The auscultatory gap.

Thursday 23rd May 1991   Morning surgery 11:20

“I am very worried about this gentleman’s blood pressure, Dr Dennis. It’s 160/100.”
“No, it’s not, Dylan. It’s 140/80.”
“I checked it in his right arm, Dilys and you checked it in the left arm. The British Hypertension Society recommend checking the blood pressure in both arms then taking the highest reading.”
“But you checked it as soon as Mr Pemberton came into the room, Dylan. You hardly gave him time to sit down. I had a little chat with him before I checked his blood pressure. He was quite relaxed by then.”
“Dr Dennis doesn’t have time to hang around having a little chat every time he checks someone’s blood pressure, Dilys.”
“And you pumped the cuff up really tightly. I could see it hurt him.”
“You have to do that because of the auscultatory gap.”
“No, you don’t, Dylan. If you want to check for an auscultatory gap, you are supposed to feel the radial pulse while you pump up the cuff.”
“I am not sure that I believe in the auscultatory gap,” my Dad said. “There are a lot of things about blood pressure that we don’t really understand.”
“Listen, Dr Dennis, can you check Mr Pemberton’s blood pressure so we can see what it really is?”
“There’s no point in me checking it, Dylan. It’s bound to be very high now he has heard both of you bickering.”

“Look, Mr Pemberton,” my Dad said, “I think it is reasonable to assume that your blood pressure is somewhere between the 2 figures; let’s say 150/90. In my book, that’s not too bad. I suggest we continue the same medication and check it again in 2 months.”


Cerys Bevan’s notes.

Thursday 16th May 1991   Morning surgery 09:39

“Good Morning, Dr Dennis. Thanks for fitting me in at short notice. It’s Malcolm Travis here.”
“Yes, of course, Mr Travis.”
“I’ve brought you these. They’re Cerys Bevan’s notes. You left them in our front room when you came to visit Mary yesterday.”
“Did I?”
“Yes, you were in a rush. Quite a lot of visits, you said. Mary is feeling much better by the way.”
“I’m glad to hear that.”
“Anyway, I thought I had better bring the records straight back to you. You wouldn’t want them falling into the wrong hands.”
“Of course not! Thank you very much Mr Travis. Thanks for bringing them in.” My Dad took the notes and looked up at Mr Travis, waiting for him to leave.

Mr Travis sat down. He cleared his throat.
“Mary and I had no idea that Cerys was so depressed. It’s hard to believe she lived just a few doors down the road from us. We must see her 3 or 4 times a week. Neither of us had an inkling of what was going on. We feel like bad neighbours. Mary said it wasn’t surprising that she suffered from severe depression after everything she had been through: 3 miscarriages and 2 abortions within a few years. I can tell you that was a shock, Dr Dennis. She had a violent husband. I think I would have started drinking too much as well. Reading all that, Mary said, made her realise how lucky she was. She admitted to taking me for granted. I don’t think I would have put it quite as strongly myself.”
Malcom Travis paused.
“Anyway, it looked as if Cerys was improving, as if she was getting herself back together. But, then she tried to commit suicide, just 4 weeks ago. I can tell you that floored us both. If it had not been for that inquisitive postman, she would be dead!”
Malcolm Travis took a deep breath before continuing.
“We have done some thinking, Mary and I. We feel we have been self-absorbed as a couple. There is no doubt that Cerys is lonely. Mary is going to visit twice a week. She is good at talking to people. I will go there on a Sunday. I can help out in the garden. Now we know why it’s been neglected. At least something good has come out of this.”
“Out of what?” My Dad asked. I don’t think he was concentrating properly.
“Out of you leaving the records on the sofa.”
My Dad didn’t say anything.
“By the way, Dr Dennis. It goes without saying that neither Mary nor I will mention this to Cerys. We both understand the importance of confidentiality. We know how serious something like this could be. Mums the word.”
Malcolm Travis got up, leaned forward and shook my Dad’s hand before leaving the room.

I’ll just get my list, doctor.

Thursday 9th May 1991   Morning surgery 10:00

“I’ll just get my list, doctor.”
“Yes, as you know, I usually see Dr Lewis. She likes me to bring a list of my problems.”
“I am afraid that lists don’t work for me, Mrs Harris.”
“If I don’t bring a list, doctor, I won’t remember all my problems.”
“As far as I ‘m concerned, Mrs Harris, if a problem is serious enough to be discussed with your doctor, you will remember it.”
“That’s not what Dr Lewis thinks and I’m not entirely happy with your attitude, Dr Dennis.”
“I’m very sorry Mrs Harris. I am afraid that there are certain matters on which Dr Lewis and I completely disagree.”
“Perhaps I should make an appointment to see Dr Lewis then. She wasn’t available today.”
“I think that that would be the best option, Mrs Harris.”

Bell’s Palsy.

Thursday 2nd May 1991   Morning surgery 10:40

“This gentleman seems to have had a stroke, Dr Dennis.”
“I don’t think so, young man.” Valerie Vaughan ushered Vernon into Dad’s consulting room. “Hmm . . . is this another medical student?” she said looking at Dilys who was sitting next to me.
“Yes, this is Dilys. She’s in the fifth year with Dylan.” My Dad smiled at Mrs Vaughan.
Dylan opened his notebook: “Vernon Vaughan is a 78 year old . . .”
“Excuse me!” Mrs Vaughan interrupted. “It’s always a good idea to start by allowing the patient to speak for himself. In fact, I would regard that as my number one learning point for today and I am sure Dr Dennis would agree.” Mrs Vaughan continued without giving my Dad a chance to respond. “Vernon, can you explain how your symptoms started? I think you developed some discomfort in your right ear?”
“Yes, that was on Monday. It was just behind my ear.”
“Then, last night, you noticed weakness of the right side of your face. Your mouth started to sag and you were dribbling. Cleaning your teeth was difficult.”
“Yes, that’s right.” We could see that Vernon’s face was lopsided when he spoke
“This morning, breakfast did not taste quite right?”
“It didn’t have much taste at all, Valerie.”
Mrs Vaughan looked at us. I could sense this was another important learning point.
“Vernon, have you noticed any weakness of either arm or leg?”
“No, they seem fine.”
“Are you sure, Vernon?”
“Yes, Valerie.” Vernon winced.
“Are you in pain, Vernon?”
“No, it’s your voice, Valerie. It’s really grating today; more than normal.”
Mrs Vaughan shook her head dismissively. “It would be very unusual, Dylan,” Mrs Vaughan continued, “for a stroke to cause weakness of the facial muscles but not affect the arm or leg. Normally, if the right side of the face was affected, we would expect paralysis of the right arm and leg.”
Dylan nodded sheepishly.
“You will notice that Vernon cannot raise his right eyebrow.” Vernon tried. He managed to lift his left eyebrow but there was no movement of the right side.
“Close your eyes, Vernon.”
Vernon could not close his right eye properly.
“Can you see the way Vernon’s right eye rolls upwards when he tries to shut it?”
We all nodded.
“That’s called Bell’s Phenomenon,” Mrs Vaughan said. “They used to say that it confirmed the diagnosis but, more recently, it has been discredited, I think.” Mrs Vaughan looked at my Dad for confirmation. “We need to look at the whole picture; don’t we Desmond?”
My Dad nodded.
“So, it looks like the diagnosis is Bell’s palsy.” Mrs Vaughan continued. “The symptoms are due to swelling and inflammation of the facial nerve and not a stroke.” She turned to my Dad. “I don’t know if you still recommend steroids, Dr Dennis.”
“I will need to have a look at him first, Mrs Vaughan.”

My Dad confirmed the diagnosis, wrote out a prescription and arranged to see Vernon again in two weeks.
Mrs Vaughan took the prescription and turned towards Dylan. “I can’t see this young man getting through finals, Dr Dennis. It is such a waste of tax payers’ money.”
My Dad chuckled. “I am sure he’ll be fine, Valerie. He is brighter than he seems.”

Titch, Terry and Rod.

Thursday 25th April 1991   Morning surgery 10:50

Titch and Terry











Titch Mitchelson, Terry Talbot and Rodney Masters had all started smoking together in the second year in Grammar School. At lunchtime, they would nip into the park behind the school and share a fag. They would have a couple more on the way home.
They quickly realised that smoking made them feel calmer. It helped with exams, other stressful school events and, later, with job interviews or driving lessons. It was a godsend for romantic difficulties and family crises. It did not have to be entirely personal. When 19 year old Rod was dumped by Jane Finch, all three of them spent a whole morning smoking; one cigarette immediately followed by the next.
Why not have a cigarette to celebrate? There weren’t many better rewards for a Portmere victory, a good night out or a new car.

Titch and Terry gave up smoking after Rodney died of a heart attack at the age of 65. Unfortunately, it was a bit too late by then and they had both developed chronic bronchitis and emphysema.

Terry was overweight and slow. Lazy, Titch called him. If Terry got a chest infection, his lips and his fingers would go blue through lack of oxygen. He would become sleepy and difficult to wake up.
“You haven’t got much respiratory drive, Terry.” Titch would say when he visited him in hospital.
They both knew that, during one of these episodes, Terry would drift off into unconsciousness and never wake up.
“It’s not a bad way to go,” Terry did his best to reassure himself.
Titch, on the other hand, was a wiry, determined character. He would keep puffing away whatever happened. Even when he was sitting on the couch, he was breathing quickly. That’s how he managed to keep his oxygen levels up. He was always a nice pink colour.
“I feel like I am constantly running,” he said.
Titch knew that he could not carry on like this forever but he was determined to keep going for as long as he could.

Cross purposes.

Thursday 18th April 1991   Morning surgery 09:10

“I’ve got this awful pain in my tummy, doctor. It’s right up here.” Mrs Carter pressed her clenched fist up against the bottom of her breastbone.
“When did it start?”
“I can’t eat a thing. I can’t face any food.” She looked grimly at my Dad.
“Are you being sick?”
“I’m getting hunger pains.”
“Does it hurt to swallow?”
“You wouldn’t believe the wind I’ve got. The burps are terrible.”
“Have you felt bloated?”
“I am bringing up all this acid. It tastes so bitter.” Mrs Carter coughed.
“Have you lost weight?”
“The pain is going right through into my back. I can’t move with it.”

“Do you think this could be an ulcer, Mrs Carter?”
“My vertigo is back, doctor. It’s awful.”

Lots of small clots.

Friday 12th April 1991   Home visit 10:00

“Good morning, Dr Lewis.”
“Good morning, George. When did you come home?”
“On Tuesday . . . you were right, I was having clots.”
“It’s Dilys and Dylan you need to thank, George. They made the diagnosis.”
George Gwilym smiled at the students. He held out his hand. They both shook it. Dilys seemed embarrassed but Dylan looked pleased with himself. “Dr Harper said I was having lots of small clots,” George continued. “He said that small clots are quite difficult to diagnose. Apparently, a big clot is easier to pick up.”
“I thought you were anaemic to start with, didn’t I?” Dr Lewis was blushing now.
“Mmm . . . “ said George. “Don’t worry about that. Anyway, I am feeling a bit better already. Dr Harper thought it would take a few months before my breathing got back to normal.”
“It might not ever be as good as it was,” Dr Lewis said.
“Well, there’s a lot going on,” said George.

Not quite ready for oxygen.

Thursday 11th April 1991   Morning surgery 11:20

“Despite being younger and giving up smoking a few years ago, Emrys Evans is quite a lot further along the road than his brother, Eifion.” My Dad had just finished examining Emrys.
“I don’t think being asthmatic has helped.” Emrys said. He was slightly breathless just talking.
“No,” Dad turned to us, “Emrys has been quite a bad asthmatic since he was a child. Asthma and smoking don’t mix. Emrys is really struggling with his breathing, now. He cannot manage anything more than the slightest slope and, even on the flat, he is much slower than his wife and grandchildren.”
“My grandchildren get very annoyed. They don’t want to go shopping with me any more.”
“He is already on 3 inhalers and we have been thinking about adding a tablet,” my Dad continued.
“I don’t know if I fancy the tablets, Dr Dennis. Don’t they cause a lot of side effects?”
“Some patients get side effects but the majority don’t. I think it is worth a try if it helps your breathing. What are the common side effects of aminophylline, Dylan?”
“Nausea, diarrhoea, headache, irritability, sleep problems, palpitations, low potassium, convulsions . . . . . .”
“Very good, Dylan, but I just wanted the more important ones not the whole list. You are going to put him off the idea of taking them completely.”
“I’m sorry, Dr Dennis.” Dylan looked at the floor. Dilys raised her eyebrows.
“Don’t worry, Dylan. Now, Mr Evans has had to go into hospital twice in the last 12 months because of his chest. He is coming to see me every couple of months. I think it is fair to say that we are getting to know each other quite well. You could almost consider us friends.”
“I don’t like wasting your time, doctor.”
“You’re not wasting my time, Emrys. Your chest is pretty bad these days. We expect to see a lot of our chronic bronchitics as they deteriorate.”
Emrys frowned.
“I suppose that our next big conversation will be oxygen,” my Dad continued. That’s always an important step. Do you think Emrys is ready for oxygen yet, Dilys?”
“No, Dr Dennis. His colour is still quite good and he seems to be managing. You would want to get his oxygen levels checked in the hospital, first.”
“Excellent! We tend to give oxygen if patients have persistently low blood oxygen levels. Do you know how many hours a day the patient needs to use the oxygen for?”
“16?” Dilys wasn’t sure.
“It’s 15 hours, Dr Dennis.” Dylan corrected Dilys a bit too enthusiastically.
“Shut up, Dylan! I don’t think one hour is going to make much difference.”
“You are probably right, Dilys, but if we follow the official line, oxygen needs to be used for 15 hours every day. They say, if you do that, it makes you live longer. However, it’s quite a commitment. Most patients see it as a last resort. As you say, I don’t think Mr Evans has quite reached that stage.”

“Let’s try the aminophylline tablets. If they don’t help or you get side effects, you can stop them.”

Chronic bronchitis.

Thursday 4th April 1991   Morning surgery 09:00

“Well, this is how it usually starts, Mr Evans. A smoker’s cough. Bronchitis once or twice a year. You have probably noticed that you are slightly out of breath walking to the Newsagent’s in the morning. Of course, as you point out, your difficulty breathing could be due to your age or a general lack of fitness. Perhaps it’s because you are a little overweight. Those chest infections are nothing that a quick course of antibiotics won’t sort out and who doesn’t, at some stage, get a cough that goes on for months and months . . . and months?”
Eifion Evans raised his eyebrows. He didn’t say anything.
“I am aware that you would rather not have a breathing test,” My Dad continued. “What’s the point? What’s it going to tell us that we don’t already know? You certainly wouldn’t want an inhaler. We all know where that could lead! You agree that it would be better to stop smoking but, funnily enough, a cigarette seems to help that cough.”
“Alright, Dr Dennis,” Eifion Evans looked at Dilys, Dylan and myself with an expression of resignation. “I will have a breathing test if you really think it will help. I just didn’t want to end up like my brother, that’s all.”

Mrs Eleri Goldman.

Thursday 28th March 1991   Lunchtime 13:07

My Dad must have ducked into the newsagent’s at exactly the same second that Mrs Eleri Goldman collapsed. He had picked up The Times and was so intent on the front page that he heard nothing of the commotion outside; cars skidding, passers-by crying for help and Sally Goldman crying uncontrollably. It was only when Alun Warne came running in, shouted his name and grabbed him by the arm that he became aware that there was a serious emergency taking place behind him.

My Dad has never liked performing in public and I don’t think he could have imagined anything worse than having to run out to attend an unconscious patient lying in the middle of the high street. The traffic in both directions had been stopped and a large audience of people including a coach load of American tourists, who were visiting Portmere for the day, had already gathered.

He seemed to stand there for ages as if he wasn’t sure what to do. Then he quickly knelt down and checked the pulse in Mrs Goldman’s neck, took off her glasses and removed her false teeth. He made a fist and thumped her firmly in the centre of the chest. The crowd gasped. He checked her carotid pulse again, shook his head and started surprisingly professional looking cardiac massage.

We’re worried he’s having clots, Dr Lewis.

Thursday 21st March 1991   Morning surgery 10:05

“We’ve just seen George Gwilym for you Dr Lewis. He’s not well at all. He’s much more breathless than last time.” Dylan had come to Dr Lewis’ door. He looked very concerned.
“His lips are going blue.” Dilys said.
“He’s having a pain in his chest. It’s really sharp and catches when he takes a breath.”
“It’s pleuritic.”
“Obviously!” Dylan frowned reproachfully at Dilys. “He’s got quite a fast pulse, too. It doesn’t sound like a chest infection and I don’t think it’s the anaemia. He’s much too breathless for that, now. We’re worried he’s having clots, Dr Lewis. We think he needs to go into hospital straight away.”
“He’s a cancer patient which means he’s at high risk of clots.” Dilys added helpfully.
“Dr Lewis knows that! Would you like us to call an ambulance? I’ll ask Harriet to get the oxygen.”
“Yes, you ring for the ambulance, Dylan. I’ll go and have a look at George.”

A little bit breathless.

Thursday 14th March 1991   Morning surgery 09:30

“How are you, Mr Gwilym?”
“Well, I’ve been quite good really, Dr Lewis. The stent seems to be working. I am still eating quite well. The only thing is, I’ve been feeling a little bit breathless, just over the last week or so.”
Dr Lewis looked concerned. “Have you had a cold?”
“I haven’t.”
“Are you coughing?”
“Have you had any pain in the chest?”
“No, none at all.” George Gwilym reassured Dr Lewis.
“What’s your breathing like at night?”
“It seems fine, then.”
“Can you lie down flat in bed?”
“Yes, that’s no problem.”
“You don’t wake up out of breath?”
“Are your legs swelling?”
“Have you had any trouble with your breathing before?”
“No. I haven’t.”

Dr Lewis examined George Gwilym’s chest. In fact, we all had a listen. She checked his pulse and blood pressure.
She sat down. “Your chest sounds fine to me.” The three of us nodded in agreement. “Your blood pressure is on the low side and you do look pale. I am wondering if you are slightly anaemic. That can make you breathless.”
“I do feel dizzy at times.”
“Yes, anaemia could make you feel dizzy as well. We will book you in for a blood test tomorrow morning. We’ll see you again next Thursday for the result.”

Dylan and Dilys.

Thursday 7th March 1991   Morning surgery 11:59

Cardiff uni emergency illustration










By the end of their first surgery, it was obvious to Dr Lewis and I that Dylan and Dilys, our new medical students, were in love.

They had spent the whole morning glancing furtively at each other. They sat very close together so that their elbows or knees, at least, were always in contact. Their hands would accidentally collide, Dilys would grab Dylan’s arm and during longer consultations, he would find himself leaning against her.

The worst thing was when Tiffany Jones brought her new baby in. He was only 3 weeks old and, to be fair, he was cute. Dilys could not contain her excitement. She was all over Tommy. Dylan controlled his emotions more stoically but you could see that, even from a distance, he took an almost fatherly interest in the child. I got the impression that, as soon as we had finished surgery, they were going to rush off and start a family of their own.

Testicular torsion.

Thursday 28th February 1991   Morning surgery 11:40

After Dr Lewis had finished examining Arthur Rowe’s tummy, she took a peek down his trousers. I thought his mum might call the police.
“There we are, Dennis,” she said, “a very painful, swollen, purple testicle.”
Even though she knew I did not want to become a doctor, she made me look. “Don’t touch it,” she warned.
Dr Lewis really didn’t need to tell me that. No one wants their testicles touched at the best of times. In this situation, it would be unbearable.

“In testicular torsion, Dennis. The testicle is twisted. The twist cuts off the blood supply. In effect, Arthur’s testicle is strangling itself. If we want to save his testicle, it has to be untwisted quickly. They suggest it should be operated on within 6 hours.”

“You will need to take him straight to hospital, Mrs Rowe.”

Her heart is going like the clappers!

Thursday 21st February 1991   Morning surgery 10:05

My Dad scowled and picked up the phone. He hates being interrupted in the middle of a consultation.
“It’s Penny from reception, Dr Dennis. I am sorry to disturb you. I have just had a phone call from Mrs Gwenllian Graham. It sounds like she’s in atrial fibrillation.”
“I wouldn’t have thought so, Penny.”
“I am quite sure she is. She says her heart is going like the clappers. It’s all over the place. She feels breathless and dizzy too. She is coming out in cold sweats.”
“Mmmm . . .”
“I have arranged for Harriet to do an ECG and I’ve squeezed her in with you, after.”
“Squeezed her in with me?”
“Yes, I have squeezed her in between Mavis Marsh and Alan Adams.”
“Mavis Marsh! She always takes ages. She’ll probably have a long list of problems.”
“Yes, when I spoke to her yesterday, she said she had seven problems she wanted to discuss with you.”
“You will have to ring her and cancel, Penny. Tell her I’ve had a serious emergency. You can book her in for next week.”
“She won’t agree to that, Dr Dennis. She said that three of her problems are very urgent.”
My dad groaned. “You will have to try, Penny.”
“Don’t worry! Everything is sorted out. Mrs Graham has agreed to see Dennis first. All you will need to do, is decide whether she should go into hospital. That won’t take more than a couple of minutes. I can even ask Dr Lewis to look at the ECG if you want.”
“I am perfectly capable of diagnosing atrial fibrillation, Penny.”
“I am sorry, doctor. It was just a suggestion.”

Safety netting.

