Читать книгу The Complete Confessions of a GP - Benjamin Daniels - Страница 44

I had a call to visit Jackie again. She is in her late thirties and lives in a tiny two up two down council house with her three teenage children. The house is thick with smoke and painfully cramped. The TV takes up most of the lounge and lying on the sofa in front of it was Jackie.

‘You’ve gotta help me, Doctor. It’s the pain. I can barely walk. Those pills don’t work. None of it works!’

Jackie has been a patient at my surgery for years. She switches from doctor to doctor and has been on almost every painkiller known to modern medicine.

‘Are you going to see Jackie?’ my colleague asked me as I picked up her notes and headed out of the door of the surgery. ‘She’s got the worst case of TLS I’ve ever seen.’ TLS stands for ‘tough life syndrome’. Jackie has had a really tough life and this now manifests as chronic pain and fatigue. Jackie was abused as a child and young teenager by her stepdad. She then ran away from home and worked as a sex worker for a bit before she became pregnant at 17 by an abusive partner. Two more abusive partners and two more children later, she was alone at 21 with three children and an alcohol problem. Her children are now teenagers. Her son threatens her and regularly steals her benefit money and her daughter is a heroin user. Her eldest son is constantly in and out of prison. It’s not exactly The Waltons.

Jackie has pain all over her body. Her abdominal and back pains have been fairly constant over the last ten years or so and now she has general pains in her legs, arms, chest and hands. Jackie has had multiple scans and X-rays that have all been normal. She has seen neurologists and rheumatologists who have examined her thoroughly and run specialist blood tests and scans looking for rare disorders. They all drew blanks. She was finally diagnosed last year with fibromyalgia. The definition of fibromyalgia is ‘fatigue and widespread pain in the muscles’. It is a diagnosis of exclusion which means that we diagnose it when we haven’t found anything else that could be causing the symptoms.

Officially there is no known cause for fibromyalgia, but time after time when I dig deeply in to the sufferer’s past, I find stories of trauma, abuse and unhappy childhoods. Perhaps in years to come they will find some odd hormone or virus that is responsible for this condition and find a cure, but in my experience it almost always occurs in people who have had tough and troubled lives and can’t articulate that pain verbally so it is expressed instead as physical pain.

I’m clearly not the first doctor to have recognised the likely association between Jackie’s physical symptoms and her emotional state. She has been tried on antidepressants and been referred to counsellors in the past, but she has always been reluctant to accept them. ‘I’m not depressed, Doctor. If you could just get rid of this pain then I’d be fine.’

Whenever I visit Jackie she wants me to try her on a new painkiller. Giving out a quick prescription is the easiest option for me as it is the quickest way that I can get out of the house. The problem is that I know that whatever I prescribe won’t work. She has tried every painkiller I can think of and now the only step up from here is morphine. I really don’t want to be responsible for making her a medicalised heroin addict; besides I know her kids will steal it and either take it themselves or sell it on the estate. Perhaps if I could just help her take some ownership of her condition and recognise the psychological element to it, maybe I could genuinely help her.

‘Jackie, why do you think you’re having all this pain?’

‘I dunno. You’re the doctor.’

‘It looks like you have had quite a hard time over the years.’

‘You can say that again.’

‘Some people find that going through large amounts of stress and upset can contribute to having physical pains and low energy.’

‘You think I’m making it up, don’t you? This pain is real, you know.’

‘I don’t think you’re making it up, Jackie. The pain is real but I just think that perhaps all the stress you’ve been through might be a big component to your symptoms.’

‘Nobody believes me. You doctors are all the same. You can’t leave me like this. I need something for the pain. I’m only 39 and I’ve not been out of the house for weeks. That can’t be normal, can it? You have to help me. I need something for the pain!’

‘I’m sorry, Jackie, but research has shown that fibromyalgia doesn’t really respond to painkillers. Some people find that gradually increasing activity levels and exercise can help. I could also refer you for some specialist talking treatment called cognitive behavioural therapy. There have been some studies to suggest that this can be useful.’

‘So you’re basically doing nothing for me.’

‘I’m not sure what more I can do, Jackie. I’m sorry.’

Doctors tend to deal with patients like Jackie badly. By simply organising more tests and giving more drugs we are positively reinforcing the idea of the sufferer having a medical illness that is the responsibility of the medical profession to treat. The years of hospital out-patient appointments and specialist referrals encourages the idea that the person is sick. It is a role that they subconsciously fill and become dependent on. Being labeled as ‘ill’ is a distraction from the fairly miserable social and emotional problems that are the underlying problem. In some cases being ‘ill’ is also a way of exerting some control on the people around them.

My best efforts at trying to gently persuade Jackie to start thinking about the connection between her physical and emotional health were clearly spectacularly unsuccessful and the next time she requested a home visit she specifically asked to see any doctor other than me. I know that this means I have failed, but I have to admit that it is a real relief to know that I won’t have to stand awkwardly in her lounge feeling helpless as I watch her suffer. One of my colleagues visits her instead and starts her on morphine.