Thursday 6th July 1989   Morning surgery 10:06

“Nothing in particular! What do you mean? You can’t put nothing in particular as a cause of death. This woman must have died of something.”
My Dad held the phone away from his ear. The Coroner was shouting so loudly that I could hear every word he said.
“Which patient do you mean?” My Dad asked.
“Mrs Gwenda Lloyd, of course! I hope you haven’t got any more patients who have died of nothing in particular.”
“No, it’s just Mrs Lloyd. What I meant was that I could not find anything very specific to account for her death.”
“Well, I am afraid that neither nothing in particular nor nothing very specific are acceptable on a death certificate. You should be well aware of that.” The coroner sounded extremely irritated.
“She was 93 years old,” said my Dad. She had become gradually weaker over the last 6 months and, eventually, just faded away. I suppose you could say that she died of old age.”
“Old age! Nobody dies of old age. There is always something.”
“Do you think she should have a post-mortem, then?” My Dad enquired.
“No, I don’t. We certainly don’t need to go to the trouble and expense of a post-mortem in a 93 year old. Do you want to upset the family? All we need is a simple cause of death.”
My Dad said nothing.
“Do you think she died of a heart attack or heart failure?”
“No, there was no chest pain. She wasn’t breathless.”
“Perhaps it was a stroke?”
“I don’t think so. There were no signs of paralysis. She had no difficulty with her speech.”
“What about pneumonia?”
“No, she had no cough or fever.”
“So, it must have been cancer?”
“There was definitely no evidence of cancer. It wasn’t cancer.”
“Are you suggesting foul play?”
“Certainly not! Her family were devoted to her. The two daughters were two of the most caring that I have ever met. Perhaps it was a little bit of everything.”
“A little bit of everything?”
“Yes,” my Dad continued. “In my experience a lot of very elderly people die of nothing in particular or a little bit of everything. I imagine their various organs are all working less effectively.”
“Well, in my experience,” the coroner retorted. “The majority of patients who appear to have died from nothing in particular or a little bit of everything have actually died of pneumonia or congestive heart failure.”
My Dad said nothing.
“Which would you like me to put down?”
“I don’t think she died of pneumonia or congestive heart failure.”
There was a long pause.
“Right, I am going to put pneumonia down as the main cause of death and I am going to say that it was secondary to congestive heart failure. There you are. It’s all sorted, as simple as that.”

“Can I offer you a word of advice Dr Dennis?”
“Of course.”
 “I think it would pay you dividends to be more precise with your diagnoses. I am sure it is something all your patients would appreciate particularly those who are still alive.”

My Dad thanked the coroner and put the phone down.

The Coroner.
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