Dear Doctor..

Dear Mr Consultant,

I came to see you the other day for my final appointment at the end of treatment for breast cancer. I waited an hour in a room filled with elderly patients who by necessity were filled with the War Spirit and happily geeing each other along. I looked around at them and realised that some were probably there for ‘Results’. Sitting there, laughing with strangers in this limbo-like space. Waiting for words that would change everything. The very worst thing you can do to someone with their emotional breath held, is make them wait. Thankfully that was not me, that day.

When you finally came to get me, you barely glanced at my face. When you said my name, it was the last time I would hear it from your lips. You rushed ahead down a long, unfamiliar corridor and I started to feel like Alice down the rabbit hole. Once, you half turned your head to mumble an apology for the wait but I only caught part of it. I felt a pressure at the back of my head to start talking, to reassure you in the gaps, to fill the social holes that launched our interaction. I didn’t feel up to it. We had had a previous encounter once before when I didn’t feel heard, felt dismissed. So I’m already coming into this interaction with baggage. I don’t want to be nice to you. I’ve raised my defences and nothing so far is causing me to drop them.

I remain silent as we enter your office. Your space, your territory. You go straight to the computer and pull up my file. You scan read my life-saving treatments. You are thorough though and open up the report from an ECG I had 8 weeks ago that no-one has told me the results of yet. 60-65% heart function, that’s good you say. I’m relieved and happy you told me the details. I like the details. I like to know as much as I can about my body and how it’s doing. It helps me to feel at least a smidgen of control in an otherwise free-falling situation.

I got encouraged to be curious and asked what that meant, those percentages. You seemed flustered that I wanted to know and half laughed at my misunderstandings of biology. Maybe you were sharing a bonding moment with me. Perhaps you thought a bit of laughter would break the tension. Humour can do both those things. But laughter can also feel mocking and belittling when you feel an inequity in the relationship. Your response made me also question why you had told me the numbers in the first place. Was it to help me understand, to reassure me I was OK? Or was it a way to distance me from you.

Because this was how I was feeling. Distant. I wanted to hug you, to thank you. How could I ever show enough gratitude for the immense act of saving my life. I wanted to bring you cake and a card with all the words I couldn’t squeeze into my allotted time. But action by action, you pushed me away. One micro-detachment at a time.

You said you wanted to listen to my heart and lungs and asked me to take off my ‘top things’. You pulled the curtain and went to get a female nurse. She was supposed to be there to reassure me, to make me feel safe, to prevent any ‘misunderstandings’. I didn’t see her face or hear her voice until she asked me if I needed help getting my bra on after it was all finished. You didn’t ask permission to touch me or take care in that touch. You hurt me where I had been cut open. Your hands were cold, rough and fast. You didn’t ask if you could examine my ‘good’ boob. You just did it. I didn’t even know you were going to examine my scars, my hurt places. The places on my body that had just started to become private again.

When you finished, you washed your hands and I felt violated and a bit ashamed.

I can try to understand why you act this way. You see hundreds of patients, some of them are going to die. All of them are going to suffer. You must need to build up defences to protect your own human feelings. Maybe that’s how it starts. Then little by little, it turns into something meaner, nastier. It becomes self-fulfilling. I must have seemed by an ungrateful, cold person to you. I didn’t laugh at your jokes. I didn’t even say thank you. All your hard work and nothing back. If you’re already detached from me, this must send you a little further towards misanthropy.

It is a tricky thing to protect yourself emotionally while keeping engaged with people. We all struggle with it. The best doctors and nurses I’ve had seem to find that balance. Even if I’ve had to wait hours, they walk me slowly to their rooms. They ask me how I am and listen to the answers. They say my name many times. They look in my eyes and away from the computer screen. They tell me everything they want to do, every examination they want to make before they do it. They ask permission for every touch and apologise for any hurt they cause. They encourage my questions and answer them patiently and thoroughly. They even get energised by it and take me further into their own world of understanding.

They make me feel like the only patient in the world in a world of chaos and pain.

So dear consultant, I wish you that hug and I am grateful for your knowledge and expertise. You saved my body. Please find the strength and will to soothe my soul too.

Yours, in respect and peace.

The patient.


The Evils of Grapefruit

I changed the way I eat recently. I say it that way and not that I’m on a diet because I want my eating habits to shift permanently. Diets leave me open to failure, to regression. So I’m reducing portions, going for 60/40 raw to cooked food and cutting out sugar. It seems to be working apart from the odd packet of crisps when I’m feeling tired and lazy. Crisps will be the last thing to go being so tied into my emotions from comforting myself after giving up smoking in another life. I was tucking into my new healthy breakfast of two glasses of water, a cup of coffee and half a grapefruit the other morning when Adam told me he had read somewhere that grapefruit can interfere with drug absorption. I paused in mid-spoon and looked at my ‘healthy’ fruit anew. Adam doesn’t glibly throw out information like this so it warranted further investigation.

I made a quick Google effort but either my search terms were lacking or my brain, because all the information on the subject came from unreliable sites. So I left a message for my Breast Care Nurse asking half-laughingly if my grapefruit breakfast was nullifying my life-saving drugs. When she called me back the answer was ‘yes’. It seems a chemical in grapefruits called furanocoumarin shuts down an enzyme in the gut that is crucial to absorbing certain drugs. Apparently they told me not to eat it during chemotherapy and advise to avoid it while still on medication. When I was in the middle of chemo and actually all of my life up to that point, grapefruits were certainly very far from my mind. As far as I was concerned they were evil oranges. I suppose because they weren’t on my radar, I saw the advisory on them as irrelevant to me as the warning about shellfish. It never occurred to me that grapefruit was ‘dangerous’ as well as horrible tasting.

devil grapefruit

But my tastes have changed as I’ve thrown out sugar and brought in more fruits and veg. I’ve embraced tastes that made me squeeze my eyes shut before. As the historian Bee Wilson writes, food preferences are learned through culture and not biology, so can be easily shifted. Evidence my shift to eating chilli, coffee and sushi after extreme husbandly peer pressure over the years. I am resistant to having to choose between grapefruit and life-saving drugs though. Why am I even spending one minute longer on this quite obvious decision? I suppose the shift to grapefruit was the single biggest change to my eating habits that symbolises that small bit of control I might have over improving my own health. Having spent my whole life hating grapefruit and only recently learning to love it, I now have to give it up. And give up that big change I made. But I guess they are evil oranges after all and I’ll have to make do with plain old oranges. Except for Seville oranges, because those are bad too. And pomegranete.. and star fruit. Sigh.