Confessions of a GP

Empathy is defined as an ‘identification with and understanding of another’s situation, feelings and motives’. I like Kirsty but I can’t really empathise with her, as I just find it so hard to imagine what it would be like to be so unhappy with the gender I was born with. Kirsty is quite astute and I think that she has spotted this in me. As she left, she said, ‘It’s fucking hard being me, you know. You should try being a trannie for a day.’

I did once lose a bet at medical school and had to spend an evening out dressed as Smurfette. I’m not sure it really corresponds to empathising with the emotional and physical turmoil experienced by a transsexual; however, being painted completely blue and wearing a dress and blonde pigtails, it did take me a hell of a long time to get served at the bar.

‘It’s my boobs, Doc’

Stacy was in her late thirties but the years of smoking and sunbeds made her look much older. She stormed in and sat down with the look of someone who wasn’t going to leave until she got what she wanted. ‘It’s my boobs, Doc.’ I must have had a slightly puzzled look on my face, so in order to enlighten me she lifted her top to reveal her large and extremely distorted breasts. They looked like two oval-shaped melons surrounded by a layer of puckered skin and had two nipples drooping off the ends. They were pointing at awkward angles and looked completely disconnected from the rest of her body.

‘Something needs to be done,’ she demanded. ‘I ’ad ’em done ten years ago but they need redoing.’

It turned out that the original surgeon was happy to ‘redo’ them and his letter from 1998 did clearly state that her breasts would need repeat surgery after ten years. The problem was that he was charging 10K for the redo and, according to Stacy, she didn’t have that sort of money. ‘I need ’em done on the NHS, don’t I?’

My sympathy for Stacy was limited. Yes, she did have hideously deformed bosoms but the local breast surgeons were rather busy removing cancers. I didn’t really feel that she should qualify for NHS treatment. I began to try to explain that I wouldn’t be referring her today when Stacy began rummaging through her bag, eventually emerging triumphantly with a copy of a women’s magazine. She opened it up to a double-spread headlined: ‘My Fake Boobs Burst and Nearly Killed Me’. I read on to see that, like Stacy, this woman had had a breast augmentation in the 1990s, but ten years later her implants ruptured and left her in intensive care with blood poisoning.

The prospect of Stacy being poisoned by her exploding fake breasts might have entertained a lesser doctor than me, but then Stacy pointed out the part of the article showing that the poisoned implant lady was taking her GP to court for not referring her earlier. I could see in Stacy’s eyes that nothing would give her more pleasure than suing my arse for every penny she could. Defeated and broken, I made an apologetic referral to the surgeons as Stacy looked on smugly.

Two weeks later Stacy stormed back in with the letter from the surgeons stating that she didn’t qualify for the operation because of ‘PCT funding guidelines’. It was the perfect scenario for me. I didn’t really want NHS money spent on Stacy’s new boob job but could now blame some faceless managers for it not being done. I was off the hook and happily faked sympathetic noises as Stacy complained about how unfair the world was. A month later Stacy found the money to get her breasts redone privately.

Mr Hogden

I was spending a few weeks working in a very pleasant rural practice. It was nice to have a break from the poverty-fuelled social problems of the inner cities. I had dug out a few ties that I had long since stopped wearing and also rediscovered my best posh accent that I had last used for my medical school interview in 1996. Surrounding the surgery was a collection of very pleasant villages with big houses and twee thatched cottages. It was fox-hunting and green welly territory. During a sweltering few weeks in July, it was a pleasure to be cruising around the countryside doing my home visits rather than stuck in city traffic jams cursing the lack of air conditioning in my car.

Driving down a small country lane, I came across a row of small run-down bungalows. They looked a little out of place in contrast to the rest of the local housing. They were the area’s small quota of council housing that the rest of the village tried to ignore.

The patient I was visiting was called Mr Hogden. He lived quietly with his sister in one of the less well-kept bungalows. He was only in his early forties but hadn’t left his bungalow for nine years. The medical notes seemed to suggest that this was due to a history of agoraphobia, but more obvious on meeting him was that there would be no way Mr Hogden would have fitted through the door. He was fucking enormous.

Mr Hogden resided in the smallest room of the bungalow. It was about the size of a double bed and was taken up entirely by Mr Hogden himself sprawled out on the floor. He had long since broken his bed and now spent his time on a very old, filthy-looking mattress on the floor. Each of his limbs was made up of several huge rolls of fat with a hand or foot poking out at the end. His head emerged out of a humungous mass of lard that was his torso.

The sight of Mr Hogden sprawled out on the floor was a bit of a surprise but it was the smell that I really struggled with. The bungalow was like an oven in this hot July sunshine and there was only a tiny window in the room that barely let in any air or light. Flies were buzzing around in their hundreds and as my eyes slowly adjusted to the dimly lit room, it became apparent where they were coming from. Unfortunately for Mr Hogden, the flies had found that the warm sweaty crevices between his rolls of fat were a perfect place to lay their eggs. Emerging from his legs and body was a legion of maggots. The sight of the maggots and the horrendous smell were almost too much for me and despite priding myself on a strong stomach I had to do my utmost not to vomit.

‘You’ve got to help me, Doctor,’ Mr Hogden pleaded with me as he watched me take in the horror of his predicament. Despite the terrible state in which he was living, this was the first time that Mr Hogden had called out a doctor in the last ten years. He had managed to get to the toilet and back up until now and he simply spent the rest of his time lying on his mattress watching a tiny television that was mounted on the wall of his bedroom. His sister brought him his meals and Mr Hogden had quietly grown enormous without bothering a soul. Until now that was. This was yet another of those moments where I felt completely useless and, like all good cowards, I fled. To be fair, what was I going to do? I could have crouched down and picked the maggots out of Mr Hogden’s groin creases but I would have vomited. The flies would have fed off the regurgitated contents of my stomach, only adding to his problems.

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