Wednesday 13th February 1991   After dinner 19:45

“What’s safety netting, Dennis?”
“It’s a fancy, medical term that doctors use when they explain how they ask patients to come back to see them if they are not getting better.”
“Isn’t that just common sense?” Declan raised his eyebrows.
“You would think so. But Dad says that none of his patients have got any common sense.”
“Aren’t we his patients, Dennis?”
“No, Declan. I’m with Dr Lewis and you’re with Dr Rothman, the locum.”
“But Dr Rothman is never in the surgery.”
“If you’re ill, Declan, and Dr Rothman isn’t there, you can see Dr Lewis. That’s the way we organise things.”
“Why can’t Dr Lewis be my doctor all the time?”
“She can’t, Declan. She’s too busy. Anyway, the interesting thing about safety netting is that all doctors do it differently.”
“What do you mean, Dennis?” Declan looked puzzled.
“Let’s take Dr Lewis. She likes a tailored approach to safety netting. It depends on the individual patient, their particular disease, their social circumstances and, sometimes, even the day of the week or the weather.”
“The weather? Come off it, Dennis!” Declan obviously thought this was ridiculous.
“Declan, many illnesses are affected by the weather.”
“Hay fever is a good example,” said Mum as she cleared the dishes.
“Exactly! Now, Dad is much more simplistic.”
“You must remember that he has been a GP for many years, boys.” Mum smiled.
“When he safety nets, he say one of three things: don’t come back and see me for at least a week, don’t come back and see me for at least a month or don’t come back at all. I think he goes more by whether he likes the patient than by how seriously ill they are.”

Cardiac arrest!

Thursday 7th February 1991   Morning coffee break 12:40

“Cardiac arrest! Cardiac arrest!”
Dr Lewis and Harriet went flying out of the staff room and down the stairs. I jumped up to follow them but Dad stopped me.
“Hang on, Dennis, Isobel Shaw was having a blood test today. She’s probably fainted again. Let’s wait for the third call.”

Dad offered to make Dr Lewis and Harriet a cup of tea when they came back. You could see from the expressions on their faces that they had mixed emotions. On the one hand, they were pleased that Isobel Shaw had only fainted but, on the other, they had missed an opportunity to save someone’s life.

Fish hook removal.

Thursday 31st January 1991   Morning surgery 11:20

Fish hook NEW








The difficult thing about removing a fish hook from a patient’s finger is the barb. You can’t just pull the hook out. The barb is there to make sure that the fish doesn’t get away and, most of the time, it works pretty well.

Once you have anaesthetised the finger you have to push the hook right through. Then, with a sharp pair of pliers, you can snip off the tip of the hook including the barb. After that, the rest of the hook can easily be pulled back out.

My Dad couldn’t understand why anyone would go fishing in the middle of Winter but I knew it was a good time for cod.

Three funerals.

Thursday 24th January 1991   Morning surgery 09:40

“Good morning, Mrs Vaughan.”
“Good morning, Dr Dennis. I’m just here for my review.”
“How are you, then?”
“I’m fine. However, I’ve been to three funerals in the last few weeks. I was at Mrs Austin’s two weeks ago. I was very fond of her.”
“She was a very nice lady. The perfect patient, in fact. She was one of those people who always accepted and was grateful for any medical advice.” My Dad gave Mrs Vaughan a telling look.
“I was surprised that you didn’t go to the funeral,” Mrs Vaughan retorted disapprovingly. “How long have you been looking after her?”
“I’ve told you before, Mrs Vaughan, I don’t have time to go to patients’ funerals. No family doctors do, these days. Of course, I may make an exception for you as you are such an old friend.”
“I haven’t decided who’ll be invited to mine. Anyway, I went to Mrs Grey’s funeral on the Tuesday before. We were in school together. It was such a shame she would never have the flu jab. She might still be here. I’ve been trying to persuade her every year.”
“She was very frail.”
“Then, there was Mrs Chapman. Her funeral was last Friday. That brain tumour was quite a surprise. Sudden onset of weakness in the right arm and not one single headache. Even I thought she’d had a stroke! It was only when the symptoms progressed that the cause became obvious. I don’t think it would have made any difference if you had made the diagnosis straight away, Dr Dennis. Mrs Chapman didn’t think so. She said that they couldn’t have removed the tumour. It was in a very delicate part of the brain. Of course, she would never say a word against you.”
My Dad sighed. “Anyway, how are you getting on with the medication?”
“I’m fine, doctor. No problems at all. It’s only the eye drops. Can I do Vernon’s review while I’m here?”


Two tricky telephone calls.

Thursday 17th January 1991   Morning surgery 09:20

Ryan Ellis had celebrated his 18th birthday on New Year’s Eve. Now he had severe pain every time he went for a wee and ‘two swollen balls that hurt like hell’. After a bit of discrete prying by Dr Lewis, he admitted to a new girlfriend.
“I am afraid it’s chlamydia, Ryan.” Dr Lewis patted his knee sympathetically. “I can’t think of any other explanation.”

Ryan’s situation was complicated by the fact that he still had his old girlfriend.
“You’ve got two tricky telephone calls to make, Ryan.”

A mince pie with custard and clotted cream.

Thursday 10th January 1991   Morning surgery 10:40

“How are you, Mr Gwilym?”
“I’ve been good, Dr Lewis. The stent seems to be working. I’m eating quite well, mostly soft foods. I’ve had lots of soups. We had turkey soup every day for a week. I’ve tried mashed sprouts. They’re awful!” George Gwilym laughed. “Gwen has been making some lovely, creamy mashed potato with lashings of butter. It’s very rich. I have a pudding every day. A mince pie crushed up with custard and clotted cream is my favourite at the moment. I’ve managed to put some weight back on.”
“That’s very good.” Dr Lewis said. “Are you getting much pain?”
“Now and again. I get it in the middle of my chest. I am not sure if it’s the tumour or the stent. The painkillers seem to be working, though.”
“The stents aren’t normally painful. It must be the tumour.”
“I thought so. I guessed it was that.” George Gwilym looked apprehensively at us.
“You are bound to get some pain,” Dr Lewis said reassuringly. “Are you keeping busy?”
“I’m doing a bit. I go for a walk every morning. Gwen and I have a day out three times a week. We’ve made a list of things to do. Last week, we went to Powys Castle on Monday and Llangollen on Wednesday. Then, we visited Norman and Marjorie, my cousins. We are trying to meet up with all our relatives and friends. Norman doesn’t go out of the house. He’s got severe Parkinson’s disease. He won’t go in a wheelchair. He complained because we haven’t been to see him for 20 years but he did say he was pleased to see me.”
“I’m sure he was.”
“He asked us to try to go to again. If not, he said he would catch up with Marjorie at the funeral.” George Gwilym laughed again. “Norman has always been pretty straight talking.”



Tuesday 1st January 1991   At home 09:07

Fred Christmas Day












At 9 o’clock on New Year’s Day, Gary and Maisy Wilkins found Fred slumped against their snowman. Maisy lifted his hat. Fred was cold and icily blue. They shook him but he wouldn’t wake up.”
“He’s ruined our snowman!” Gary said angrily. “He’s drunk!” Fred still smelt strongly of whisky. Obviously, he had been too incapacitated to walk all the way home last night.
“I think he’s dead,” Maisy said. They both looked down at him.
“We better get Uncle Desmond.”

Dad was still in bed when they ran into the house. He sent me to investigate. I called an ambulance.

Fred was suffering from severe hypothermia. He was lucky to survive.

Portmere vs. Blaenau Ffestiniog.

Wednesday 26th December 1990   Portmere vs. Blaenau Ffestiniog 14:15

The wind was bitterly cold and the rain stung our faces as we walked towards the stadium. We kept our heads down.

Kevin Kendall was on the turnstile. He had his right arm in a plaster of Paris and a sling.
“Hi boys! Your Dad was right about my wrist. He made the diagnosis on the ‘phone! I have broken one of the little bones. He even said it might not show up on the first x-ray. I’ve got to go back in 2 weeks for another check.”
Kevin took our money awkwardly in his left hand and gave us the tickets.
“Would you like a programme?”
We both looked at him as if he was stupid.

We passed the kitchen. Bethan Rees appeared to have made a good recovery from her recent heart attack. She was cleaning the worktops energetically and chatting chirpily to her sister, Lynne. Big Sam was lurking in the background. He’s in charge of the hamburgers and disposes of any stray chips he can find and a few that are not officially missing. Sam looks as if he could have a heart attack at any moment.

Phil was standing in the queue waiting for a cup of tea. We nodded to each other.

“Is that cancer, Den?” Declan was looking at a large, black mole on Mr Crombie’s forehead.
“Don’t be stupid, Declan. He’s had that for years.”

Laurence Lawson walked quickly past us. He coughed loudly and I could hear him wheezing. Maybe I should have given him some antibiotics.

The Blaenau lads were jogging purposefully up and down the touchline. Half of our team were on the pitch, toe poking the ball about. The rest were in a huddle outside the changing room having a final cigarette before kick-off.

It was a dreadful match. We lost 1:0.

Last weekly practice influenza debriefing.

Monday 24th December 1990   Afternoon coffee and debrief 16:50

“Good afternoon, everybody. I am very pleased to report that this week has not been as busy. It looks as if the 1990 influenza epidemic may be waning.” Mrs Andrea Jones smiled and sat down.
“It’s been rather short,” my Dad said. “Perhaps there will be another wave.”
“Don’t say that, Desmond. I remain optimistic that we are over the worst. We should all be able to enjoy the bank holidays.”
“I don’t know. I’ve got this feeling . . . “
“Dr Rothman has been very helpful.” Andrea interrupted. “He has done double-booked surgeries every day. He has been signing prescriptions left, right and centre.  On Wednesday, he made everyone in reception a cup of tea.” She gave my Dad a pointed look as she said this. He didn’t notice and took another bite of his mince pie.
“Mary Lomax has been as busy as a bee. She has managed to vaccinate 200 patients this week. She is so efficient!”
All the staff except Harriet looked impressed.
“Would you like to give us an update on our admissions, Lois?”
“Miss Sandiford has come home. She’s quite well. Dennis and I went to see her on Wednesday. I am very pleased to see that Adam Watson has also been discharged. He seems much better. You’ve seen him, Harriet?”
“Yes, he came for his review. He has promised to take his asthma more seriously in future. He agreed to have a flu jab.”
“I am not sure how useful it is to give someone the flu jab after they have had the flu, Harriet.” My Dad raised his eyebrows.
“I wanted to start him off on the right foot, Desmond. The flu vaccine covers 3 strains of flu. Because there are similarities between the various strains of influenza, they do say that patients who have the vaccine every year build up their general immunity to the illness.”
“You should know that, Desmond.” Andrea raised her eyebrows.
“I have sent in another 6 patients,” Dr Lewis continued, “of these, 4 had influenza and bronchopneumonia and are doing well. However, 2 patients are extremely ill. Idris Jones has developed acute respiratory distress syndrome. This is a complication of a number of conditions including influenza where the virus causes a severe inflammatory reaction in the lungs. It is difficult to treat. The consultants in the Intensive Care Unit are not sure if Idris will survive. The other patient is poor little Rosie Rampling who I sent in on Tuesday. She did have the flu but I couldn’t work out why she looked so ill. They have discovered that she’s got leukaemia. That’s why the flu affected her so badly. They are planning to transfer her to Liverpool for treatment early next week.”
“That’s awful! The poor little girl,” said Penny Parry. All the staff looked shocked.
“These days, the treatment for leukaemia in children is very effective.” Dr Lewis tried to be as reasurring as she could.
“She’s only 4 years old. Lois. What a Christmas she’s going to have!”
Everyone was so upset that Andrea decided to abandon the rest of the meeting.

Typical flu symptoms.

Thursday 20th December 1990   Morning coffee break  12:17

“Mr Gibson was stroppy this morning.”
“Why was that, Desmond?” Dr Lewis was signing the prescriptions. She looked up.
“I said that we wouldn’t visit his wife. She’s had typical flu symptoms: fever, shivering and aching all over. There’s been no cold but she’s had a headache and some tummy pain. She only started feeling ill last night. I told Mr Gibson that we couldn’t go and see every patient with the flu.”
Dr Lewis went back to her prescriptions. The rest of us drank our coffee quietly.

“Did she enjoy her holiday?” Harriet had just finished her soup.
“Holiday? I really don’t have time to ask all my patients about their holidays, Harriet.”
“It was just that Mrs Gibson and her husband came in for their vaccinations at the beginning of November. It was a bit of a rush because they were leaving on the 8th of December. They must have just got back.”
“Vaccinations?” Dr Lewis pricked her ears up. “Where did they go, Harriet?”
“Mmm . . . I am not sure . . . let me think . . . I know, they went on safari, to Africa.”
“Africa! Oh my God, Desmond! She’s probably got malaria. Come on Dennis. We better go and see her straight away.”

It’s not the flu, Mrs Vaughan.

Thursday 20th December 1990   Morning surgery  10:34

“It’s not the flu, Mrs Vaughan. You’ve got a cold.”
“Aren’t we in the middle of an influenza epidemic?”
“Yes, we are.”
“I was under the impression, Dr Dennis, that, in a flu epidemic, any patient with an infection of the upper respiratory tract such as a cold is likely to have the flu virus.”
“That’s right, Mrs Vaughan.”
“And am I correct in saying that some patients with the flu virus have no symptoms at all?”
“You are.”
“Research has been done that proves that?”
“It has.”
“Well, if we are in the middle of an epidemic and I’ve actually got symptoms, I would have thought that I almost certainly have the flu. It stands to reason.”
“Ah . . . I see what you are getting at, Mrs Vaughan. I can understand the confusion. You mean that you’ve got the flu virus. However, as you have so clearly pointed out, having the flu virus is not the same as having the flu. There’s a subtle difference. That, I think, is where I come in. That’s what I’ve been trained for.”

Mrs Austin died last night.

Wednesday 19th December 1990   Afternoon coffee 17:00

“Mrs Austin died last night.” Dr Lewis looked really upset when she told us.
“Listen, Lois,” my Dad said. “You can’t keep getting attached to these patients. You have to maintain a professional distance. At the end of the day, Mrs Austin was just another old lady with heart failure. She wasn’t your grandmother.”
“Don’t be so horrible, Desmond!” Dr Lewis retorted. “She was lovely. She was determined. Until two weeks ago, she did everything for herself. She managed to do all her cooking and cleaning. The house was spotless. She was brave too: she never complained or made a fuss. She was always cheerful. I liked her, Desmond. I was attached to her.”
My Dad frowned.

Could I have the flu jab?

Tuesday 18th December 1990   After dinner  20:00

“Could I have the flu jab, Dad?”
“Don’t be stupid, Declan.” I scowled.
“You don’t work in the surgery. Dad and I have the flu jab because we work in the surgery?”
“What about Mum?”
“She’s a nurse, Declan. Mum has the flu jab because she works in the hospital.”
“Couldn’t you sneak a flu jab out for Declan, Desmond?”
“I am afraid not, Daphne. The government regulations on influenza vaccination are very strict.”
“So, I’ll be the only one in this family who gets the flu!” Declan was quite indignant. “What if I die? Will you be happy then, Dennis?”
“I don’t think you’ll die, Declan.” Mum smiled reassuringly.
“Mum, people do die of the flu,” I protested. “According to the experts, about 10,000 patients die of the flu every year. Some of those people will be annoying, young teenagers like Declan.”

I think it’s influenza.

Monday 17th December 1990   Dennis’ evening surgery 17:30

“I’m sorry, Mr Brightman. That’s what I think it is. You can see my Dad if you want but you will have to wait a couple of hours. He’ll probably say the same as me.”
“What about Dr Lewis.”
“She’s gone out. She had 5 home visits to do.” I looked at my watch. “She’ll probably go straight home afterwards.”
“Haven’t you got any medical students?”
“No, not at the moment, Mr Brightman.”
“Listen. If it won’t offend you, Dennis, I would prefer to wait and see your Dad.”
“That’s fine, Mr Brightman. No offence taken. I will add you to his list.”

First weekly practice influenza debriefing.

Monday 17th December 1990   Afternoon coffee and debrief 16:50

Mrs Andrea Jones came breezily into the staff room.
“Good afternoon, everybody.” She said. “Thank you for coming. I thought it would be useful to have a weekly practice influenza debrief. I would like to start by congratulating Desmond. He notified the first case of flu in Wales this year on Thursday 29th November. I understand that, as usual, his report was treated with some derision by the experts in Public Health. However, they announced the 1990 influenza epidemic on the the very next Monday. Well done, Desmond!” Mrs Jones smiled at my Dad.
“I would like to thank everybody for all their hard work last week especially Dennis who came in every day. I know he’s not here but I would also like to thank Declan who has been doing all of Dennis’ homework. I hope your marks don’t take a dip, Dennis.” Mrs Jones laughed and winked at me.
“They’ll probably do exactly the opposite,” said my Dad.
“So far, Harriet and the doctors have seen 397 patients. 374 patients have had uncomplicated influenza. 21 patients have had influenza with secondary infections, mostly bronchitis. We have seen one lady who thought she had wax in her ears. Julian Marshall tried to catch us all out with a primary pneumococcal pneumonia. Dr Lewis spotted that immediately. Well done, Lois! I don’t know if you want to discuss the admissions?”
“Of course, Andrea.” The compliment about her emergency care made Lois glow with pride. “I admitted 5 patients last week. The first was Julian who we have already mentioned. He only needed to stay in overnight because of the speedy diagnosis and referral. On Tuesday, I sent in Mrs Grey, Miss Sandiford and Mrs Mellor. I think most of you are aware that these are three very frail, elderly ladies. All of them had quite nasty bronchopneumonia. Mrs Grey and Miss Sandiford have always refused the flu vaccine. However, Mrs Mellor has had her vaccine every year.”
Dr Lewis took a deep breath and sighed. “I am afraid to say that Mrs Grey and Mrs Mellor passed away on Friday.”  All the staff looked sombrely at each other.
“Miss Sandiford has also been extremely poorly but appears to be picking up. It looks as if she is going to make a full recovery.” Dr Lewis said. “My fifth admission, on Thursday, was Adam Watson. He is a 23 year old asthmatic. He also started with typical flu but this precipitated a very severe asthma attack. Adam is still extremely unwell. In fact, he had to be put on a breathing machine over the weekend. We are all keeping our fingers crossed for him. Like many of our younger asthmatics, Adam has never had the flu vaccine.”
“They don’t think they need it.” Harriet said. “They have no idea how serious influenza or asthma can be.”
“What about you, Desmond?” Andrea looked at my Dad. “Have you sent anyone in?”
“No, I haven’t actually, Andrea. Lois has done most of the visits and seen the more seriously ill patients. She has really taken the idea of the Community Influenza Rapid Action Team Flying Squad to heart and decided to try to run a pared down version herself.”
“Unfortunately, it is not quite the same when there is only one of you, Desmond.” Dr Lois responded. “I did ring Public Health to see if anyone was interested in joining me. Apparently, they were all too busy in meetings.”
“Hmm . . . “ my Dad laughed. “They are probably trying to decide how we should deal with all the extra patients. No doubt they will send us their recommendations in a few weeks.”
“Right,” Andrea continued. “Let’s get on. You’ve all got more patients to see afterwards. We have already administered 650 flu vaccines which is excellent. Well done, everybody!  Of course, in addition to those young asthmatics, we have plenty of other die-hard patients who won’t consider it. Hopefully, the flu outbreak will convince some of them to change their minds. Don’t forget to keep asking.” Everybody nodded.
“I have made a few changes for the next couple of weeks,” Andrea continued. “I realise that none of you are managing to get a proper lunch break. I have arranged for Branwen from Roberts’ Bakery to bring sandwiches, sausage rolls and mince pies every day this week. We have borrowed the tea urn from Portmere Primary School so we can have a continuous supply of hot tea. Dr Rothman has agreed to come in all day Wednesday and Friday to help out with the patients. I have also arranged for Mary Lomax to run a daily flu vaccine clinic to free Harriet up to see more patients. Enid Marshall has agreed to assist in reception. Everyone is rallying round!”
“That’s fantastic, Andrea.” Dr Lewis looked delighted. I knew that my Dad would be very pleased about the sausage rolls and mince pies.
“I have also cancelled all routine appointments for the next two weeks. I think we’ll only need you on Thursday this week, Dennis.  Has anybody got any other suggestions?”
No one did. We all went back to work.

Another trip to Ashbury Lodge.

Thursday 13th December 1990   Morning coffee break  12:45

“There’s been a late call from Ashbury Lodge, Lois. They’ve got 9 patients for you to see.”
“I went there yesterday, Desmond. I saw 5 patients then.”
“Well, 3 of those have deteriorated and there are another 6 that they’d like you to see.”
“They’ve probably all got the flu.”
“I am sure they have, Lois but, if they’ve got the flu, they’ll have coughs and, according to Mrs Thatcham, if they’ve got coughs they’ll be chesty and, if they’re chesty, they need to see the doctor.”

Man flu.

