declined to be anything more, and a great deal of being talked down off my own ledge by parties who shall remain anonymous. The short version is that I am better now than I was, by a margin that won't mean much to most of you and means a great deal to me.
The old man's still on the ward. I think about the one-way doors. I've got the kind that still open, for now, and I intend to keep walking through them, if only out of spite, which is the one mature defence mechanism Vaillant forgot to list.
*I call her that to her face, and it makes her giggle. Good to know that lesbians, old grannies, the delirious, the psychotic, and other characters find me funny. Also, she is into some really freaky stuff, and I suppose knowing what Langhans lines are might help. Shame that she is probably not lying about being asexual or a lesbian, but I've had worse company. I am nothing if not an optimist.
There's always a bit of sting to rejection, even by people you aren't interested in. With the exception of those you're looking for a way to escape from. Kudos to this girl for saying it cleanly and to your face though rather than ghosting you after the date.
I really don't blame her for what the NHS is really causing. I did thank her for letting me know, shook her hand goodbye, and confirmed that she made it home in one piece. I try to keep my problems my own, and she didn't need to know that something that small was all it took to make me begin unraveling.
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