The patient's name was Paul (except it really wasn't, because of confidentiality reasons).
He comes into his GP consultation looking like he hasn't slept in days. I ask him what's wrong, and he points to his tummy. "It hurts, yea?" he says, and describes a three week history of irregular bowel habits and occasional vomiting. He hasn't been eating well on most days, partly because he can't afford it and partly because he doesn't have the appetite to. He doesn't smoke nor drink, is currently unemployed, and living in a council flat.
"Do you think I've got cancer, doc?" he asks. It's a common question we get, and I have to tread carefully. I make it clear that I'm just a medical student and don't really have any authority to make a clear diagnosis, but given that he's only 31 I tell him that bowel cancer is unlikely. He nods, but it doesn't seem to quite put him at ease.
"Do you have any other concerns?" I ask. It's a magical question that a) gets the patient to open up and b) fills in any uncomfortable silences that naturally occur during a medical-student led consultation.
He looks at me and says, "Where do I begin?"
You see, Paul's bowel habits aren't the things worrying him on this particular day, even though we've spent a majority of time talking about it. What worries him is the fact that everyday he feels like killing himself and doesn't really know what's stopping him. Everyday is a struggle to survive, to get out of bed, to feel any sense of self-worth. Everyday Paul does not feel like Paul; he feels like an empty shell that's been hollowed out many years ago. It all started out, he said, with his mother's suicide. You can tell it still bothers him because he subconsciously puts his hands over his eyes everytime he says suicide, as if he's trying to shield himself from the horror of the word. Since then his mental health has been in a death spiral, out of which he can't find any escape. Now he rarely leaves the house, and rarely eats. He is at risk of being homeless and penniless. "I don't know what I can do, doc," he says to me. And I didn't know what to do either. I'm not a counsellor, I'm not a friend, I'm not a doctor - I'm not even a very comforting person to talk to. I'm just a medical student.
I call in one of the senior GPs in the practice. His name was Dr Mirth (except it really wasn't, because of confidentiality reasons). He's always smiling and humming a tune, as if ready to burst into song at the turn of a phrase. He greets both of us with his usual cheer, and asks Paul to talk about what exactly is going wrong. Paul opens up to Dr Mirth as well, and the doctor listens carefully. "Sounds like there's a lot going on, isn't there? But let's talk about some of the positives you have. You've been homeless before, but at least now you've got some place to stay. You've stayed off alcohol and drugs, which is more than many of my patients can handle. And there's some positive steps we can take. I can give you a medical certificate to make sure you don't get kicked out of your flat. And we can try a round of antidepressants to lift your mood up a bit. But importantly Paul, you gotta focus on the positives and take things one step at a time. Call back into the GP and talk to me anytime you want if you need more help. How does that sound?"
Paul looks up at Dr Mirth, thinks for a couple of seconds, and nods. "Yea, that sounds like a plan."
It's not a long term fix. There's a lot more demons that will plague Paul. His depression and anxiety will not be cured with antidepressants; he needs further psychological help with it. He needs to find a job and become self sustaining. And he needs to start fighting the spiral that's dragging him down. But for now, Paul feels slightly better.
Paul thanks me for the consultation as he walks off following Dr Mirth to get his prescription, and I tell him that's it's been a pleasure.
Except it really wasn't.
I can't help but feel terrible for Paul. Life is throwing everything it has at him, and he's at breaking point. In a way, I feel guilty that medicine can't offer a magic switch to fix Paul's problems. But what would medicine be, if there was that switch? Medicine isn't like replacing a broken chain on a bike or replacing a faulty button on a keyboard. Medicine is about treating the patient as a human being - to alleviate symptoms, to calm their worries, to address their concerns. It's about treating Paul, the man bearing the full brunt of life's storm. Not Paul, the patient with irregular bowel habits.