Thursday 13th December 1990   Home visit  11:45

“You shouldn’t have come to see me Doctor. It’s just a slight touch of flu.”
“Your wife was quite worried about you.”
“Yes, Gladys does tend to overreact. Look, if I had known you were coming I would have got up and got dressed. I haven’t even put my pyjamas on; I’ve been feeling pretty warm.”
Mr Greene did look very red and hot. He was drenched with sweat. In places, it was running down his chest. My Dad shook his thermometer and popped it under Mr Greene’s tongue.
“Mmm . . . 42.3*C . . . that’s as high a temperature as you can get!”
“I’m sure it’s no higher than anyone else’s, doctor.”
“Right, let’s have a look at your throat.”
Mr Greene opened his mouth.
“Mmm . . . .”
“Oh, hang on! Here we go!” Mr Greene’s hands started trembling. As we watched, his arms began to shake and then his legs. Soon his whole body was moving so violently that his bed started clattering noisily on the wooden floor. My Dad leant on the foot of the bed to try to steady it. The attack built up to a crescendo over several minutes and then gradually died down.
“Goodness me!” My Dad exclaimed. “That was a dreadful rigor.”
“A rigor?” Mr Greene said.
“Yes, these attacks of shivering are called rigors,” my Dad continued. “You tend to get them with a high temperature. Have you been aching?”
“He’s been awful, haven’t you Gavin?” Gladys Greene shouted from her bedroom next door. “His arms and legs have been as heavy as lumps of lead. They were so painful he could hardly stand yesterday.”
Gavin Greene nodded reluctantly. “They’re not quite so bad, today, Dr Dennis.”
My Dad looked thoughtfully down at Gavin Greene as he lay on the bed. “Well, Mr Greene, he said. You have definitely got the flu but, I must say, it’s the worst case I have ever seen.” He shook his head as he spoke. “To be completely honest, it’s the worst case we’ve ever had in the practice . . . I don’t know what we can do.”
“I’ll be fine, Doctor Desmond. I am due two more paracetamol now. I’ll get up after you’ve gone and make Gladys some lunch.”
“Make Gladys some lunch!” My Dad looked incredulous. “You are not fit to do anything.”
“I’ll have to, doctor. She’s had another one of her migraines this morning. Her vision’s all lopsided and she’s got a thumping headache. She can’t get out of bed. You know what she’s like if she doesn’t eat a proper lunch. Her indigestion will be awful.”

Tara, Tabitha and Tesni.

Monday 10th December 1990   Morning sugery  09:20

“Good morning! How’s Andrew?”
“He’s been flat out with the flu but he’s a bit better today.” Mrs Tarley sat down. “The receptionist said that, while I was here, I could ask you to have a quick look at the triplets.”
Tara, Tabitha and Tesni were well behaved for 3 year olds. They stood quietly and looked at my Dad from under mops of curly, straw coloured hair. Their cheeks glowed red. They smiled. Each of them had the same front tooth missing. Tesni covered her mouth with the back of her hand and giggled.
Dad did not appear to be moved by their appealing nature. He frowned.
“I am sorry, Mrs Tarley, I haven’t got time today. You’ll have to make another 3 appointments.”

It’s just influenza, Mr Soames.

Monday 10th December 1990   Morning sugery  09:10

“It’s just influenza, Mr Soames.”
“Just influenza! I‘ve got a dreadful headache. It’s right over this eye.”
“You can get a dreadful headache with influenza.”
“I am sure I’ve got sinusitis, doctor.”
“You may be right, Mr Soames. People often get sinusitis with influenza.”
“Don’t I need something for it?”
“Not, really. The influenza will certainly get better on it’s own and sinusitis usually does.”

She’s got the flu, Mrs Price.

Monday 10th December 1990   Morning sugery  09.04 

“She’s got the flu, Mrs Price.”
“But she’s got a really bad sore throat, doctor.”
“Yes, I’ve got an awful sore throat. I can’t eat a thing, doctor. It’s feels like I’m swallowing broken glass.” There were tears in Petra’s eyes.
“You can get an awful sore throat with the flu, Petra. It is one of the normal symptoms.” My Dad tried to be as sympathetic as he could.
“I’m worried she is going in for tonsillitis again. She gets terrible tonsillitis.”
“She won’t get tonsillitis on top of the flu, Mrs Price. I can completely reassure you there. It’s one or the other.”
“I would like her to have some penicillin, Dr Desmond, in case.”
“I am not going to prescribe penicillin for the flu, Mrs Price.”

You’ve got the flu, Mr Wiley.

Monday 10th December 1990   Morning sugery  09:00

“You’ve got the flu, Mr Wiley.” My Dad sighed.
“I am sure I’ve got a chest infection. I am coughing up loads of phlegm.”
“Your chest sounds completely clear. You’ve got typical flu symptoms.”
“I am really sure I’ve got a chest infection, Dr Desmond. If it was just the flu, I wouldn’t have come to see you. It even said on the News last night that we shouldn’t go to see the doctor if we’ve got the flu.”
“Yes it did, Mr Wiley. I am sorry. I assumed that, like the majority of my patients, you hadn’t seen the News.”

Toad in the hole.

Friday 7th December 1990   At home  21.17 

We’re starving!

Mum always insisted that we had to wait for Dad to come home from work before having dinner. Tonight, he hadn’t arrived until 9:15. He looked defeated.
“Oh, Desmond! You must have been so busy.” Mum was very sympathetic whenever he came home late. Declan and I just got annoyed if we were hungry.
“The flu really hit us today, Daphne. To start with, Andrea and Mary were off sick. They were both fine, yesterday, but flat out today. Then, the phones didn’t stop ringing. All our appointments were gone before 9.30 am. I did double-booked surgeries all day. Dr Lewis had 17 requests for home visits. She did 14 of them this morning, an emergency surgery this afternoon and the last 3 visits on her way home. Penny Parry was rushing around trying to calm everyone down but only made things worse. By the time we stopped for a very late coffee, everyone was frazzled. Harriet refused to have a drink. She said it would make her palpitations even worse.”
“No wonder you were so late, Desmond.”
Dad nodded.

“This batter looks remarkably crispy and light, Daphne.” Dad said. He obviously did not want to say anything else about his difficult day. Declan and I had heard enough anyway. We all tucked into our food.

“Listen, Dennis,” Dad had half a sausage poised on his fork. It was dripping with Mum’s unctuous onion gravy. “I am afraid I’m going to have to ask you to come in to help out after school next week. You are just as capable as me of telling our patients that they don’t need antibiotics for the flu.”
“I can’t, Dad. I’ve got loads of homework.”
“Dennis!” Mum exclaimed. “You were just telling me that you’ve got an easy week next week.”
“I didn’t mean it was that easy.”
“Isn’t there teachers’ training on Monday?” She continued.
“Mum!” I groaned.
Dad raised his eyebrows. “I had forgotten about that, Dennis. That’s perfect! You can come in and help. Monday is always very busy. It will be better than moping around at home.”

If you’ve got the flu, dial 222!

Thursday 6th December 1990   Morning coffee break  11.55 

“The government are launching the new Community Influenza Rapid Action Teams tomorrow, Lois.” Mrs Andrea Jones came into the staff room carrying a large glossy brochure.
Dr Lewis looked up. “Really!”
“Yes, it all sounds very impressive. There is going to be a 24 hour help line manned by specialist nurses and doctors from Public Health. They will make a detailed telephone assessment of each patient. Low risk patients with uncomplicated flu will be given the usual advice.”
“Plenty of fluids and paracetamol?”
“Exactly! High risk patients with uncomplicated flu will be offered antiviral antibiotics. They will be able to pick these up from their local pharmacists.”
“It does sound good, Andrea.” Dr Lewis looked visibly excited.
“We will still need to see patients in the practice with suspected chest infections or other complications.”
“I have no objection to that.”
“The most seriously ill patients, those who are too poorly to come to the surgery, will be visited at home by our own Local Community Influenza Rapid Action Team Flying Squad. The flying squad is a hand-picked unit of highly trained intensive care and respiratory consultants with full nursing and ancillary back up. They expect to be able to visit up to 100 patients a day in our area. They are hoping that, with early and comprehensive support, they may be able to prevent the majority of hospital admissions.”
“That’s fantastic, Andrea. It should significantly reduce our workload.” Dr Lewis looked delighted.
“Yes, they estimate that it should cut the additional GP workload during an epidemic by 75%, Lois. We will be able to get on with our normal day-to-day activities.”
“It’s not like the government to think ahead or put extra resources in like this.”
“The chances are, by the time they get all this organised, the flu outbreak will be over.” My Dad said.
“Don’t be so cynical, Desmond! In fact, I phoned the helpline this morning and got straight through to a very nice lady. She told me that they are fully staffed and have actually got reserve teams in place.”
“I can’t believe this, Desmond. It’s too good to be true! We are going to have a very relaxing winter.”
“Yes, it is too good to be true, Lois. Andrea is pulling your leg. It was her idea of a little joke. She knows how worked up you get when the flu starts. It will be backs to the wall, no lunch and late nights as usual, I’m afraid.” My Dad chuckled.
Dr Lewis looked horrified. “That’s really mean, Andrea! If there are no Community Influenza Rapid Action Teams, what’s that brochure?”
“It’s the House of Fraser Christmas Catalogue, Lois. Would you like to borrow it?”

I’m not having the flu jab, Dr Dennis.

Thursday 6th December 1990   Morning surgery  10.50 

“Are you aware that 250,000 people died in the United Kingdom in the 1918 Spanish Flu epidemic, Mrs Highly?”
“I am not having the flu jab, Dr Dennis.”
“They also estimate that influenza causes over 10,000 extra deaths every year.”
“I am not having the flu jab, Dr Dennis.”
“Patients like you with chronic heart disease are over 10 times as likely to die from the flu, Mrs Highly.”
“I am not having the flu jab, Dr Dennis.”
“The vaccine reduces your chance of catching flu by about 70%.”
“I am not having the flu jab, Dr Dennis.”

Nathan Preston and the 1990 flu epidemic.

Thursday 29th November 1990   Morning coffee break  12.22 

“I don’t know why we don’t give school children the flu vaccine,” my Dad said angrily.  “That’s where it starts, in school. I have just seen Nathan Preston and I can guarantee he’s got the flu.”
“He’s our first case, this year then.” Dr Lewis looked up apprehensively.
“Nathan’s going to give it to all his friends,” my Dad continued brusquely, “and, of course, he’ll give it to his parents. His friends will give it to their friends and their parents. Nathan’s Dad will give it to his colleagues in work and his mates in the Pub. Nathan’s Mum will give it to her colleagues in Tesco’s and the members of the ladies’ luncheon club. One way or another, the grandparents will get it. Of course, the teachers will catch it from the children. They will pass it around in the staff room. I suppose Mrs Blunt, the dinner lady, will catch it and Mrs Burns, the lollipop lady. They’ll spread it around at Bingo: everyone wins tonight! Before you know it, we’ll have the 1990 influenza epidemic! It will be on the news and in the papers. If the journalists do their homework properly, little Nathan will be on the front page.”
“Come on, Dennis, you can’t blame Nathan. That’s not fair!”
“Listen, Lois! It’s the same every year. It always starts with a child! If someone had given Nathan Preston the flu jab, it wouldn’t have happened. We could all sit here, enjoy our coffee and not worry about being bombarded with patients next week.”


Every time I have the flu vaccine, I catch the flu.

Thursday 29th November 1990   Morning surgery  10.10 

“I tell you the same thing every year, Dr Dennis. Every time I have the flu vaccine, I catch the flu.”
“The flu vaccine doesn’t cause the flu, Mrs Crosby. Perhaps you mean you get a slight cold.”
“Every time I have the flu vaccine, I catch the flu. That’s what I mean. I can’t see any point in having it if it is going to give me the flu.”
“It’s not the proper flu, Mrs Crosby. Some patients do get mild, flu-like symptoms after the flu vaccine but you don’t get proper flu.”
“Well, I don’t want a slight cold and I don’t want mild flu-like symptoms so I am not going to have it. Can you write that it big, red letters on my notes so you don’t have to ask me again?”
“What if you catch the flu and die of pneumonia?”
“I have no intention of dying of pneumonia. If there is any sign of pneumonia, I will come straight down here. You can prescribe a strong, expensive antibiotic.”
“We are trying to cut down on our antibiotic use, Mrs Crosby. You know that.”
“ I would rather have an antibiotic than the flu jab and I’m not going to get involved in any further discussion on the matter.” Mrs Crosby put her prescription in her bag, stood up and left.

My father died after having the flu jab.

Thursday 29th November 1990   Morning surgery  09.10 

“No, I am not going to have the flu jab, Dr Dennis. My father died after having it.”
“Your father died after having a massive stroke, Mrs Hunter.”
“He died the day after he had the flu jab: less than 24 hours later. I suppose you are going to tell me that that was a coincidence.”
“It must have been, Mrs Hunter. The flu jab wouldn’t cause a stroke.”

Oesophageal cancer.

Thursday 22nd November 1990   Morning surgery  10.00 

“You were right, Dr Lewis, it was a tumour.” Mr Gwilym smiled uncomfortably.
“I was very worried about you.”
“I went to see the Mr Langford, yesterday. He said it’s oesophageal cancer.”
“Yes,” Dr Lewis nodded.
“He can’t remove it because it has spread into the glands in my chest. My liver is alright, though: I’ve had a scan. Mr Langford said that these tumours can grow very quickly or very slowly. If it’s a quick grower, I’ve probably got a few months. If it’s a slow grower, I could live a year or two.”
“It is very hard to predict these things. It could be somewhere in between.”
“I know. That would give me 9 months. That’s what I’m aiming for.” Mr Gwilym took a big breath and sighed.

“How’s Gwen?” Dr Lewis asked.
“She was distraught when he told us. She was much more upset than me. I had tried to warn her but it was still a complete shock. She wanted to come with me, today.”
“You should have brought her.”
“No, you know what would have happened. I couldn’t bear to see you both in tears.”
Dr Lewis went bright red. I looked at the floor.

“Next Tuesday, they are going to put a plastic tube into my oesophagus so I can swallow food again. That’s all they can do.”
“It will help.” Dr Lewis reassurred him.
“Yes, I am hoping I can manage a couple more steak sandwiches.”
“I don’t know about that! You would need to chew the steak very carefully, Mr Gwilym. It could block the tube.”
“What about bacon? Streaky bacon?”
“That might be better.”

“Mr Langford said he would leave things like painkillers to you and Dr Dennis.”
“Yes, that’s fine. We will keep a close eye on you. You can come here and see us regularly.”

Toenail elevation.

Thursday 15th November 1990   Minor surgery  15.30 

toenail elevation












There is nothing nice about watching an ingrown toenail being operated on. From the point of view of the observer or the patient, if they haven’t got their eyes tightly shut, the worst bit must be toenail elevation. The minor surgeon slides a thin blade under the edge of the nail to separate it from the toe beneath. If the local anaesthetic has worked, you are laughing but if it hasn’t . . .

Until Geraldine Hargreaves screamed this morning, I hadn’t understood why Harriet gripped the patient’s hand so tightly during this part of the procedure.

The pitfalls of fundoscopy.

Thursday 8th November 1990   Morning coffee break  12.25 

“I like your new glasses. They are very stylish.”
“I haven’t got new glasses.”
“Don’t be coy, Desmond. Tortoiseshell really suits you.” Dr Lewis laughed. She enjoyed teasing my dad.
My Dad took his glasses off. He stared at them. “These aren’t mine!”

“Oh, my God! These are Mr Wilkins glasses. I wanted to look at the back of his eyes with the ophthalmoscope and put my glasses on the desk. He put his glasses next to mine. I must have put his on by mistake. No wonder I couldn’t make head or tail of Mrs Wood’s rash. I am sorry, Dennis. It probably was Tinea Corporis after all.”
“It looked pretty obvious to me, Dad.”

“ANDREA!” my Dad had to shout because the practice manager’s office was half way down the corridor. “Can you get hold of Mr Wilkins. I need my glasses back as soon as possible.”

Could I be a doctor?

Wednesday 31st October 1990   After dinner  19.20 

“Could I be a doctor, Dad?”
“Declan, I’ve explained this before. I really don’t think that you are intelligent enough.”
“He is not even clever enough to be a nurse!” I laughed.
“Shut up, Dennis! You don’t even want to be a doctor and you come and work in the surgery every Thursday. How stupid is that?”

“Being a doctor is not all about being clever.” Mum said. “You need to have a really good memory. There are hundreds of things to remember: thousands, in fact.”
“Have I got a good memory, Mum?”
“Yes, I think you have, Declan. You need to be a good listener too. I think that that’s one of the most important things.”
Declan and I both looked at Dad. He didn’t say anything.

“You are already showing the signs of being a good listener, Declan. Gran said to me the other day that she thought you were a good, little listener for your age.”
Declan smiled.
“He’s only a good listener because he’s got nothing to say!” I said.

I’ve had some good news.

Thursday 25th October 1990   Home visit  13.20 

Mrs Austin was panting as she carried our drinks in. Dr Lewis got up and took the tray from her.
“You really know that things are catching up with you when you can’t bring three cups of tea through from the kitchen,” said Mrs Austin. She sat down with a sigh. “Oh, I forgot your chocolate biscuit, Dennis,” she continued.
“It doesn’t matter. I’ve just had lunch!”
“How are you then?” Dr Lewis asked.
“Not very good, really. I’m sleeping in the chair now. I can’t lie down. I take a teaspoon of morphine liquid before bed. It helps me sleep. Who’d have thought that I would have ended up on morphine?” Mrs Austin looked at me and winked.
“Don’t worry about that. The most important thing is keeping you comfortable.” Dr Lewis smiled.
“My legs are more swollen too. They are really getting heavy.”
We sipped our tea. Dr Lewis and I were both looking at Mrs Austin’s swollen legs: wondering if there was anything else that could be done about them.
“How’s your appetite?” asked Dr Lewis.
“I feel nauseous. I am not eating much, now. I don’t know why that is.”
“Your liver is probably congested, full of fluid. It can affect your appetite.”

“Anyway, I’ve had some good news?” Mrs Austin looked over at us as she spoke. “My daughter, Alice, has managed to get some time off work. She’s coming over from Australia for a week at the end of next month. It will be the first time she’s been for two years. I’ve wanted to see her so much. We’ve always got on really well.”
“That’ll be nice,” said Dr Lewis.
“Yes, I’m looking forward to it. I’ve got a feeling I’ll be alright until then, at least.”
Dr Lewis nodded: “I’m sure you will.”

The lowest common denominator.

Thursday 18th October 1990   Morning surgery  08.56 

“I want to see the chiropodist.”
“The chiropodist?”
My Dad look puzzled.
“I phoned the Department of Podiatry. They said that I need to come to see you to see if you think I need to see them.”
“Right?” My Dad looked even more puzzled.
“If you do think I need to see them, they want you to send a referral letter.”
“Right. What’s wrong with you?”
“I’ve got a corn.”
“Is it painful?”
“Well, if you’ve got a painful corn you need to see them. I am not sure why I need to write a letter to them. Couldn’t you write to them and tell them you’ve got a painful corn?”
“They specifically said that you have to write to them. I don’t think it’s just a letter they want. I think they want you to make sure it’s a corn.”
“I am afraid I don’t know much about corns. When I was in medical school, we didn’t really spend much time in looking at feet in general. We certainly never covered corns, callosities or cutting toenails. If I remember correctly, the podiatry students did that. I have seen a few verrucae, though. Both my children have had them.”
“They said that they can’t see me unless you write to them.”
“I will write to them, as you are here but I don’t think I should be doing this. If you had a toothache, would you come to me, to see if you needed to go to the dentist?”
“No, obviously not. Do you want to look at my foot as I am here? They might like a description of the corn in the letter.”
“No, I don’t think so. I’ll just tell them you’ve got a painful corn. I imagine all corns look pretty similar.”


Thursday 11th October 1990   Morning surgery  10.30 

“From what you have said, Mrs Vaughan, I don’t think that this dizziness is anything to worry about.”
“I did not describe the dizziness, doctor, and you didn’t ask me anything about it. I just told you that I had been feeling dizzy.” Mrs Vaughan stared indignantly at my Dad. She obviously felt short changed.
“Yes, I know that. I was listening carefully to you.”
“If that’s all you knew, how could you say that it was nothing to worry about?”
“Well, after you told me about the dizziness, Mrs Vaughan, you mentioned your painful shoulder. You also said that you were getting heartburn and wind. Food seemed to be sticking in your throat and your feet were burning. The mucous running from both nostrils was irritating. You had noticed a dry, itchy patch of skin on your stomach. Your sciatica felt worse and your knee was playing up again.”
“So, I realised that the dizziness was nothing to worry about.”

A sexually transmitted disease!

Thursday 4th October 1990   Morning coffee break  12.00 

“Have you considered a sexually transmitted disease, Desmond?”
“Dr Lewis,” my Dad looked horrified. “I am an old fashioned GP. I work in a quaint, respectable town. I know all my patients personally. I am proud to say that, since starting in the practice in 1959, I have never had to treat a single sexually transmitted disease. Occasionally, I will admit, one or two of my patients has had slightly worrying symptoms but there has always turned out to be a perfectly innocent explanation.”
“What about Mr Davis? Didn’t he have a genital wart?”
“No, I am afraid that was a rather painful diagnostic error on Dennis’ part.”

Lazy days.

Thursday 27th September 1990   Morning surgery  09.10 

“I find this a little odd, Mr Burrows. Your condition is obviously deteriorating slowly but, in yourself, you seem a bit better.”
“He likes to be ill. That’s what it is, Doctor Dennis.”  Mrs Burrows smiled.
“Yes,” said Mr Burrows, “it does have certain advantages. I don’t have to do anything. I like to read my paper in the morning and my book. Sometimes, I listen to the radio. I will put my feet up and have a nap after lunch. Putting my feet up is on your advice, of course.”
“It helps the leg swelling.” My Dad nodded his head as he confirmed this.
“In the evening, Gladys and I watch the television,” he continued. “There’s no pressure. I don’t feel guilty about my lazy days.”
“He’s very well looked after, doctor.”
“That helps,” Mr Burrows continued. “Gladys is a devoted nurse. She helps me wash and dress. She prepares all the food: there are often little treats to perk me up. She is very attentive and very patient. My illness seems to have brought out the best in her. There is never a cross word. Her bad temper has disappeared altogether.”
“Really?” My Dad looked surprised but interested.
“I enjoy looking after, Colin, Dr Dennis. It has become a bit of a vocation.”
“Gladys did want to be a nurse. It would have really suited her. I think she got bored with secretarial work.”
“It wasn’t bad, Colin.”
“Yes, but you would have made a first rate staff nurse. Listen, Desmond, being ill is not always as bad as we all think. A busy man like you could do with a rest and someone to look after him.”
“It’s funny you should say that, Mr Burrows,” my Dad said. “I have been feeling a little unwell today. I thought I looked quite pale in the mirror this morning. I still feel light-headed and slightly nauseous. There is a general feeling of malaise that has been building up during the day. Dennis . . . Daphne is a real nurse . . . do you think she would . . .”
Dad and I looked at each other and shook our heads sombrely.
“Actually, Mr Burrows, I feel fine. Let’s get on and have a listen to your chest.”

Early booking.

Thursday 20th September 1990   After dinner 20.10 

Dad’s already booked next year’s holiday. He and Mum are heading off to a remote Shetland island. There is only one guest house and no pub. Neither Declan nor I have been invited. We can go away with our mates if we want. There has been no mention of the Vaughans.

First day back at work.

Thursday 20th September 1990   Thursday morning 

Dad still looked jaded. He was pale but not clinically anaemic. All he had had for breakfast was a large cup of black coffee. He told Mrs Andrea Jones that this had caused his slight shakiness. Usually, he would spend 15 minutes looking through the mail before seeing his first patient. Today, he stared aimlessly at the clock.

He was irritable and hypersensitive to sound. I could see him visibly cringing as Miss Rebecca Radcliff complained loudly about her symptoms and his failure to offer a medical solution. He jumped as she slammed the door behind her.

As the morning progressed, his communication deteriorated. He listened reluctantly and answered every question with a terse grunt. He gave a prescription to his last patient without saying a single word.

By the time he arrived upstairs for coffee, he had a greenish tinge. He sat down, looked around at all the staff eating and drinking, groaned, got up and went back out.


Monday 17th September 1990   Still in bed 07.45

I feel awful. My mouth’s like sandpaper. My head aches. I’m knackered. I’ve only been in bed for a couple of hours so I don’t want to get up. Mum and Dad have already phoned in sick. I don’t see why Declan or I should go to school.

Back with Dad.

Thursday 6th September 1990   Morning coffee break 11.55

My Dad has decided he needs my help again. He thinks that, if I am in the surgery, it takes the pressure off when he sees his difficult patients.
“They don’t moan half as much when you’re with me, Dennis. I am not sure why. Maybe they are embarrassed about making all that fuss in front of someone else.”

He doesn’t agree that I’ve got so much more to learn from Dr Lewis and I felt she let me down by going along with him. After all, she had been getting me to see more and more patients on my own and it was only this morning that she said how well we worked as a team.

Eventually, I managed to negotiate a compromise. I would do one surgery a month and occasional home visits with Dr Lewis. The rest of the time, I was back with Dad. It wasn’t what I hoped for but it would have to do.

A brilliant diagnosis!

Thursday 6th September 1990   Morning surgery 10.20

Dr Lewis picked up a new patient with mitral stenosis today. My Dad thought that it was a brilliant diagnosis.
“In the first place, Dennis,” he said, “we hardly ever see mitral stenosis these days and, secondly, the murmur is notoriously difficult to hear. I missed a case in finals. I would have failed if I had not done so well with the Parkinson’s patient and that was because my grandfather had Parkinson’s disease and insisted on telling me all about it every time I visited. If only my grandmother had mitral stenosis; I could have had a distinction!”

The mitral valve is one of the most important valves in the heart. In mitral stenosis, it is damaged and does not open properly so the heart cannot pump as efficiently as it should.

Dr Lewis described the sound of mitral stenosis so well that I was almost sure that I could hear it myself.
“High pressure makes the stiffened valve leaflets open with a snap, Dennis. Then, as the blood gushes through and tumbles down into the apex of the left ventricle, you will hear a low, rumbling sound. That’s the murmur. After the murmur, the valve may shut with another snap.”

Dr Lewis had positioned my stethoscope very precisely on Mr Gilroy’s chest. She looked at me as I listened.
“Can you hear it, Dennis?”
I nodded as convincingly as I could.


Saving lives every day.

Thursday 30th August 1990   Morning coffee break 11.40

“You like your emergencies, Lois.”
“Yes, I do, Desmond.”
“I always remember when you came for your interview in the practice. You told us that you were going to save at least one life every day.”
“You laughed, Desmond.”
“I must admit, if someone’s life needs saving, I have always been inclined to call an ambulance.”
“I’ve saved quite a few lives over the years.”
“I don’t think you have saved one every day though, Lois.”
“Perhaps not but, on some days, I’ve saved more than one.”
My Dad look surprised.
“Do you remember the Conroy twins?”
“You must do, Desmond. They both had double pneumonia. What about the St Luke’s School coach trip when I saw 27 children suffering from gastroenteritis?”
“I don’t think you saved any lives then, Lois.”
“I have to disagree with you, there. Two or three of those children were suffering from severe dehydration.”
“Do you remember when you diagnosed scabies in Ashbury Lodge residential home?”
“I definitely didn’t save any lives, there.”
“Yes, you did. Some of those old biddies were scratching themselves to death.”

“What about you, Desmond? You had that lady who was going to commit suicide because of her husband’s snoring.”
“Yes, he had a very severely blocked nose. His wife was at the end of her tether. I didn’t save her life though. I referred him to the Ear, Nose and Throat Specialist but they wouldn’t do anything.”
“She didn’t commit suicide, I hope?”
“No, they decided to get separate beds.”

The golden boy.

Saturday  25th August 1990   Portmere vs. Porthmadog 14.33

I couldn’t believe it! It was our new striker’s first game. He was our one hope for the season. He had played in both the Welsh and Welsh Alliance Leagues and had 40 top flight goals under his belt. Ifan Pushton had called him ‘the golden boy’.  There had been careless talk of a league and cup double but Declan and I were just hoping to avoid relegation.

He was making one of his famous wide runs. He was not particularly fast but had considerable momentum. As he stepped outside the right back, his foot landed in one of the larger Portmere potholes, turning his ankle. His knee twisted, taking the full force of his weight. There was a loud crunch and he went down with a groan. We could see his knee starting to swell before he hit the ground.

“Anterior cruciate, Den,” Declan gasped. “It’s completely gone!”
There was no arguing with Declan’s diagnosis. It was a classic Portmere home game injury. The golden boy was out for the season and, maybe, longer.


Thursday 16th August 1990   Morning surgery 09.40

“So you’re telling me the food sticks about here.” Dr Lewis pointed to the bottom of her chest.
“What happens then?”
“It feels quite uncomfortable, as if there is a lump there. Slowly the pain eases off.”
“Does the food ever come back up?”
“No.” Mr Gwilym shook his head.
“Are you ever sick?”
“No. I feels as if I want to be sick but I’m not.”
“Do you get heartburn or acid reflux?”
“Are there any particular foods that are worse than others?”
“Not, really. Well, I used to have a steak sandwich every Friday night. The last time I had one, it was bad. I suppose I ate it too quickly. It felt as if a huge lump of steak was lodged there. It really hurt and it lasted for over an hour. I tried all sorts: milk, fizzy drinks, a few sips of beer. Nothing would shift it. That was three weeks ago. I have not had another sandwich since. I’m having mostly soft foods now.”
“How is your appetite?” Dr Lewis was looking increasingly concerned.
“I am not eating much. I am afraid it will get stuck. To be honest, I don’t really fancy anything.”
“Have you lost weight?”
“Yes, I’ve lost nearly a stone since this started.”

“Look, Mr Gwilym, it sounds as if you have got a blockage in the gullet. There is something that is stopping the food from going down.”
“Yes, I thought that.”
“It could be scar tissue. Patients that get a lot of heartburn can sometimes get a ring of scar tissue inside the gullet.”
“I don’t get heartburn at all really.”
“I know . . . that makes me think it might be a growth.”
“A growth? Do you mean cancer?”
“Yes, cancer is a possibility, especially with you losing all that weight. I am very worried. We will need to get a barium meal examination as soon as possible.”

“Dysphagia is another red flag, Dennis,” said Dr Lewis after Mr Gwilym had gone.

Another death from meningitis.

Sunday 12th August 1990   Sunday morning 10.00

“There has been another child who has died of meningitis, Daphne. It was in Huddersfield this time.” My Dad looked up from the front page of his Sunday paper. Mum was still eating her toast.
“Oh, it is such a dreadful illness, Desmond. I have always been so frightened of the boys catching it.”
“Of course, they blamed the GP as usual. Apparently, he thought it was flu.” My Dad was clearly irritated.
“Meninigits is so difficult to diagnose, Desmond. One minute, the patient can seem perfectly well and, the next,  they can be at death’s door.”
“I was lucky, wasn’t I, with little Robin Pritchard two years ago? He had a high temperature but he did not look too bad. There was certainly no rash. Fortunately, his mother ignored my reassurances and took him straight to the hospital. He was in intensive care a few hours later.”
“At least he made a full recovery, Desmond.”
“Yes, thank God for that! I would never have forgiven myself. Did I tell you that Dr Lewis had had a case a few weeks ago?”
“It was a 15 year old boy who was staying here on holiday. She made the diagnosis as soon as he walked through the door. Dennis gave him a penicillin injection whilst she phoned the hospital. By the time she’d finished on the ‘phone the ambulance had arrived.”
“She is so good, Desmond!”
“She did say that no one could have missed the diagnosis. He looked awful and his legs were covered in big purple blotches.”

Are you still taking three water tablets?

Thursday 26th July 1990   Home visit 13.00

“How are you feeling today, Mrs Austin?” Mrs Austin was breathing quite quickly after walking back into her front room. She looked pale.
“I’m not bad, doctor. My legs aren’t as swollen and I’m not waking up at night.”
“Are you still taking the three water tablets?”
“Yes, I am. It’s a bit of a struggle to get to the toilet quickly enough but I’m managing. I’ve had one accident.” She laughed and glanced at me.
Dr Lewis smiled. “I know it’s a nuisance but I’m worried that if we cut them back down, you would start getting more breathless.”
“That’s fine. I am still very weak. I can’t do much. I did a bit of ironing yesterday. I’ll tidy my bedroom later. I try to do one job a day.”
“It is important to keep as active as you can.”

“I have been thinking about what you said, doctor. I would prefer not to be resuscitated. There wouldn’t be any point, now that I am as ill as this. You are already doing everything you can.”
“I think that that’s the right decision, Mrs Austin.”
“Do I need to sign any papers?”
“No, of course not. I will make a note of it in your records and I will let Dr Desmond know.”
“Yes, you’d better. He would be extremely annoyed if he had to come rushing out to resuscitate me in the middle of his lunch.” Mrs Austin glanced at me again.

Itchy feet.

Thursday 26th July 1990   Morning surgery 10.40

“Don’t worry, Mrs Fraser. Of course I don’t mind looking at William’s throat and listening to Gareth’s chest, and it will be no trouble for me to check the baby over. First, I need to have a feel of your tummy, examine those itchy feet and look at that mole that you are so worried about.”

A very small bee.

Thursday 19th July 1990   Morning surgery 08.57

Oh my God! I knew it had to happen in the end. Dr Lewis wants me to see a patient on my own. It’s a lady with a bee sting of all things. What if she has anaphylaxis? By the time I have looked up the symptoms, it could be too late.
I am dreading seeing her. I feel sick and dizzy. My heart is pounding and my chest is tight. My face is coming out in hot, red blotches as I walk to the waiting room to call her in. My lips and my fingertips are tingling.
She doesn’t look too bad after all. She manages to walk down the corridor to my room. I help her to the chair. She holds up her hand. There is a tiny red dot where the bee has stung her. She asks if the sting is still there.
I take a closer look and shake my head.
“No, it is hard to see anything.” I reassure her. “It must have been a very small bee.”
We both sigh with relief.

Suspected meningococcal meningitis.

Thursday 12th July 1990   Morning surgery 10.33

Meningococcal meningitisrash













“I’ve got a 14 year old year old boy with suspected meningococcal meningitis. He has been unwell with a high temperature and abdominal pain for 24 hours. This morning, he did not want to get out of bed. He has vomited twice. He is pale and sleepy. GCS is 13. Temperature 39.2. Pulse 134. Respiratory rate 22. Blood pressure is low: 80/40. CRT is 5 seconds. He’s got cold hands and feet. Chest is clear and abdomen normal but he has large, dark red blotches on both legs. They do not blanch on pressure.”

If a patient with meningococcal meningitis is going to survive, antibiotics must be started as soon as possible. Dr Lois sent me to the treatment room to get a penicillin injection while she finished speaking to the on-call paediatrician.

Category A calls.

Sunday 8th July 1990   Sunday morning 11.30

“Listen to this, Daphne: Crushing, central chest pain? Breathless? Sweating? Don’t panic! A suspected, heart attack is no longer a medical emergency. Ring 999 . . . then, sit down, put your feet up and relax. Have a hot drink.”

“What are you talking about, Desmond?” Mum did not like being disturbed when she was reading the Sunday supplement.
“It’s one of Tony Copperfield’s reports,“ Dad continued. “He is writing for the Western Mail, now. I’ll read it to you:
This week, Terry Thompson, chief executive of the Welsh Ambulance Service announced that a new call classification system is being adopted across Wales. The old fashioned Category A calls are being abolished. Patients with acute, severe chest pain will now be designated as AMBER. Our drivers no longer have to battle to reach the patient in 8 minutes, Mr Thompson said. He expects it to take a huge amount of pressure off his staff.
Mum knew there was no point in trying to carry on reading her magazine.
“Apparently, there won’t be a specific target time for AMBER calls. They will be decided on a ‘case by case’ basis.” Dad raised his eyebrows.
“Isn’t it quite difficult to tell if the patient is having a heart attack over the phone, Desmond?”
“Of course, Daphne. That’s why acute chest pain has always been a Category A call before.”

“Norman Needham, survivor of seven heart attacks, asked Mr Thompson what would happen to patients who had a cardiac arrest while they were waiting for an ambulance.
Don’t worry, Norman, Mr Thompson responded. Of course, if you have a cardiac arrest, we will upgrade your call classification to RED; as long as someone phones to tell us.”
“Well, at least that’s reassuring, Desmond.”

Another sick note.

Thursday 5th July 1990   Morning surgry 11.00

Max hobbled into the consulting room. He lowered himself cautiously onto the chair, took a deep breath and groaned.
Dr Lewis smiled sympathetically.
“I can’t walk more than ten yards, Doctor. It’s agony and I’m exhausted after. I have to lie down. I can’t carry a mug of coffee. Even changing channels on the television is too much for me. I can’t do anything around the house. Would you believe that I’ve actually tried to hoover? You  ask my mum. She’ll tell you I’ve tried my best. She won’t let me now. She can’t bear to watch. She says it’s cruel. My Dad doesn’t care. He made me wash the car last week. I still haven’t recovered properly. My right shoulder is still hurting and I think I’ve got tennis elbow and my eyes are funny: blurred with flashing lights so I need another sick note. That’s all I want.”

I don’t think you would even have enough time for a cup of tea.

Thursday 28th June 1990   Home Visit 13.09

“How am I doing?” Mrs Austin asked, optimistically.
Dr Lewis sat down after she had finished examining Mrs Austin. She reached out and took her hand.
“I think that things are reasonable. You are certainly no worse than last time I was here.”
Mrs Austin nodded: “I feel about the same.”
“Your heart is extremely weak, now.”
“That’s why I’m so breathless?”
“Yes, it makes you breathless and tired. Your blood pressure is very low and that causes the dizziness and unsteadiness. I am worried about you falling.”
“I’m managing.”
“Yes, you are managing quite well, considering.”
“Do you want me to carry on with the same tablets?”
“Actually, Mrs Austin, there is something else that I want to discuss with you.”
“Well, when you are as poorly as this, there is a possibility that your heart will stop beating. You could have a cardiac arrest.”
“I suppose it happens to us all in the end.”
Dr Lewis paused. “I suppose it does, really. That’s what I wanted to ask you. If that does happen, if you do have a cardiac arrest, do you want to be resuscitated?”
“It would be my last chance?”
“It would be . . . but . . . your heart is so weak that I think resuscitation would be extremely unlikely to be successful. If we did manage to get your heart going, I suspect that exactly the same thing would happen again, very quickly.”
“How quickly?”
“To be completely honest, I don’t think that you would even have enough time for a cup of tea.”

“The alternative,” Dr Lewis said, “is to let nature take it’s course. If your heart stops beating, we don’t do anything. I think you would be quite comfortable.”
“There wouldn’t be any pain?”
“I don’t think so. It wouldn’t be a bad way to die.”
Dr Lewis and Mrs Austin looked at each other as they considered the situation.

“I don’t want you to make any decisions now, Mrs Austin. We can have another chat about it when I come and see you next time.”

An evening with Ifan Pushton.

Thursday 14th June 1990   Portmere Sports & Social Club 22.23

I thought that everyone had forgotten my 16th birthday, including Mrs Vaughan.

As it turned out, they had organised a surprise party for me at Portmere Sports and Social Club. My celebration had been incorporated into the Annual Charity Dinner and Dance Fundraiser with special guest speaker, Ifan Pushton. Ifan was a Portmere legend who had led the team to victory in the Welsh Cup for three consecutive seasons.

Ifan might have been a great midfielder but he was an awful speaker. His jokes were worse than my Dad’s and his changing room stories made us all feel sick. Declan lapped it up. His appearance for Portmere U14s had rekindled his hopes of a career as a professional player.

Some of my patients were there. Fred was leaning against the bar, staring into his empty pint glass. Emrys Roberts was selling raffle tickets. Mrs Vaughan was arguing about the new offside rule with Albert Boyce, the Chairman of the Referees’ Committee.

Phil Davies was lurking around. He slipped me my first ever half of bitter. I sort of enjoyed it but it did not go well with the chocolate buttercream birthday cake that Mum had made. He whispered hoarsely that he had a spare condom I could have. It was past it’s expiry date but should be fine in an emergency.

Phil seems to have adopted the same strategy for condoms that Dad uses for his adrenaline injections.

Four tearful patients.

Thursday 7th June 1990   Morning  surgery 11.30

Today, we saw four tearful patients. The first was a lady whose periods had stopped. She could start crying at any time of the day or night. The second was a lady whose periods were too heavy. The third was a man whose knee was so painful that he wanted another sick note: Dr Lewis spotted those fake tears straight away. The fourth patient was a lady whose husband had died 4 weeks ago. Dr Lewis cried then and even I had to grit my teeth.


Thursday 31st May 1990   Morning  surgery 11.30

I have seen quite a few patients with gastro-oesophageal reflux. My Dad isn’t interested. He regards it as a minor, mechanical failing of the upper gastrointestinal tract, a leaky valve. It is not really a disease, Dennis. He uses terms like a touch of heartburn or a splash of acid. He tries his best to subtly blame the patient for their symptoms recommending small meals, swapping tea or coffee for milky drinks, losing weight and avoiding alcohol. He will advise the more severely affected patient to elevate the head of the bed. Gravity helps keep the acid in the stomach, Dennis. Occasionally, he’ll prescribe an antacid medicine or one of those tablets that helps the stomach empty.

Dr Lewis has a completely different approach. She understands how the peptic acid produced in the stomach can burn and eat away at the lining of the gullet and how, at night, it can creep up into the back of the throat and wake the patient, coughing and spluttering. She realises that even drinking a hot, normally refreshing, cup of tea can be agony. She is aware that enjoying a Chicken Tikka Masala, our curry night favourite (apart from Declan and Gran), is impossible. She knows that two glasses of red wine can lead to much more than a hangover.

The capsules that Dr Lewis prescribes reduce gastric acid production by 90%. They have an almost immediate, miraculous effect and, within a week, her patients are usually eating and drinking whatever they want.

An awful headache.

Thursday 24th May 1990   Morning  surgery 10.10

“I’ve got an awful headache, right here.” Neil Plummer rubbed the back of his head. “It started this morning after breakfast. I got up to go and clean my teeth when it struck me. It felt as if someone had hit me with a plank of wood. The pain was so severe that I wanted to vomit. I nearly passed out. It is not quite as bad now but I feel dizzy. I still feel sick. I wondered if you could give me some strong painkillers.”

Dr Lewis did not answer. She was already dialling 999.

Three cheers for Dr Lewis!

Thursday 17th May 1990   Morning  surgery 11.30

As I have already said, Dr Lewis is fantastic! It is easy to see why all the patients like her so much. Kindness and warmth radiate from her. She is always calm. The tone of her voice and the touch of her hand are reassuring.

Whatever problems they have, Dr Lewis’ patients always feel much better after leaving her consulting room.

Mildred Price said that Dr Lewis was as good as any tonic she had ever taken. Jack Anthony and Dr Lewis both wholeheartedly agreed that it was, at last, exactly the time right time for him to be referred for a new knee joint.A thorough neurological examination carried out on Mr Tobias Laurence completely convinced him that he did not have a brain tumour. Ceri Carter felt relieved after pouring her heart out for 25 minutes. She would have stayed for longer but Dr Lewis ushered her gently out of the consulting room.

P.S. Dad insisted on the title for this post.



Thursday 3rd May 1990   Morning  surgery 10.00

My Dad gets himself into a muddle when he is tired. Today, he checked someone’s blood pressure three times without realising it. Then, when the patient had gone, he couldn’t remember what any of the figures were. I think he was going to make up a something suitable but he looked at me, sighed and decided to go and get his next patient.


Thursday 3rd May 1990   Morning  surgery 09:20

“I am not referring you for a scan, Mrs Crosby.”
“I am sure I’ve got a kidney stone, doctor.”
“No, the pain is muscular.”
“It feels just like a kidney stone.”
“You’ve never had a kidney stone.”
“I know but I know what they feel like. Phyllis has had three kidney stones. Two affecting her right kidney and one on the left, like this. It feels exactly the same.”
“It’s not a stone.”
“I’d like to make sure.”
“You have made sure. You’ve been to see your doctor.”
“I mean that I would like to really make sure.”
“I am not referring you for a scan, Mrs Crosby.”



Thursday 26th April 1990   Morning  surgery 09.40

“You are correct, Mrs Vaughan, it is gout.”
Mrs Vaughan was very pleased with herself. “I thought so, doctor.”
My Dad seemed as if he was about say something but paused, deep in thought. He rubbed his chin and tilted his head slightly. He stared intently at Mrs Vaughan and tapped his fingers slowly and loudly, three times, on the arm of his chair.
“Yes, doctor?” Mrs Vaughan looked worried.
“I know that your big toe is swollen, hot, red and very painful but there must have been something else that made you suspect gout.”
Mrs Vaughan shook her head. “I don’t think so, doctor.”
“There must have been,” my Dad continued. “Think carefully.”
“No, I really don’t think so.”
“Look, Mrs Vaughan, if you are embarrassed because Dennis is here, I can send him through to reception.”
“Certainly not,” Mrs Vaughan retorted, “Dennis is going to be my doctor after you retire. He needs to know everything there is to know about me.”

Valerie Vaughan must have noticed my anxious expression, “Don’t worry, young man,” she continued reassuringly, “everyone in my family lives into their 90s. You can take as long as you want to qualify.”

“This is the way I see it,” said my Dad. “You enjoy a small glass of sherry before bed. Who doesn’t? Recently it’s been more: a few glasses every evening. I don’t suppose Vernon knows. It is so easy for these things to build up. Before you know it, it’s two bottles a week. Then you get a swollen, hot, red, very painful big toe and you put two and two together. It has to be gout.”
It was my Dad’s turn to look pleased with himself.

“Actually, doctor, you are right. There was something else that made me suspect gout.”
My Dad looked knowingly at me and raised his eyebrows.
“Vernon has grown some large, delicious asparagus, this year. We have had grilled scallops and asparagus every night for the last two weeks.”

“Grilled scallops and asparagus! What on earth have they got to do with gout?”
Mrs Vaughan looked knowingly at me and raised her eyebrows. She leant forward and patted my knee. “I think your Dad is due a little refresher on gout. What do you think, Dennis?”

Antibiotics for wedddings.

Thursday 19th April 1990   Morning surgery 09.49

We have just seen a young girl who wanted antibiotics for her sore throat. She said that she was getting married at the weekend and was worried that, if she did not have an antibiotic, she might have to cancel the wedding. She had brought her little sister along who was going to be a bridesmaid. The little sister hadn’t got the sore throat yet but the bride-to-be wanted her to have an antibiotic to prevent her catching it.

My Dad said that he hoped that the bride-to-be would not have to cancel the wedding. He hoped that the little sister would not get the sore throat but she might. He hoped that the groom would not catch the sore throat from kissing the bride.

My Dad said that, although he hoped all these things, he wasn’t able to prescribe antibiotics for the bride-to-be or her little sister.


Thursday 12th April 1990   Morning surgery 09.21

“SEPTICAEMIA! SEPTICAEMIA!” Dr Lewis’s voice rang through the surgery. “We’ve got a collapse in the waiting room. Help me, please!”

Dad is a bit slow in responding to emergencies, these days.  By the time we arrived, everything was under control.
The patient was lying on his back on the floor looking pale and sweaty.
Mr Emrys Roberts, in for his annual diabetic review, was holding the patient’s legs up because of low blood pressure.
Mrs Gail Granger, who had come about her hip, was supporting the patient’s arm so that Dr Lewis could put a drip up.
Mrs Joan Jordan, from the Post Office, was kneeling on the floor next to the man and talking quietly: trying to reassure him.
Harriet, our nurse, was sorting out the oxygen.
Mary Thompson, from reception, was calling an ambulance whilst Penny Parry had been dispatched to find Mrs Green, the patient’s wife. Mrs Green had popped out to the shop to buy bread and milk while her husband was waiting to see the doctor.

Dad and I were looking a bit sheepish as we wondered what to do.
“Why don’t you go and put the kettle on, Desmond?” said Dr Lewis.

That was the thing that I most enjoyed about Dr Lewis’s emergencies; we would all sit down and have a cup of tea and a biscuit afterwards.

Go and see your doctor!

Thursday 5th April 1990   Morning surgery 10.00

“Dr Weston, the Cardiologist, suggested that I should come to see you. I was coughing when I went to see him.”
“It wasn’t just that, Henry, you sighed.”
“I don’t remember that.”
“Yes, you did, Henry. He coughed twice, Dr Desmond, and then gave a big sigh. One of those really big sighs so that anyone would think he had a dreadful cough or a cough that had been going on for weeks and weeks and weeks.”
“I don’t remember that.”
“Well, that’s why Dr Weston suggested that you came to see Dr Desmond, Henry.”
My Dad stood up and picked up his stethoscope.

“It was my back. That’s what it was.”
“Your back? What do you mean, Henry?”
“My back was really stiff after sitting on that hard, plastic chair in the waiting room for nearly two hours.  That was why I sighed. It was nothing to do with my cough.”
“Right, Mr Jackson, do you want me to listen to your chest?”
“Not really, Doctor, my cough has almost gone but I wouldn’t mind you checking my back.”

On the subs’ bench.

Saturday 31st March 1990   Portmere vs. Newtown 11.39

Subs bench










Declan has been called up for Portmere U14s. We are all excited. Even Mum has decided to come to the match.

He was sent on for the last minute of injury time. He misjudged his one and only tackle, gave away a free kick in a very dangerous area and got a yellow card. Thankfully, the Newtown captain whacked the ball miles over the crossbar.

Double headaches.

Thursday 22nd March 1990   Morning surgery 10.40

“I can’t stand these headaches, Dr Dennis.”
My Dad nodded.
“To start with I have been having those so-called tension headaches. You know that I don’t agree with your diagnosis but I think that it is probably easier not to dispute it whilst I am feeling like this. For two weeks, I have been having them every day, all day. You might as well say that I have got a continuous headache.”
My Dad nodded again.
“Then, I have been having my migraines. That’s on top of the tension headaches. So I have a never ending tight band of tension that makes my skull feel like it is being squeezed in a heavy duty vice. Then, I get a sledgehammer of a migraine over my right eye. It distorts my vision and makes me want to vomit. The tension headache is continuous, the migraines last for hours.”
“Are you trying to tell me that you are suffering from two different headaches at the same time, Mrs Vaughan?”
“Yes I am, doctor. Yes, I am.” Mrs Vaughan looked close to tears.
“Well, I am sorry, Mrs Vaughan, that’s not medically possible.”
“Well, it is possible, doctor. It’s occurring right in front of you. Look at me!”

I am no expert but Mrs Vaughan did look to me like a woman suffering from at least two headaches.

“No, Mrs Vaughan, I am afraid you’re mistaken. In thirty years of general practice I’ve never heard of anything like it.”

Antibiotics for holidays.

Thursday 15th March 1990   Morning surgery 10.10

This morning we saw a man who was going on holiday in a week’s time. He was desperate for some Winter sun. He had a sore throat and wanted antibiotics. He hated the thought of his holiday being ruined because he was ill.

My Dad said that he couldn’t prescribe an antibiotic for the man’s sore throat but he would recommend a holiday.

It’s really none of my business.

Thursday 8th March 1990   Morning surgery 09.30

Today we saw a small child who would not sleep. His mother brought him in. She was distraught.
“When I put him down at night, he just stands in his cot and screams, doctor. He will carry on for hours. Sometimes, he will bang his head on the bars. If I turn the light off, it makes him worse. Going downstairs and leaving him doesn’t help. Eventually, he’ll collapse and sleep for a while but he’ll wake up again. He’s fine during the day. It’s affecting all of us. I don’t know what to do.”
My Dad said that he felt really sorry for the woman. He explained that he was a doctor and said that whether small children went to sleep or not at night was really none of his business.
The lady left in tears.

Another scare about hormone replacement therapy.

Thursday 1st March 1990   Morning coffee break 11.59

“How was the course, Lois?”
“They have changed their minds about hormone replacement therapy again, Desmond. When I qualified, they were saying that we should be treating everybody with HRT. There has been another scare and now they are saying that nobody should be on treatment. There is no consistency. What annoys me most is that, whenever there is a new bit of research, they seem to come to the conclusion that all the old research is wrong. They have even said that, if any of our patients are already on HRT and refuse to stop, we should get them to sign a disclaimer.”
“That’s ridiculous!” my Dad said.
“It is going to be so difficult for these ladies.”
“I feel sorry for the husbands,” my Dad said. “I was reading an article the other day that said that the husbands of ladies with menopausal symptoms have been neglected by the medical profession.”
“You’re right, Desmond. I think we should do more for the husbands.”
“Daphne gets terrible premenstrual tension: doesn’t she, Dennis?”
I nodded.
“I am sure that we are all going to have an awful menopause.” My Dad sighed.
Dr Lewis smiled sympathetically: “Perhaps HRT will be back in fashion by then, Desmond.”


Thursday 22nd February 1990   Morning surgery 08.55

“Good morning, Mrs Vaughan!”
“Good morning, Dr Dennis! This is my neice, Victoria. She is staying with me for half term.”
My Dad smiled. “What can I do for you, Victoria?”
“It’s iritis, doctor: my left eye. It’s red and sore. I have got photophobia and my vision is slightly blurred. I’ve had it before.”
“I was just looking at your Snellen chart, on the wall. The fourth line is out-of-focus. Normally, I can see right to the bottom.”
“It is lucky that your light bulb needs replacing. A brighter light would be quite uncomfortable.”
“You can examine my eye, if you want. Last time, my own doctor gave me maxidex drops. They work very quickly.”

Victoria leant forward, close to my Dad, and whispered. “Auntie Val said that her eye was sore this morning, doctor. She doesn’t realise you can’t catch iritis!”

National Paracetamol Prescribing Day.

Thursday 15th February 1990   Morning surgery 11.00

It must be National Paracetamol Prescribing Day. We all know that paracetamol is effective for muscle aches and ligament sprains. It will promptly bring the temperature of feverish children down. It’s the only thing that my Dad will take for flu. However, he has been recommending it for everything this morning.

It is this week’s number one treatment for migraine, Mr Brook.

I’ve got three patients who take it to help them sleep, Mrs Dobson. It works a treat.

The good thing about paracetamol is that it doesn’t have any side-effects and it will mix perfectly with all your other tablets, Mrs Ridley. In fact, you will probably find that they all work a little bit better.

You’ve got to sell your treatment to your patients, Dennis. That’s what he said after Mrs Ridley left his room with a big smile on her face and a prescription for 50 paracetamol in her hand.

Another complaint from Mrs Aitkins.

Thursday 8th February 1990   Morning coffee break 12.05

“You’ve had another complaint from Mrs Aitkins, Desmond.” Mrs Andrea Jones came into the staff room and sat down.
“Why don’t you see her, Lois? She is always complaining about me.”
“I don’t mind.” Dr Lewis smiled.
“I have discussed that with her several times,” Andrea explained. “She won’t see anyone else.”
My Dad sighed. “Well, what was she unhappy about this time?”
She said that, although she agrees that toothache is usually a dental problem, she did not feel that you should have been so angry about her wasting a valuable doctor’s appointment.”
No one said anything.

“I have drafted a letter of apology. Can I ask you to sign it, Desmond?”
“You are very efficient, today, Andrea.”
“Not really, I just made some minor changes to the painful corn letter we sent her last time.”

A frozen shoulder.

Thursday 1st February 1990   Morning surgery 09.50

“Come on, Mrs Vaughan, you try this on every Winter! I don’t know how many times I’ve told you. A frozen shoulder has got nothing to do with the weather.”
“It feels exactly like a frozen shoulder to me, Dr Dennis.”
“You don’t suddenly wake up with a frozen shoulder. It usually comes on gradually over weeks or months.”
“My frozen shoulder did start suddenly this morning. It was bitterly cold and there was a thin frost. I could feel it seizing up as soon as I got out of bed.”
“I don’t remember there being any frost.”
“I was up very early, doctor. You know I don’t sleep well.”

“Sometimes, a frozen shoulder can be caused by an injury. Have you fallen or have you wrenched it in the garden?”
“No, doctor, neither. There definitely hasn’t been an injury and, of course, I am not diabetic. I understand that a frozen shoulder is quite comon amongst patients with diabetes.”
“That’s correct, Mrs Vaughan.”
Mrs Vaughan turned to me and raised her eyebrows. “A useful fact for you to remember, Dennis?”

“Well, which ever way you look at it, it doesn’t seem like a frozen shoulder to me, Mrs Vaughan.”
“I suppose not. I’m sorry, doctor. I will try to remember next year. It’s probably just a touch of rheumatism. Even you would admit that rheumatism is affected by the weather.”
My Dad nodded reluctantly.
“Listen, while I am here,” Mrs Vaughan continued, “can I have some of that special cream for my chilblains. They’re really painful.”


My worst nightmare!!

Thursday 18th January 1990   Early morning waking 03.30

A harmless freckle? Thanks, Dad!

My melanoma has spread everywhere. There are big, black lumps all over my skin. My liver is full of it. I’ve got nodules in both lungs.

Dr Miller, my dermatologist, was kind but painfully honest. “I am afraid that there is nothing we can do for you, Dennis. You won’t live for more than a few weeks. We will try to keep you as comfortable as we can.

 Mum hugged me and cried. Even Declan seemed upset. Dad was too ashamed to come to the hospital.


How are things at home?

Thursday 11th January 1990   Morning coffee break 12.17

“I couldn’t make head or tail of that lady’s pain. What did you think it was, Dennis?”
“I’ve got no idea, Dad.”
“We have just seen Mrs Talbot, Lois. She has the most bizarre pain in her right leg. Her symptoms make no medical sense whatsoever.”
“Tiffany Talbot?”
“She’s having marital difficulties, Desmond. I think she and her husband are going to split up.”
“Actually, she did mention Mr Talbot twice during the consultation.”
“Her unhappy relationship could be the cause of the symptoms, Desmond.”
“I should think it must be, Lois. I was tempted to ask how things were at home. Thank god, I didn’t. She would probably have burst into tears and we’d still be there consoling her now.”

Mr Dennis Desmond.

Tuesday 2nd January 1990   After breakfast 08.00

It was just over a week after his heart attack and my Dad was going back to work. He felt fine. In fact, he said he felt so good that he was sure that they had made a mistake with the diagnosis. It had probably been a touch of indigestion and not a heart attack at all. There had been a patient on the ward with a similar name to my Dad, a Mr Dennis Desmond. It was very likely that my Dad’s and Mr Desmond’s results (the blood tests and electrocardiographs) had been mixed up. That sort of thing often happens in busy hospitals.

Dad has stopped taking his aspirin (it can make indigestion worse) and is being very careful about his diet. He decided to continue his blood pressure tablets (not a bad thing at his age).

Homemade crackers.

Sunday 24th December 1989   After dinner 19.41

Mum is usually in charge of most of the Christmas preparations but Dad always does the crackers.

On Christmas Eve, he carefully takes them apart, swaps the jokes for some of his own and puts them back together. He never upgrades the novelty prizes and the snappers don’t usually work after he has fiddled about with them. He sometimes forgets to put the hats back in. He says that the better jokes make up for all that.

Antibiotics for Christmas?

Friday 22nd December 1989   Morning surgery 10.50

“I wouldn’t usually come about a sore throat, Doctor Dennis, but it’s Christmas on Monday and I still have loads to do. Maybe I’m a bit run down with all the excitement. I seem to have been getting things ready for months. I bought my first present in September. I’ve still got most of them to wrap and half the cards to write. Len can’t wrap and he won’t help write the cards. He says he gets bored writing the same thing over and over again every year. Of course, the cards we’ve received still need to be displayed. We hang them on ribbons. I’ve put the lights on the tree but not the glass balls or tinsel.
I will be making mince pies, sausage rolls, pigs in blankets, stuffing and bread sauce over the weekend. I’ll need to prepare the veg. I always do enough sprouts for everyone although I know the kids won’t eat them. Len wants fresh peas this year instead of frozen and Lynn, my daughter, has asked for spiced red cabbage casserole. She had it at her works do.
All seven grandchildren are coming on Christmas Eve. Their parents are having a ‘night off’ but are expected for breakfast. I’ve got to make up the beds and I’ve volunteered to pack the stockings which reminds me that I’ve forgotten to get the apples and oranges. Len will be fast asleep by midnight so I will have to hang the stockings. It will be a late night by the time the kids are asleep. I might fall on the stairs in the dark and I’ll need an early alarm call to get me up to put the turkey in.
I am coughing so much that I am frightened I’m going to lose my voice. I have been hot and cold and my muscles are aching. As you can see, doctor, I just haven’t got a minute to be ill.”

“You have got a bad sore throat, Mrs Logan, but I am not giving you antibiotics for Christmas.”


Antibiotics for exams?

Thursday 7th December 1989   Morning surgery 10.40

We saw a schoolboy with a sore throat this morning.

“I wouldn’t normally ask for antibiotics for a sore throat,” his mum said, “but Dylan has got an important exam tomorrow.”
“I don’t usually prescribe antibiotics for sore throats,” my Dad explained, “and I have never prescribed an antibiotic for an exam. I don’t think it would help.”

It’s not sinusitis, Mrs Crosby.

Thursday 30th November 1989   Morning surgery 09.50

“It’s not sinusitis, Mrs Crosby.”
“But I’ve got horrible, thick, green catarrh.”
“That’s because you’ve got a cold.”
“My sinuses are really painful.”
“They’re uncomfortable.”
“I get excrutiating pain when I put my head down.”
“That’s not considered a particularly reliable, diagnostic feature of sinus infection.”
“I can smell burnt rubber.”
“You’ve just looked that up. You’ve been to the library, haven’t you?” My Dad looked angry.
“I need some antibiotics.”
“You have just had half a course for your cold. You don’t need any more.”

A bad dream.

Wednesday 22nd November 1989   Early morning waking 01.32

“It’s time you started seeing your own patients, Dennis.”
“I’m not ready, Dad.”
“You’ll be fine, Dennis. I’ll be sitting in the room next door. You’ll learn so much.”

 Of course, my first patient was Mrs Vaughan.

 “I need to see the skin specialist, Dennis. This rash is dreadful! It’s so itchy!”
“I can’t see a rash, Mrs Vaughan.”
“It’s all over me, Dennis. It’s everywhere. It’s driving me mad!”
“I can’t see it, Mrs Vaughan.”
“You can feel it. There are hundreds of small, prickly bumps under my skin.”
“I can’t feel it, Mrs Vaughan.”
“You’ll have to press harder, Dennis.”
“I still can’t feel it, Mrs Vaughan.”
“I’ve got to see the dermatologist, Dennis.”
“I’ll ask my dad.”
“I don’t want you to ask your dad, Dennis. I want you to phone the skin specialist now. I need to see him this afternoon.”
“You won’t be able to see him this afternoon, Mrs Vaughan. There’s a 27 week wait for a routine appointment.”
“There’s nothing routine about this, Dennis. It’s a dermatological emergency. It’s driving me mad!”

Just pop in and ask your doctor.

Thursday 16th November 1989   Morning coffee break 12.10

“Just pop in and ask your doctor?” My Dad looked puzzled and annoyed.

“Yes, Desmond, it’s a new government scheme.” Our practice manager, Mrs Andrea Jones, was reading a large, glossy brochure. “The idea is to encourage patients to come in and discuss any little worries they have. It can be the most trivial question or the tiniest concern. I suppose it’s for things that they would not usually dream of making an appointment for.”

My Dad look less puzzled and more annoyed.

“Here, they’ve got some real examples. Mrs Joan Charles had been suffering from intermittent pins and needles affecting the tip of her left little finger. She wondered if this might be the first sign of multiple sclerosis.”
“Probably not.” Dr Lois Lewis looked up from signing the prescriptions.
“I’ll read another,” Andrea continued. Three weeks ago, Mr Jack Bradbury had suffered from a morning of quite nasty diarrhoea. He had initially put this down to something he had eaten but wanted to know if it could have been one of his tablets.”
“Do we know what tablets he was on?”
“No, I’m sorry, Dr Lewis, they don’t mention that. Anyway, participating practices would be expected to make a senior doctor, that’s you Desmond, available for an hour every day. Patients don’t need an appointment: they just pop in. They suggest running the service over the lunch break to avoid interfering with normal surgeries. Of course, the scheme would attract extra remuneration: that goes without saying.”

No one spoke. Andrea continued to look through the brochure. My Dad kept taking small sips of his coffee. He does that when he is trying to work out whether the milk is sour.

“Mmm . . . listen to this . . the scheme has been successfully piloted by doctors in Oxford and Cambridge . . .” Andrea smiled dreamily. Dr Lewis looked up again with a similar expression. They both appeared very impressed by the thought of doctors in Oxford and Cambridge. “Patients are extremely satisfied with the new service,” she continued. “Little Middleton resident, Mrs Vera Vaughan, who has used it every day has only the highest praise. It has also reduced the demand for routine appointments by a third. That’s fantastic, Desmond.”

My Dad got up, marched across the staff room, tipped his coffee down the sink, dropped his cup into the bowl and left.

A new trick.

Thursday 2nd November 1989   Morning coffee break 12.00

“Dennis, I have just realised something. How long have I been working here in the practice?”
I sighed. “You keep asking me that, Dad. It’s thirty years.”
“Yes I have and, since then, I have seen hundreds of patients with arthritis of the hip.”
“Yes, Dad.”
“In all those patients, I have done the same thing. I have waited until it is exactly the right time for them to have a hip replacement, exactly the right time. Then, not a moment too soon, I send them to see the hip surgeon.”
“Yes, Dad.”
“I have never sent a patient a day too early and I have never sent a patient a day too late. For twenty nine years, that has worked perfectly well.”
“Yes, Dad.”
“This year, I have sent 12 patients to see the hip surgeons. Each time, the consultant has said; Oh! Your hip’s not quite ready to replace yet. Let’s see you again in six months. This, in itself, is slightly surprising. To cap it all, when they go back to the clinic in six months, their hips are perfectly ready to be replaced and they’re put on the waiting lists for their operations.”
“Yes, Dad.”
“So suddenly and strangely, Dennis, I have been sending everyone that needs a hip replacement exactly six months too early. It has been puzzling me a great deal.”
“Yes, Dad.”



Sunday 29th October 1989   At home 17.00

I told my dad that I didn’t know anything about hormones but, of course, I do. We’ve got hormones at home.
On a Sunday, we always try to have a relaxing, family afternoon. Mum will do a bit of housework and prepare the dinner while Dad and I watch The Big Match.
Mum likes to serve up the food as soon as the football finishes. This can be annoying if there is a lot of injury time or extended highlights.

So there we are tucking into a nice roast dinner when, suddenly, Mum snaps. It’s completely out of the blue. She usually starts on me. My room’s a mess. All my clothes have been thrown on the floor and my school books.
Dad steps in, in a supportive way: “You really should try to clear up, Dennis.”
Then, she attacks him.
“You can talk! You’re just as bad! You’ve got clothes all over the place.”
To be fair, it is true. It’s a genetic problem that Dad and I have. We regard it as an illness. It’s something that we both accept.

Then, we both catch on: Mum’s hormones have kicked in. It’s the same every time. She’s bad tempered and highly irritable. She seems to lose any logical train of thought. Of course, if we try to explain that we understand or say that there’s no offence taken, it just makes her worse. So now, when Dad and I realise what’s going on, we don’t say anything. We just sit as still and as quietly as we can.

Malignant melanoma!

Wednesday 18th October 1989   After breakfast 08.15

Malignant melanoma! I knew it. The worst kind of skin cancer. I should never have listened to my Dad.
“It’s not even a mole, Dennis. It’s just a freckle.” That’s what he had said when he looked at it at Easter.

Since then it had doubled in size. It was itching. This morning, oh my God, it was bleeding! That’s a danger sign, a red flag! To top it all, my doctor, Dr Lewis, was on holiday.
“It is exactly the same size, Dennis, 3 mm by 4 mm.”
“You should be wearing your glasses, Dad.”
“No, I can see perfectly well.”
He picked up a tissue and moistened it. He rubbed the ‘freckle’.
“That hurts.”

He looked at the tissue. “Just as I thought, Dennis. It’s not blood. It’s a tiny speck of Mum’s bolognaise sauce. She is putting too much tomato puree into it these days. I have tried to tell her.”

A stronger antibiotic.

Thursday 12th October 1989   Morning surgery 08.53

“Right, Mrs Crosby, let me sum up. You came to see Dr Lewis on Monday.”
“Yes, doctor.”
“At that stage, you had had a cough for 3 days and a bit of a cold.”
“Yes, doctor.”
“You insisted that you were given an antibiotic.”
“I wouldn’t say that, doctor.”
“Well, that is exactly what Dr Lewis has written in your notes.” My Dad picked up the record card and read: “Cough and cold 3 days. Chest clear. Patient insists on having an antibiotic.” He looked sternly at Mrs Crosby and raised his eyebrows.
Mrs Crosby did not say anything.
“As far as I can make out and, against her better judgement, Dr Lewis prescribed an antibiotic.”
Mrs Crosby nodded reluctantly.
“Today, you are here because you feel no better and you want a stronger antibiotic?”
“Yes, doctor, I told Dr Lewis that amoxycillin never . . . ”
“Mrs Crosby, It doesn’t surprise me in the least that, if you didn’t need an antibiotic in the first place, the antibiotic prescribed by Dr Lewis won’t have made you feel any better. It’s like taking a pain killer when you haven’t got a pain. It doesn’t really help. It shouldn’t surprise you, either, to be told that I am not going to give you a stronger antibiotic. In fact, not only am I not going to give you a stronger antibiotic, I am also going to take this antibiotic, the one that you placed on my desk with a barely disguised expression of annoyance, away from you. You don’t need it.”
Mrs Crosby looked very unhappy.
“My advice, Mrs Crosby, is to go away and wait patiently for your cough to get better.”

Have we run out of marmalade?

Sunday 8th October 1989   Sunday morning 09.07 

“Have we run out of marmalade?” My Dad looked bedraggled after being on call. Mum passed him some hot toast and coffee.
“I had to go to see poor Mrs Austin, last night. She was in acute, heart failure. She was very breathless.”
Mum looked concerned. “Did you send her into hospital, Desmond?”
“She refused.”
“I hope you made sure that she understood the consequences.”
“The consequences?”
“Yes, the consequences of not going into hospital.”
“At 3 o’clock in the morning?”
“Yes, of course, Desmond.”
“I explained the diagnosis to Mrs Austin and said that we ought to get her into hospital. I am not going in, Dr Dennis. Those were her exact words.”
“Well, what did you say?”
“I said, Oh!”
“That’s all?”
“Yes, that was all I said. Anyway, after that I suggested a frusemide injection to get rid of the fluid.”
“Did it work?”
“I don’t know. It takes about 30 minutes.”
“Didn’t you wait?”
“No, it was 3 o’clock. I came home.”
“What if she fell, rushing to the toilet?”
Dad took a deep, irritated breath. “She didn’t fall. I’ll phone her later . . . Daphne, have we run out of marmalade?”

Two brothers married two sisters.

Thursday 5th October 1989   Morning surgery 10.20 

Valerie Vaughan’s husband Vernon had a brother called Victor. Victor had married Valerie’s sister, Vera.
“To be completely honest, Dennis, both brothers had their eye on me. In fact, I went out with Victor first. He wasn’t half the man that Vernon was, though. Vera has always been happy to make do.”

My Dad had just popped out to get a new prescription pad and Mrs Vaughan was telling me about her planned trip to visit her sister in Little Middleton.

Tip-top condition.

Thursday 28th September 1989   Morning surgery 11.00 

“Good morning, doctor. How are you?”
“I’m fine, thank you, Mr Parry.”
“Yes, I must say that you are looking very well. Did you enjoy your holiday?”
My Dad looked slightly surprised. “Yes . . . I did.”
“I have just been on holiday, myself,” explained Mr Parry. “In fact, that’s what prompted me to come to see you.”
“It was a lovely day. I was lying on the sun bed thinking how well I felt. In fact, I don’t think I have ever felt so healthy. My wife agreed that there couldn’t be a better time to come for a check-up.”
“I mean, I hardly ever come to the doctor and, if there is nothing wrong with me, it must be much easier for you.”
My Dad did not look convinced.
“I haven’t got any symptoms at all. My appetite is excellent. My weight doesn’t vary.  I never get pain. My breathing is fine. I’ve got no dizziness. I don’t suffer from any difficulty passing urine. I open my bowels every morning without fail. I think I’m in tip-top condition.”
“Mmmm . . . ”
Mr Parry continued: “I was hoping you could listen to my heart and lungs and check my blood pressure. That’s all.”

My Dad glanced at his watch and smiled. I could sense him warming to what was turning out to be a quick and straightforward consultation. He readied his stethoscope whilst Mr Parry took off his shirt and tie.

The Department for Emergency Circumstances.

Tuesday 19th September 1989   Rethymnon 14:17

Trust Declan!
He had been rock climbing, fallen and cut his head open. His best holiday t-shirt was covered in blood. Dad said that he would stitch him up.
“I don’t want to be sitting in the hospital for 4 or 5 hours.”
But Mum put her foot down. “I am sorry, Desmond. You really should know better. Your fishing line isn’t sterile. In fact, it’s probably not clean. It has been in that tatty, old bag since last Summer.”

The waiting room for the ‘Department for Emergency Circumstances’ was bright and airy. A few people were waiting patiently on comfortable chairs.
Dad had brought a flask of coffee, two sets of sandwiches, all three of his books and a newspaper that he had picked up on the plane. He sat down grumpily and sighed. He wondered whether to eat a sandwich but decided it was too soon after lunch.

A cheerful lady with a trolley of refreshments gave Declan and I a cold drink. Mum had a cup of tea.

As soon as the receptionist had taken Declan’s details, one of the nurses took him through to the treatment room. Mum and I went with him while Dad read his paper. The nurse gave Declan a big smile and said how brave he was. She cleaned the wound gently and carefully.

Dr Emmanuel Zarifis came and introduced himself. He explained to Declan that he would need two stitches. The local anaesthetic injection hurt as expected but the stitches were painless. Dr Zarifis recommended a waterproof dressing so Declan could continue to go swimming. The nurse gave Mum a couple of spares.

Dad was still studying the front page of his paper when we came out. He didn’t notice us.

“Leave him there,” said Mum. “He’s in a bad temper and it will be an hour before the bus comes. We’ll walk down to the beach and get ice creams.”


My last family holiday.

Friday 8th September 1989   After dinner 19:30

We are off to Agia Galini tomorrow. I told Dad that this would be my last family holiday. Next year, I am going to go with my friends after we have finished our exams.

He didn’t argue which is always a bad sign.

Declan said that, if I wasn’t going with them, there was no way that he would go unless they went to Florida.

“I’m trying to check your blood pressure, Mrs Crosby!”

Thursday 7th September 1989   Morning surgery 09:20

“I’m trying to check your blood pressure, Mrs Crosby!”
“I am sorry, Doctor.”
“Well, if you talk to me while I am checking your blood pressure, I won’t concentrate properly on what you are saying or measuring your blood pressure or BOTH. It’s common sense; isn’t it?”
“I am so sorry, Doctor.”
“Yes, well it annoys me, Mrs Crosby. It really annoys me.”

A postcard from Agia Galini.

Tuesday 29th August 1989   After breakfast 07:50

Greek postcard










Dear Desmond,

We were very disappointed to find that you had changed your holiday dates at the last minute. By then, of course, it was too late for Vernon and I to do anything about our own travel arrangements. What a stroke of luck it was that the room next to ours was occupied by a Consultant Gastroenterologist! He took no time in getting to grips with my tummy troubles. He did not say anything but I got the distinct impression that he felt you had been half-hearted about my symptoms. Anyway, he is going to write to you to recommend a series of investigations and some new treatment.
Although it is not really his field, he did have some sensible suggestions to make regarding Vernon’s bladder. We will discuss these with you on our return.

 We still wish you were here!

 Val and Vern

“Don’t keep arguing with me, Mrs Crosby!”

Thursday 24th August 1989   Morning surgery 10:30

“Don’t keep arguing with me, Mrs Crosby!” Dad’s alarm had not gone off. We got up late and left home without any breakfast.
“I am not arguing, Doctor.”
“Yes, you are, Mrs Crosby. I have told you that this pain is caused by a trapped nerve and that the trapped nerve is due to a slipped disc. I think I explained that quite clearly.”
“Yes, you did, Doctor.”
“I told you it would take between two and six months to settle down.”
“Yes, that’s exactly what you said, Doctor.”  Mrs Crosby looked very apologetic.
“Since then, you have said to me twice: I don’t know why I am getting this pain. Now, you are saying: I don’t know why it’s not better.”
“It’s just a way of explaining how bad it is.”
“Well, it sounds like you are arguing to me. Either you are not listening or you don’t believe me. If you aren’t going to listen to what I’ve got to say, I can’t see any point in you coming to see me.”

Atrial fibrillation.

Thursday 17th August 1989   Morning Surgery 11:10

“How are you, Mr Lawley?”
“My back is awful, Dr Dennis.”
“I am very sorry to hear that.”
“Your’s would be too if you had spent 18 hours on a trolley in the Emergency Department.”
“I’m sure it would.”
“I told you that I didn’t want to go into hospital.” Mr Lawley glared at my Dad.
“Well, I was concerned about you. You had a rapid, irregular pulse.”
“Yes, they said that you were concerned about me in the hospital. I think that they thought you were a bit too concerned.”
“Your pulse was going at 145 beats per minute!”
“Yes, I remember you being very dramatic on the ‘phone. Anyone would have thought that it had been going at 145 miles per hour!”
“A fast pulse like that can be quite dangerous, especially in an elderly gentleman.”
“They did not seem too worried about it in the hospital. In fact, by the time the doctor saw me, it was back to normal.”
“It wasn’t due to a heart attack, then?”
“They didn’t say anything about that.”
“Did they give you any treatment for it?”
“No, they didn’t.”
“As far as I can see, Doctor, I didn’t need to be in hospital at all. I might as well have been at home, curled up in front of the television with a nice cup of tea. That’s what I have come to tell you really. Next time you see a patient with a rapid, irregular pulse, I would like you to bear that in mind.”
My Dad nodded his head.

“Oh, by the way! They would like you to arrange for me to see a cardiologist, urgently.”
“Didn’t you see a cardiologist in the hospital?”
“No, he was too busy.”


Thursday 10th August 1989   Morning surgery 11:20

Meet Max (1)










I thought Max looked really ill. He walked slowly and painfully down the corridor to Dad’s room, leaning heavily on his crutches. He wore dark glasses (even though it was a miserable day) and a soft collar to support his neck. When he sat down, his knee looked massively swollen but Dad said he was wearing a heavy duty brace.
Max sighed loudly.
“So the new tablets aren’t helping,” my Dad said.
“No, I’m no better at all. In fact, I think I feel worse.”

Fish and chips.

Friday 4th August 1989   Criccieth beach 17:12

Our discussions about waiting lists had made us all feel hungry. It was Dad’s afternoon off and he decided to take us for a walk on the beach followed by fish and chips. It was a long way to go but it was worth it.

Waiting list theory.

Thursday 3rd August 1989   At home 19:22

“I don’t understand these waiting lists, Dad.”
“It’s very straightforward, Dennis. It’s just a queue, really.”
“Yes, but you’ve been telling everybody that there is a 24 week waiting list for an orthopaedic appointment.”
“Well, why is it always 24 weeks?”
“It just is, Dennis. That’s how long it takes to get an appointment in the clinic.” It seemed perfectly obvious to my Dad.
“I don’t see why it should always be 24 weeks. Let’s say the clinic could see 20 patients every week . . .”
“So, if there were 20 new referrals a week on average or less, there wouldn’t be a waiting list.”
“But if there were 21 new referrals or more every week, the waiting list would just get longer and longer.”
My Dad looked puzzled as he thought about this.

“It’s just like the fish and chip shop in Criccieth, Dennis.” Declan piped up. He was about to bite into one of Mum’s large, fluffy Yorkshire puddings.
“Fish and chips! Don’t be stupid, Declan!”
“Actually, Dennis, he’s got a point. There is always a queue when we go for fish and chips and it always goes from the door, along the back wall and round, in front of the counter. I would guess that there are usually between 10 and 12 people in the queue. I suppose that that is the waiting list for fish and chips.”
“Yes, but that’s what I can’t understand. Why are there always 10 or 12 people waiting? Why does the queue always go round to the door?”

Declan glared at me as if I was stupid. “It’s because the fish and chips are so good, Dennis.”


Flea bites.

Thursday 27th July 1989   Morning surgery 10:13

“They’re flea bites.”
“Flea bites, doctor! They can’t be.” Mrs Vaughan looked quite upset.
“Yes, they are, Mrs Vaughan.”
“It’s not shingles, then?”
“You know I’m susceptible to shingles. I’ve had it three times before?”
My dad took a deep breath. “No, you’ve never had shingles, Mrs Vaughan.”
“How can you be sure they’re bites, Dr Dennis?”
“Well . . . you’ve got a cat, haven’t you?”
“Yes, Milly, but she hasn’t got fleas.”
“She has. That’s where the bites have come from.”
“She hasn’t. I’m sure she hasn’t.”
“Let me try to explain, Mrs Vaughan.” My Dad sounded like my chemistry teacher. “Milly rubs herself against you. When she does this, one of the fleas jumps from her back onto your leg.”
Valerie Vaughan shuddered.
“It bites you. Then, it crawls along a bit and bites you again. After four are five bites, it’s had enough blood and off it jumps, into your nice, thick carpet.”
Valerie Vaughan shuddered again.
“That’s why you’ve got four itchy bites, all in a row.”
Valerie Vaughan started scratching her leg.
“Don’t scratch. That will make them worse.”

“What treatment do I need, Doctor?”
“You don’t need any treatment, Mrs Vaughan. It’s Milly that needs treatment.”

Phil’s back!

Thursday 20th July 1989   Wart clinic 16:30

Phil's back










Phil had caught a wart from one of his girlfriends. It was on a very embarrassing part of his body.
I gave him a long blast of liquid nitrogen: 50 seconds which is twice my usual maximum dose. It brought tears to his eyes.
“I am sorry, Mr Davis,” I explained. “It is going to be very sore and blistered for a couple of weeks but I want to be completely sure that we get rid of it.”
Phil nodded sheepishly.

I can’t wait to tell Declan when I get home tonight. Dad has already explained that there are certain situations where doctors are obliged to breach confidentiality.

I hate to admit it but, at times, I get a certain sense of satisfaction from my work in the surgery.

The Coroner.

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.

Cauliflower cheese and chips.

Friday 30th June 1989   After dinner 19:40

Cauliflower cheese and chips used to be my Dad’s favourite snack when he was on-call in the hospital. He would arrange to meet Alistair, one of his colleagues from the surgical ward, in the canteen at 10 o’clock on a Saturday night. The cook would be waiting with a big plateful of food for each of them.
Both Alistair and my Dad resented the fact that, on an on-call weekend, they would be expected to work for 80 hours without a proper break and with hardly any sleep.  When they came for supper, they would turn off their bleeps for 30 or 40 minutes. That way, they could tuck in without any interruptions.

On one particular weekend, a patient on Alistair’s ward collapsed. By the time he had finished his food and switched his bleep back on, it was too late. The man had passed away.

Mum has always said that califlower cheese and chips is an unhealthy combination.

“My hairdresser sent me.”

Thursday 22nd June 1989   Morning surgery 11:00

“My hairdresser sent me.”
“Did she, now?” My Dad looked less than impressed.
“She thinks that I have got a small skin cancer on my right ear.”
My Dad laughed.” Does she, now?”
“Yes, she does.” Mrs Neville looked disdainfully down her nose at us. “It keeps bleeding.”
“Hmm . . . She’s probably just nicked you with her scissors. Anyway, how’s that cough?”
“It’s better, thank you.”
“And the breathing?” My Dad continued.
“Back to normal, now.”
“Excellent, I will check your blood pressure. Let’s have your arm.” My Dad picked up his blood pressure cuff and reached for Mrs Neville’s arm.
“Don’t you want to look at my ear?”
“Your ear?”
“Yes, that’s what I have come about. My hairdresser . . .”
“Mrs Neville, I really don’t have time for all this!”
“Well, I’m not leaving until you have had a look.”
My Dad sighed. He got up and went to have a closer look. There was a small, pink nodule on the top of Mrs Neville’s right ear. My Dad tilted his head slightly. He rubbed his chin thoughtfully. His face reddened. He bent forward and peered more closely. He squeezed the nodule between his finger and thumb. He coughed uncomfortably.
“I think she’s right, Mrs Neville, I think she’s right.”
My Dad sat down. He looked thoroughly unhappy. He explained to Mrs Neville that he would refer her urgently to the Ear, Nose and Throat specialist. She smiled smugly.

As Mrs Neville went out, my Dad looked at me. “That poor woman has got an awful haircut, Dennis.”

Life is painful.

Thursday 8th June 1989   Morning surgery 10:40

Valerie Vaughan was in today with more pain. After she had told my Dad all her symptoms, he said to her: “Look, Valerie, I think we have all got to accept that life is painful. I am 59 years old. When I get up in the morning, my back is stiff.  When I try to reverse the car, my neck hurts. When I do a busy surgery, I get a headache. I don’t like using these pain rating scales but, if I did, I would rate a normal day as 3/10. I realize that your life is probably more painful than mine. I don’t think that there is any particular reason for that and I don’t think that there is much we can do about it. I think that we both have to just get on with things as best we can.”

Mrs Vaughan always tends to fear the worst and asked my Dad if he was sure that his headaches weren’t due to a brain tumour.

“No, I am quite certain about that. They are busy surgery headaches. I have been having them for years.”

Coffee and walnut cake.

Wednesday 31st May 1989   Lunchtime 13:10

Zoe and Chloe are going back to Cardiff today. They baked a big coffee and walnut cake for all the staff.

Everyone is sad to see them go. Dr Lewis came in on her day off to say goodbye. I popped in during my lunch break. Dad said that, apart from the incident with the spotty teenager, they were the best medical students that we had ever had in the practice. The receptionists hugged them and cried.

Spotty teenagers.

Thursday 25th May 1989   Morning surgery 10:20

Zoe and Chloe have been seeing their own patients. They take turns in presenting ‘each case’ to my Dad.

“Melissa Martin is 15 years old. She has had a sore throat for 3 days. She has also had a bit of a cough and cold. She is managing to eat and is drinking plenty of fluids.” Zoe paused. “On examination, her temperature is normal. Her throat is red but her tonsils are not enlarged. Her chest is clear.” Zoe looked up at my Dad.
“Does she need any treatment?” He asked.
“We would like to give her something for her spots.” Chloe said.
“Her spots?” My Dad looked shocked.
“Yes, she has awful spots. We asked her if she was concerned about them and she burst into tears.”
“I thought she had come about her throat.”
“Her throat isn’t bad at all,” Chloe continued. “We think that the real reason she came was the spots.”
“Listen,” my Dad said. “She came about her throat and that’s what we are going to deal with. We can’t go looking for all sorts of other problems.”
Chloe took a deep breath. “She is getting to the age where she is worried about her appearance. Maybe, she is thinking about boyfriends.”
“I am very sorry,” my Dad said. “If she is going to make a song and dance about her spots, she will need to make another appointment. Dr Lewis likes treating spotty teenagers.”



Wednesday 17th May 1989   After dinner 19:40

Dad and I were having beans on toast for tea because Mum was visiting Gran in the hospital. She and Declan arrived home just as we finished eating.
“Well, Gran’s had her bunions done.”
“At last,” said my Dad. “I’ve had enough of hearing about those feet of hers. How is she?”
“She is fine. In fact, she is better than fine. She loves being in the hospital.”

“You remember when she was in with the heart attack and chest infection last year?”
“Yes,” my Dad nodded.
“She realises now that she felt far too ill to appreciate her time in hospital. She didn’t make the most it. Bunion surgery has been an altogether more satisfying experience. So much so, that she has decided to get her shoulder done.”
My Dad looked surprised. “I didn’t think her shoulder was that bad.”
“It’s not, at the moment, but it will only get worse. She would like to get that out of the way before she has her new knee.”
“New knee!” My Dad looked even more surprised. “She has never complained about her knee.”
“Well, it’s been painful all day, today, Desmond.”
My Dad shook his head.

“Anyway, she’s made two new friends. Rita, in the bed opposite, has had an operation on her ankle and Phyllis, in the next bed, has had her second hip replacement. They are all going to meet up for coffee, once they have got over the worst of the surgery. She said to Phyllis: I wouldn’t be surprised, Phyllis, if I’m not back here in a few years having my own hips done. I think I will have both mine replaced at the same time.

Could this be measles?

Thursday 11th May 1989   Morning surgery 09:23

measles boy










“Let’s have a look at this rash then, Mrs Preston.” My Dad looked impatiently at his watch.
Mrs Preston was quite flustered as she hurriedly undressed Nathan. He wriggled uncooperatively.
“So far, there is only one spot, doctor.”
“Only one spot! What do you mean?”
“He has just got one spot, on his chest.”
There was a small, pink, flat spot on Nathan’s chest.
“So, what you actually meant to say was that you were worried that this was a measle.”
“I suppose so, doctor.” Mrs Preston flushed with embarrassment.

“Well, I am afraid that I cannot diagnose measles if there is only one spot.”
“I did not realize that.”
“Obviously, Mrs Preston, there has to be more than one spot.”
“I am sorry, doctor.”
“Yes, it’s a great shame that you could not have waited.”
“It was just that I thought the quicker it was diagnosed, the better. What should I do, now?”

“I think you should get Nathan dressed and take him home.”

Never forget your red flags!

Thursday 4th May 1989   Morning surgery 10:50

“Right, Zoe, was Mrs Spencer coughing up any blood?”
“I don’t know, Dr Dennis. I forgot to ask. I suppose she would have said if she was.”
“You can’t be sure, Zoe.” My Dad explained. “Coughing up blood is very worrying for patients. Some would be too frightened to tell us. It is always important to ask.”

“Coughing up blood is a red flag,” he continued. “It’s Nature’s way of telling us that something serious could be going on. In a patient of Mrs Spencer’s age, we would be most worried about lung cancer. Chloe, can you think of any other red flags?”
“Vomiting blood, Dr Dennis.”
“Excellent, Chloe! If a patient is complaining of tummy pain or gastric symptoms we should always ask about vomiting blood. What about you, Dennis?”
“Blood in the poo, Dad.” I could still vividly remember my own painful piles. They were a bright, red flag in anyone’s book.
“Very good, Dennis. I prefer to call it blood in the stools. Two other red flags are blood in the wee and having a period after your periods have stopped.”
“Postmenopausal bleeding, Dr Dennis?”
“Yes, postmenopausal bleeding, Zoe. Well done.”

“You’ll notice that all these red flags involve blood. That makes them easy to remember. There are other red flags but these are the ones I want you to concentrate on today. Whenever you see a patient, always remember to ask about the relevant red flags.” My Dad looked at the three of us. “Never forget your red flags, students!”

I don’t believe it!

Thursday 27th April 1989   Morning surgery 08:55

My Dad is furious with our local hospital. He has just spent 20 minutes trying to admit a lady with severe, acute asthma.

 The nurse who deals with all the emergencies had said that she felt quite sure that the lady didn’t need to come into hospital. She suggested that my Dad tried an injection. She was confident that this would do the trick. They ended up having a massive argument and my Dad slammed the phone down.

My Dad looked at the patient. “I don’t believe it!” he said. I have been a GP for 30 years. In my early days, after I first qualified, I had a special interest in asthma. In front of me, is a lady who can hardly breathe. Her lips are beginning to turn blue. At the other end of the phone, is a nurse who does not think the patient needs to be admitted to hospital. She cannot see the patient and she cannot listen to her chest. However, she is quite sure that the patient does not admission. I really don’t believe it!”

Take one strawberry mivvi twice a day.

Thursday 20th April 1989   Morning surgery 10:20,10:30,10:40,10:50

This morning, we had four schoolboys in: all from the same class in the same primary school and all with sore throats. Their tonsils all looked pretty similar and my Dad said the same thing to all of the mums.

“I am very pleased to say that he does not need an antibiotic but I am going to recommend that he takes one strawberry mivvi twice a day. He should find that soothing.”

The mums were quite disappointed but the boys seemed very pleased.

These tablets aren’t working.

Thursday 13th April 1989   Morning surgery 09:00

“These tablets aren’t working, Dr Dennis. The pain is a lot worse. My whole back is agony, right from the very top of my neck to the very bottom of my spine: from my atlas all the way down to my coccyx. Every single vertebra is hurting me.”

Mrs Vaughan winced, took a sharp breath in and looked expectantly at us.

Baby clinic.

Thursday 30th March 1989   Baby clinic 10:20

As Dr Lewis was on holiday, Dad had to do the baby clinic. There was no health visitor to help him.
At first, he seemed confident enough but there were 24 small children and 20 of them required vaccinations.

He gave the MMR vaccine to William Jones’ brother by mistake. To be fair, there wasn’t much of an age gap and Francis Jones was sulking: curled up in his Mum’s lap and hiding his face as if he was expecting an injection.
“A bit of extra protection won’t do him any harm, Mrs Jones. At least we can guarantee that he won’t ever get measles.”

By the end of the clinic, Dad was looking very flustered. There were cotton wool balls and empty syringes all over his desk.

He forgot to put the rest of the vaccines back into the fridge until the following day.

Tim was unconscious.

Thursday 23rd March 1989   Home visit   13:00

tim 3










Tim had deteriorated. Yesterday, he was confused. Today, he was unconscious. My Dad shouted at him and shook him. There was no response.
His breathing was irregular: quite fast at times, then slow and heavy.
His face was badly swollen. He was deeply jaundiced.

We thought that he seemed comfortable.

An interesting assignment.

Wednesday 15th March 1989   After dinner 19:20

Tim 2 (3)








Dad said that he had sent Zoe and Chloe back to see Tim. He had decided that it would be an interesting assignment for them; following Tim’s case would be a good learning opportunity.

“I don’t expect him to live for more than a couple of months. Everything should be done and dusted by the time you go back to Cardiff at the end of May.”

Of course, Dad was hardened to his ‘terminals’ but Zoe and Chloe found the idea difficult to cope with.

Tim felt pretty rough when they arrived although he tried to put on a brave face. The students did not know what to say. Mrs Chapman made them a cup of tea. They both refused a biscuit and hardly said a word. Zoe paced around the room while Chloe made notes. They didn’t stay long.


Thursday 9th March 1989   Home Visit 12:44

Tim's Friend, Fred










Tim’s friend, Fred, had come to see him. He was sitting by the bed, laughing loudly, when we arrived. Fred was holding a half empty bottle of cider and was already tipsy. He jumped up and approached Zoe and Chloe unsteadily and with an overfamiliar friendliness that made them both nervous. His speech was slurred. “Hallo, ladies.”

He turned to me and shook my hand crookedly.
“Don’t worry about my liver, Doc. It’s fine.” Fred patted his stomach to demonstrate that he was in good shape.
“Right, I better go and leave you experts to it.” He swayed slightly as he left.

Tim was feeling a little better. I think Fred had cheered him up. His Mum was very pleased to report that he had eaten half a ham sandwich for lunch.

Beer for breakfast.

Thursday 2nd March 1989   Home Visit 13:02

Tim1 remake (2)










It was another home visit with the medical students. Tim was 37 years old. My Dad said that he was dying of liver failure. His skin was yellow. He was weak. He needed to use a Zimmer frame to walk across his bedroom. Getting to the toilet was a struggle.

Tim had no appetite. He woke up feeling sick. He usually managed a few sips of beer for breakfast and, maybe, some toast later on. The alcohol stopped him shaking and seemed to settle his stomach. He wasn’t drinking much now, nowhere near as much as he used to.

My Dad said that his liver was damaged beyond repair.  It was shrunken and scarred. His spleen had been caught up in the process and was congested.  His abdomen was distended with fluid. Both his legs were swollen. There were bruises scattered all over them.

We had been called out to Tim in a hurry. He had vomited blood. His mother watched anxiously as my Dad examined him.

“You are probably bleeding from the veins in your gullet, again,” my Dad said. Tim nodded. He did not want to go into hospital and there did not seem much point in sending him back. He knew it would only buy him a few days.

They had to get the headmaster.

Thursday 23rd February 1989   Morning surgery 09:30

My Dad explained to us that tummy pain is often caused by constipation in small children.
“I am always surprised,” he said, “by the number of these children who are constipated and even more surprised by the fact that their parents hardly ever realise.”

“Right, Mrs Green, Dafydd has got this tummy pain again. Could he be constipated?”
“Not really, doctor.”

My Dad looked thoughtfully at Dafydd and rubbed his chin.

“Mmm . . . does he have to push when he goes for a poo?”
“I don’t think so, doctor.” Mrs Green shook her head.
“I do, Mum.”

“Mmm . . . is it painful when he has a poo?”
“He never complains, doctor.”
“It does hurt, Mum, and sometimes it is really painful.”

“Mmm . . . Does he pass big, hard stools?”
“Certainly not, Dr Desmond.” Mrs Green look horrified.
“I do, Mum. Last Friday, I had a massive poo in school. It blocked the toilet and they had to get the headmaster.”

A ruptured achilles tendon.

Thursday 16th February 1989   Morning surgery 10:20

My Dad was pretty pleased with himself today. He diagnosed a ruptured Achilles tendon. To top it all, they had missed it in casualty. They thought the patient had a sprained ankle. The man had only come in for a sick note but he said his ankle was still quite painful. He had been walking across the road when it happened. He felt something snap: in fact, he heard it.
My Dad turned to Zoe, Chloe and me. “I think that we better check this chap’s Achilles tendon. An Achilles rupture is a frequently missed diagnosis.”
He made the patient get up on the couch and lie down on his tummy with his feet hanging over the end. “The Achilles tendon runs from the back of the heel up into the calf muscle. It is the strongest tendon in the body.”
My Dad felt very carefully along the length of the tendon. About two inches above the heel, there was a dent that you could fit the tip of your finger in. “There,” said my Dad. “That’s where it is torn.” He made us all feel the tendon. “Now,” he continued, “we will confirm the diagnosis.”
He squeezed the man’s calf firmly to make his foot move upwards. Hardly anything happened. He compared it with the other side. There was quite a big difference.
“Well,” he said. “You will have to go back to casualty, I am afraid. This is definitely a ruptured Achilles tendon. I will write a letter for you to take with you.”

My Dad usually hated writing letters but I could see how much he enjoyed this one. He signed it with a real flourish. He handed it to the patient and gave him a congratulatory slap on the back as if they were a successful team who had got one up on the emergency department.

My best asthma attack.

Thursday 9th February 1989   At home 21:05

“Here’s another interesting story, Daphne.” Dad was reading the local paper. Mum did not look up from her magazine.
“Last Friday, 9 year old Peter Burgess was admitted to hospital with an acute attack of asthma. There were no emergency ambulances available and he had to be flown in by helicopter. When they arrived at the hospital, Peter climbed down from the cockpit with a big smile on his face. He told the nurse that he was already feeling better.” My Dad smiled.

“Peter was discharged home three days later. When he went back to school, he told all his friends that this had been his best asthma attack, ever.”

Perfect teeth.

Thursday 2nd February 1989   Morning surgery 10:59

My Dad had just finished dealing with another sore throat.
“What did you notice about Mrs Wynne, Dennis?”
“She had a normal sore throat.”
“Yes, obviously. Was there anything else?”
“Her glands were swollen?”
“Not really. I didn’t mean that.” My Dad waited for my next answer.
“I don’t remember anything else.”
“You have got to learn to be more observant, Dennis. Didn’t you notice Mrs Wynne’s teeth? She has perfect teeth. Two sets of perfect teeth. She is married to Richard Wynne, the dentist.”
I suppose she did have rather noticeable teeth but I wasn’t going to say anything.

“Dennis, I often wonder if Mr Wynne, the dentist, married Mrs Wynne because she’s got perfect teeth or if she’s got perfect teeth because she married Mr Wynne.” My Dad chuckled to himself. He seemed to think that this was very funny.

Lady doctors.

Thursday 26th January 1989   Morning coffee break 11:50

“One of the best things about lady doctors is that they can actually feel their patients’ symptoms.” Zoe, Chloe and Dr Lois pricked up their ears when they heard this.
“If a patient is describing a pain,” my Dad continued, “the lady doctor will feel exactly the same pain in exactly the same place. She will probably bite her lip or wince. You might see a tear in the corner of her eye. This means that the lady doctor can understand exactly what her patient is going through. It must be so much easier to make a diagnosis and prescribe treatment!”
My Dad paused and took a sip of his coffee.
“That’s why lady doctors are so good, Dennis.”
I couldn’t help glancing at Dr Lois when he said this.

“The fact is,” my Dad continued, “if a patient is describing a pain to me, I might be thinking about something completely different.”

Bread from the supermarket.

Saturday 14th January 1989   09:03

On a Saturday morning, Dad likes to go to the baker’s for fresh bread. If we get there at about 9 o’clock, the loaves are still warm.
He used to send me into the shop while he waited in the car, otherwise it meant at least one consultation. Mrs Brenda Evans, who worked behind the counter, always had something wrong with her although, as she pointed out, she never actually went to the doctor. Any customers waiting to be served usually remembered that they had a terrible symptom that needed urgent discussion as soon as they saw my Dad.
Of course, now I was working in the surgery, I couldn’t go in so we had had to start taking Declan. He complained all the way there and insisted on having an iced bun, a custard slice or a cream doughnut as compensation. Occasionally, if he was in a savoury mood, he would have a sausage roll.
Despite Declan’s protestations, our strategy worked well until this morning when Miss Nellie Jones (a customer in the queue) showed him her varicose veins. He is at that sensitive age where he does not like old, bare flesh and he rushed out immediately.

That’s why we had to go and buy our bread from the supermarket.


Thursday 12th January 1989  Morning surgery 10:20

“Hang on, Mrs Vaughan! Can I stop you, there?”
Mrs Vaughan gave my Dad a stern look.
“I would like to bring the medical students in.” He turned to Zoe and Chloe. “Here, we have a 73 year old lady who noticed a shower of floaters affecting her left eye. She’s never had anything similar previously. Now, what would be your main worry in a patient with these symptoms?”
“A detach . . .”
“Mrs Vaughan! Give Zoe and Chloe a chance.”
“A detached retina, Dr Dennis.” Zoe and Chloe answered simultaneously. Mrs Vaughan raised her eyebrows disdainfully.
“Excellent! Excellent! Now, in a situation like this, there are three questions that I usually like to ask the patient. We will go through them one at a time. Let’s see if we can get them all. Zoe, what would you like to ask Mrs Vaughan?”
“Have you had a knock on the head, Mrs Vaughan?”
“No, I haven’t.”
“Excellent, Zoe! Excellent!” My Dad nodded enthusiastically. “ What about you, Chloe? What would you like to ask?”
“Were there flashing lights when you had the floaters, Mrs Vaughan?”
“No, there weren’t.”
“Excellent, Chloe! Excellent! That’s very good. What about you, Dennis? What question would you like to ask?”
“Errm . . .  errm . . .  did you see . . . like a shadow . . . something like a grey shadow or a curtain across your eyes, Mrs Vaughan?”
“No, Dennis, that’s very, very good but I didn’t see anything like that.”
“Well done, Dennis. What about you, Mrs Vaughan?” My Dad continued. “What would you like to know? Are there any supplementary questions that you would like to ask our patient?”
“Yes, Dr Dennis, yes, there are. I would want to know if the patient was extremely short sighted or if she was suffering from diabetes.”
“Yes, that’s exactly what I would have asked, Mrs Vaughan. And are you?”
“Am I what, doctor?”
“Are you very short sighted or are you suffering from diabetes?”
“No . . .  No . . .  of course not, Dr Dennis. You know that.”

“Right . . . to sum up then,” my Dad took a deep breath. “A retinal detachment can be caused by a knock on the head. The patient’s symptoms usually consist of flashing lights, floaters and, sometimes, the appearance of a grey curtain. Retinal detachment is, as Mrs Vaughan has pointed out, more common in patients with severe short sight or diabetes.

Now, we need to look into Mrs Vaughan’s eyes with the ophthalmoscope. I am afraid this is a tricky business, even for a GP like myself with years of experience. The detachment usually occurs at the edge of the retina. Where the retina has been lifted up it is usually a pale grey rather than a nice pink colour which is why we see Dennis’ grey curtain.

Trying to look into the back of Mrs Vaughan’s eyes was a difficult and time consuming process. By the time all four of us had attempted to do this, she was in a distressed and dazzled state. Fortunately, she did not have a detached retina.

Side effects.

Thursday 5th January 1989  Morning surgery 11:17

“Doctor, I’ve got terrible side effects with these new tablets! I am itching all over. My lips feel swollen and my throat. My husband says my eyes are puffy. I feel sick. I could hardly eat my breakfast and I am sure I am going to have terrible diarrhoea.”
My Dad nodded his head and rubbed his chin thoughtfully. “To be honest, Mrs Wallis, I would be more concerned if you weren’t having side effects. At least you know that I have given you a good, strong tablet and that it is doing it’s job.”


A hopeless match.

Tuesday 27th December 1988  Portmere vs. Flint Town 16:15

It should have been an easy win. It was a home game against Flint Town who were second from bottom in the league.

Declan and I wanted to relax but Dad decided to come and help us watch the match from a medical perspective.

Because it was just two days after Christmas, our players were a bit thin on the ground. Half the squad had not turned up and those that had looked under the weather. We did not even have a sub. By the time our Portmere players limped off at half-time, they were losing 1:0.

Without moving from his seat in the stand, Dad had cleverly diagnosed a tweaked hamstring, two torn cartilages, a mild case of concussion and a fractured metatarsal.

The second half was as uninspiring as the first. There wasn’t a single shot on target and no more injuries. We sat dejectedly in the rain until the final whistle.

“If you ask me they are all depressed,” said Declan as the Portmere players shuffled despondently back to the changing room.
I think he was right.

Compression hoisery.

Saturday 24th December 1988  Christmas Eve 23.00

Mum doesn’t like stockings and she refuses to cut a good pair of tights in half. Every year, Dad brings home some compression hosiery for Declan and I to use. Usually, we each get a medium, class 3, thigh length stocking with a standard sock and open toes.

Class 3 compression stockings seem to suit our Santa. They are so tight that you can’t get much into them and certainly no large items. Unfortunately, the open toes mean that the apple and the orange always end up on the floor.

Odd socks.

Thursday 22nd December 1988  Morning surgery 10.00.

My Dad had always expected to marry a woman who darned socks.  Dad’s Mum, my grandmother, darned socks. Dad’s own grandmother darned socks. Mum never darns socks. If Dad’s socks are beginning to fall apart, she throws them away and buys a new pack from the market. If she is in a bad mood, she makes Dad buy his own. Dad is quite philosophical about it.

“I suppose it comes as part of a thoroughly modern marriage,” he said to Mrs Vaughan. She had noticed he was wearing odd socks. He hadn’t had time to go to the market and had done the best he could with two old pairs.

An enlarged prostate.

Thursday 15th December 1988  Morning surgery 09.38.

We saw a man who couldn’t have a wee. He had struggled to go on Monday and Tuesday. Since Wednesday night, he hadn’t managed to pass a single drop. He was bursting. He said it was agony. He couldn’t keep still. He was pacing around and sweating.
My Dad explained that he had an enlarged prostate. This was blocking his bladder. He would have to go into hospital for a catheter.
A catheter is a small tube. It is passed through your penis (willy) into your bladder. It helps empty the bladder. My Dad said he would feel better as soon as it was done.

Imagine having an enlarged prostate and having to have a catheter. I couldn’t bear it.


Thursday 8th December 1988  Home visit 12.36.

Zoe, Chloe, my Dad and I were called to see a woman with severe vertigo. When we arrived at the house we found her lying face down in the hall. If she moved her head, even a few millimetres, the room would whirl and she would feel really sick. She had already vomited five times.
Her right ear felt blocked and was buzzing loudly.
Every so often, she groaned and said she wanted to die.
My Dad could not examine her properly. He looked into her right ear and checked her blood pressure.
He gave her an injection into her leg, promised that she would feel a lot better in an hour and off we went.

Laughing gas.

Thursday 1st December 1988  Wart clinic 16.15.

Mrs Vaughan had a large wart on her arm. As I started to freeze it, she began to giggle.
“Are you alright, Mrs Vaughan?”
“Of course, Dennis.” She laughed.
The more I continued the treatment, the more she laughed.
“Are you sure that you’re alright?”
“Yes, it’s that laughing gas.”
My Dad groaned. “This isn’t laughing gas, Mrs Vaughan. It’s liquid nitrogen. Laughing gas is nitrous oxide. They are both completely different.”
“Well, it’s exactly the same as the laughing gas I had in hospital when I had the boys. I had it both times that I was in labour.”
“It’s not the same. Liquid nitrogen would not make you laugh. In fact, it hurts.”
“Some of it must be being oxidised. It’s probably the way young Dennis is spraying it around.”  Mrs Vaughan started giggling again. “I wouldn’t be laughing for no reason.”

It’s just a normal sore throat.

Thursday 24th November 1988  Morning surgery 09.30.

“It’s just a normal sore throat.” My Dad, Zoe, Chloe and I had all had a look at Michael’s tonsils.
“What do you mean? A normal sore throat?”
“Well, Mrs Morris. It is just a normal sore throat. It’s not tonsillitis. It will get better on it’s own.”
“Last time I brought Michael, you said that tonsillitis would get better on it’s own.”
“Yes, it usually does. A normal sore throat and tonsillitis usually get better on their own.”
“Does that mean a normal sore throat and tonsillitis are the same thing.”
“Mmm . . . no, it doesn’t. Tonsillitis is worse than a normal sore throat.”
Mrs Morris looked perturbed. “Is the sore throat you’ve got now worse than the tonsillitis you had last time, Michael?”
“Yes, definitely.”
“I thought so.” Mrs Morris looked scornfully at my Dad. “There you are, Dr Dennis. Michael says that this sore throat is worse and you said that the last sore throat was tonsillitis. This sore throat is worse than tonsillitis.”
My Dad rubbed his chin as he considered Mrs Morris’s conclusions. He turned to Michael. “How long ago was the tonsillitis, Michael.”
“ Err . . . “
“3 months,” Mrs Morris interrupted. “It was on 15th August. We saw you at 10.37. You were running 7 minutes late.”
“I am surprised that you can remember how bad that sore throat was, Michael, if it was in August.”
“I remember it exactly, Dr Dennis.” Mrs Morris beamed at her son.”
My Dad nodded. “If you can still remember the sore throat that you had in August, it must be worse  than the sore throat you’ve  got now. I am quite sure that you won’t remember this sore throat in 3 months time, Michael.”
“Well, I think he needs antibiotics, again.” Mrs Morris felt compelled to step in.
“I am not prescribing antibiotics for a normal sore throat, Mrs Morris. I have told you that before. In a couple of weeks, Michael will have forgotten all about it.”

Zoe and Chloe.

Thursday 17th November 1988  Morning surgery 08.58.











Two medical students, Zoe and Chloe, were starting in the practice today. My Dad had obviously forgotten that they were coming. He was quite put out when he found them waiting in his consulting room.
“Hmm . . .” he snorted. “What an inconvenient surprise! I am afraid that it is extremely busy today and I won’t have time for official teaching. I suggest that you both sit quietly, watch and learn. Yes, watch and learn. If you have any questions, you can ask Dennis. He has been working here for nearly a year.”

Zoe and Chloe smiled admiringly at me. They obviously thought that I was a small but highly qualified and experienced doctor.

Diabetes in a nutshell.

Thursday 10th November 1988  Morning coffee break 11.45.

“I think that I might write a patient information leaflet, Dennis. I thought I would do one on diabetes.”
Don’t, Dad.
“They recommended it on the communications course.”
Don’t, Dad.
“It takes quite a long time to explain what diabetes is. A leaflet would be more efficient. I will call it diabetes in a nutshell.”
Don’t, Dad.

An ethical dilemma!

Thursday 3rd November 1988  Morning surgery 09.50.

We saw a Liverpool supporter today with a really bad chest infection. My Dad thought that it might even be pneumonia. I knew that he was a Liverpool supporter because he was wearing last season’s shirt and he had a bit of an annoying swagger.

I know this is unethical but I really didn’t want my Dad to give him antibiotics.

I don’t want the pink medicine.

Thursday 20th October 1988  Morning surgery 11.00.

“I don’t want the pink one. I don’t want the pink one.” My Dad’s consulting room door flew open and little Terry Turner charged in. He saw my Dad and me, stopped dead in his tracks and burst into tears.
“I don’t want the pink one, Dr Dennis.”
Mrs Turner appeared. She struggled in holding a baby, two large carrier bags of shopping, Terry’s coat, the baby’s bottle, a plastic fire engine and an umbrella. She sat down and sighed with relief.
“I’m sorry, doctor. He doesn’t want the pink antibiotic medicine. He will only take the yellow one.”
“He doesn’t look as if he needs an antibiotic to me,” my Dad said. Terry peered at him through clenched fists.
“I think he does, doctor. He is very chesty again.”
After Terry had stopped crying, my Dad and I both listened to his chest.
“Sounds crystal clear to me, Dennis?”
I nodded. My Dad thought using me for a second opinion was very clever.
“I am very glad to say you don’t need any medicine at all, Terry.”
Terry howled again. “I want the yellow medicine. Mum promised.”
“I did say that, if he was a good boy, you would give him the yellow medicine. Maybe there is a yellow cough medicine he could have.”
“I am afraid all the cough medicines are pink, Mrs Turner.”
“I don’t want the pink one. I don’t want the pink one.”

Compulsory, military style training for all those junior doctors.

Sunday 16th October 1988  After breakfast 10.12.

On a Sunday morning, after breakfast, my Dad likes to look through the papers. He reads out interesting stories to Mum. Of course, she finds this annoying.
“Listen to this, Daphne. The health minister is going to introduce compulsory, military style training for all those junior doctors. He thinks that they need to toughen up. Apparently, large numbers are going off sick with anxiety and depression. They are having panic attacks at work and waking up in the middle of the night in their on-call rooms after terrible nightmares. Several have been found locked in the ward toilets with their bleeps switched off.”
Mum frowned. She glanced back down at her Sunday supplement.
“On Saturday 6th August at 03:00 hours, Dr Adam Allen, deserted his post and left the emergency department of Kings College Hospital without any medical cover.”
“Without any medical cover, Desmond?” Do you mean that he was the only doctor working in the department?” Mum was horrified.
“It looks like it.”
“But, that’s one of the busiest emergency departments in the country!”
“Yes, it does seem surprising. Maybe, the reporter has got his facts wrong. Anyway, Dr Allen was found, three days later, hiding in his parents’ coal bunker. He was still shaking uncontrollably when they dragged him out. They could not get any sense out of him. He just kept repeating the name of one of his patients: someone who had died after a motorcycle crash.”

“The problem, Desmond, is that, these days, the medical schools select applicants who are too sensitive and caring. I have always said that that was wrong.”
“When I applied to medical school, you just had to be good at rugby.”
“Well, you weren’t any good at any sports, Desmond.”
“No, but my Dad was a doctor.”
“He wasn’t a medical doctor.”
“No, I never said he was. I wrote in my personal statement: Dr Deiniol Dennis has a special interest in the development of the human nervous system. No one ever checked up on what sort of doctor he was.”

“Anyway, the health minister has severely criticised Dr Allen. He said that he put a great number of patients’ lives at risk and that he was very fortunate that nobody died. They are planning to take further action against him. He may be struck off.”
“Perhaps he should be court martialled and face a firing squad,” said my Mum. She got up and started clearing the breakfast things.

A recliner armchair with thick, spongy cushions.

Thursday 13th October 1988  Home visit 13.08.

“I am sorry, Sister, that is completely unacceptable. Mrs Anderson is 93 years old. She spent two days on one of your trolleys last time she came into hospital. Her back was awfully painful and she developed a small pressure sore on her heel.” My Dad was trying his best not to lose his temper.

Eventually, Sister Salter rang back. My Dad spoke to her briefly.

“Right, Mrs Anderson, one of the nurses has managed to find a recliner armchair for you. It is very comfortable with thick, spongy cushions and can be tilted back at night. The only alternative is four of those orange, plastic seats: the ones that are stuck together in a row. They use them in the outpatient clinics. They thought that, if they put some blankets across them, you could stretch out. I did not think that they would be suitable so I have accepted the armchair. They are going to squeeze you into a room with a lady who is suffering from dementia. She has been a bit noisy at night but Sister Salter will ask one of the doctors to give her a sleeping tablet.”
“That will be fine, doctor. I suppose I have got to go in, again, with this chest trouble of mine.”
“I think so,” Mrs Anderson. You are going to need the oxygen again and a drip. Mind you, it sounds to me as if you will be a lot more comfortable than last time.”

Lub dup . . lub dup.

Thursday 6th October 1988  Morning surgery 09.40.

“I can hear Mrs Pryce’s heart, Dad. Lub dup . . Lub dup . .”
“Excellent, Dennis, at last. I was beginning to think that young Dennis was going to have to give up Medicine, Mrs Pryce.”
“He will be fine. He’ll be an excellent doctor, like his Dad.”
Mrs Pryce giggled and Dad smiled smugly.
My Dad took the stethoscope and listened to Mrs Pryce’s heart, himself.
“Well, Mrs Pryce,” he said, “You have the clearest, crispest heart sounds that I have heard for a long time. You must be in tip top condition.”
Mrs Pryce purred.
“Would you mind if I ask you to come in from time to time, to let the medical students have a listen.”
“Of course not, Desmond. I would love to help out.”

Very high blood pressure.

Thursday 29th September 1988  Morning surgery 11.20.

I am glad to say that my Dad seems to have forgotten that he ever went on the communication course. He is back working on his usual need to know basis.

“Look, Mr Hutton, this blood pressure of yours is really very high. I have written a prescription for you. If you don’t take these tablets, you are going to have a stroke.”

High blood pressure.

Thursday 29th September 1988  Morning surgery 10.20.

My Dad has just been on a communication course and decided he was going to try to explain the meaning of high blood pressure to one of his patients. “If someone’s understands exactly what their medical condition is, Dennis, they are much more likely to follow our advice.”
“Yes, Dad.”
He used his ‘central heating analogy’ and got into a right muddle. He was going on about leaky radiators, burst pipes and irreversible pump damage. By the time he had finished, Mrs Wisley seemed completely confused. I was squirming with embarrassment.

Mum always sets our central heating timer, anyway.

Packed full of hard, greenish-brown wax.

Thursday 22nd September 1988  Morning coffee break 11.45.

Dr Lois Lewis










It was Dr Lois Lewis who discovered what was wrong with Dad’s stethoscope. Both earpieces were packed full of hard, greenish-brown wax.
“It must have been here for 2 or 3 years, Dennis. I am surprised your Dad could hear anything.”
It took her 20 minutes to dig it all out.
“There we are. It should be fine, now.”


Thursday 15th September 1988  Morning surgery 11.20.

We had a really awkward consultation today. A woman came in and started telling us about her periods. I went bright red and felt sick. I thought that my Dad handled it really well.
“Stop right there!” he said. “I am afraid that this is not really my area of expertise. I want you to make an appointment to see Dr Lois Lewis tomorrow. She knows everything there is to know about periods.”


Tuesday 30th August 1988  Breakfast 10.00.

Mrs V's holiday








Dad always makes the most of his Greek, buffet breakfast. Today, he has chosen Greek yogurt with honey, a peach, slices of salami and ham, soft goat’s cheese, two gherkins, some very crisp bacon, two saveloys, a rectangle of scrambled egg, a mini Danish pastry and a slice of fruit cake.

As usual, he is the last to come down. Mum is already halfway through her cereal. “They are bringing a fresh jug of coffee, Desmond.”
Declan has six pancakes on his plate with chocolate sauce and syrup. “Kostas was looking for you, Dad.”
“Yes,” Mum continues. “He is asking if you can see a patient after breakfast. They think she has severe sunstroke. Apparently, she has asked for you personally.”

30,000 feet.

Saturday 20th August 1988  German air space 13.31

Is there a doctor on board?
“Go on, Dennis. You go.” Declan sniggered and I elbowed him firmly in the ribs.
Dad did not react. He seemed completely absorbed in his book.
Is there a doctor on board?
Mum looked over at Dad and sighed. She folded her tray and started to get up. After all, Mum deals with most of our domestic emergencies.
“Stand clear, please, stand clear.” There was a commotion behind us and a young man came rushing down the aisle.
“Let me get through, please! Let me get through!”
He arrived breathlessly at the front of the plane and announced himself to the steward. “Dr Colin Morgan MBBCh (Cardiff) MRCP (London) . . .  consultant at St George’s Hospital . . . it looks like a heart attack?”
Mum was fascinated by this handsome, dashing, dynamic doctor. Dad groaned.
“Has anyone got an aspirin . . . we need 300mg . . . that’s one adult tablet . . .  what about oxygen . . . where’s the oxygen . . . let’s clear these seats . . . we need some space . . . someone must have a GTN spray . . . there must be a passenger here who suffers from angina . . . get me an angina spray . . .”
An angina spray arrived from a man near us. Dr Morgan took a deep breath, opened his mouth and sprayed a dose onto his tongue.
“Right, that’s better . . . where’s that oxygen . . . let’s get the oxygen . . . we don’t want this gentleman to die on us .. . . just relax, Sir . . . we will need to land the plane . . we must get him to hospital  . . . we need to divert the flight  . . . get the pilot to make an emergency landing . . . a crash landing, if he has to . . . “

Dad groaned again. He put down his book and shut his eyes. There was going to be a long delay before we got to Greece. He would probably have to miss his late afternoon swim.

My last post?

Wednesday 17th August 1988  Morning coffee break 11.45

This will probably be my last day of work experience. On Saturday, we are all going on holiday to Greece. Mum says it will do me and Dad good to have two whole weeks where we don’t have to worry about our patients.

Then, of course, I need to pick the right moment. I suppose it should be a day when Dad has spent the afternoon relaxing on his sunbed by the pool. I will offer to go and get him his usual bottle of Mythos.
I will tell him how much I have enjoyed being in the practice. I have seen a lot. There is no doubt about that. It has been far more interesting than I thought.
I will explain that I need to concentrate on my schoolwork. I have got exams before Christmas. I will need to do course work and revise on Wednesday mornings. I would have preferred to come in for a few more weeks but . . .

Hay fever.

Wednesday 10th August 1988  Morning surgery 10.35.

“Dr Dennis, this hay fever is unbearable!”
“Come on, Melvyn. I would never describe hay fever as unbearable. In fact, I am not sure why you have come to see me. Most of my colleagues in the profession don’t consider hay fever an illness. I suppose we would regard it more as an inconvenience.”
“Well, this hay fever is unbearable! I can’t stop sneezing. My nose keeps running. My eyes won’t stop watering. My throat is itching. I am on double doses of antihistamines. I am using my nasal spray six times a day and my eye drops every hour.” Melvyn looked thoroughly miserable.
“Look!” He held up a carrier bag full of paper tissues. “I have used all of these in the last two hours.”
Melvyn’s hay fever did look unbearable to me. His nose was red and sore. His eyes were swollen.
“Listen, Melvyn,” said my Dad, “I will admit that it is a very bad case but I cannot use the word unbearable, not where hay fever is concerned.”
Melvyn shook his head. He took a wet tissue out of his bag. “I’m having to reuse my paper hankies. I haven’t got any dry ones left. This is intolerable, Dr Dennis!”
“It is very bad,” said my Dad reluctantly.
Melvyn sneezed, missed his hankie and sprayed us both with mucous.
“Well, I think it is intolerable,” I said, wiping my eyes.
My Dad nodded his head. “Alright Melvyn, you have convinced me. We will give you the hay fever injection again, this year.”

My sprained ankle.

Monday 1st August 1988  Morning surgery 09.55.

I really like Dr Lois Lewis.
My dad had asked her to look at my ankle. I had sprained it playing football.
To start with, she was shocked at how bruised it was. She said that I was very brave. She was surprised to hear that I was still planning to come to work on Wednesday. I had hoped she would offer to give me a sick note but she bandaged it so enthusiastically and was so reassuring that I didn’t like to ask for one.

Aortic stenosis.

Wednesday 27th July 1988  Morning surgery 11.10.

“Dennis, it is a classic case of aortic stenosis.”
“I can’t hear it, Dad.”
My Dad took a deep breath and raised his eyebrows. “It is one of the easiest heart murmurs to hear, Dennis. This one is very loud . . . Oh! Don’t worry, Mr Turnbull. A loud murmur does not mean that it’s worse: not usually.”

My Dad cocked his head to one side, concentrating. “There, I can just make it out without my stethoscope. Try again.” Mr Turnbull looked really worried, now.
I still couldn’t hear anything.
My Dad smiled at Mr Turnbull. “These youngsters listen to too much loud music. It affects their hearing.”
“There’s nothing wrong with my hearing, Dad!” I passed the stethoscope angrily back to him and stuck my hands in my pockets.

By the way, aortic stenosis means that one of the most important heart valves is damaged. It is narrowed and just lets a squirt of blood through each time the heart pumps. A heart murmur is the sound made by a damaged heart valve. You can usually hear it with the stethoscope.

Housemaid’s knee.

Wednesday 20th July 1988  Morning surgery 10.30.

Mrs Vaughan knee (1)










“I don’t think that you should keep looking these things up, Mrs Vaughan.” My Dad had just finished examining Mrs Vaughan’s knee.
“Why not, doctor? It must be a help for you if I have already done half the work. I know the latest treatment for a torn cartilage.” She looked at me and smiled, suspecting correctly that I didn’t know much about torn cartilages.
“You haven’t got a torn cartilage. You’ve got housemaid’s knee. But it isn’t that. You know that you’ll only worry. You’ll pick out the worst possible cause for your symptoms.”
“I can always come to you for reassurance.”
“But you never believe me.”
“Only if my book says something different. Housemaid’s knee, for instance, is quite red and hot. My knee isn’t at all hot or red. I think it’s a torn cartilage: swollen but not hot or red.”

A weekend on call.

Saturday 9th July 1988   Lunchtime 13.00.
My Dad hates weekends on call. Once a month he works all day Friday, all day Saturday and all day Sunday. My Mum says it makes him bad tempered. He is alright during the day but he gets very annoyed if he is woken up at night. Once he has finished speaking to the patient on the ‘phone, he starts to swear under his breath: quite rude things. He will swear repeatedly while he gets dressed and continue as he goes downstairs. He swears in the car, all the way to the patient’s house. Once he gets there he is, apparently, a bit calmer and usually manages to avoid being nasty.

On the way home, he has a bit of an adrenaline buzz. He will play one of his CDs very loudly and swerve the car from side to side.

The adrenaline keeps him awake after he gets back into bed.

A job in Ashbury Lodge?

Wednesday 6th July 1988   Morning coffee break 11:45.
“You must apply for a job in Ashbury Lodge, Dennis.”
“Dad, I am not going to work in a nursing home.”
“You’ve got to do some voluntary work if you want to get into medical school.”
“I wouldn’t work there if you paid me. I am certainly not going to do voluntary work.”
“Dennis, everyone does it. It is to show that you are a caring person.”
“Mum is a caring person. She wouldn’t work if she didn’t get paid.”
“Mum is a qualified nurse, Dennis. That’s different.”
“What about Johnny Johnson? He couldn’t care less about anyone. In fact, he is always laughing about that old, disabled supply teacher in school. He leaves his bag in the corridor to trip her up. He is just working in Ashbury Lodge so he can get into medical school. That’s the only reason. I am not going to do that.”

A healthy plate.

Wednesday 29th June 1988   Practice nurse clinic 10:00.
I am sitting in with Janet, the practice nurse, today. Our first patient is a very overweight lady. Janet shows her a picture of a healthy plate; a neatly arranged plate of wholesome foods with plenty of even healthier empty space. Whilst Janet is explaining how tasty cucumber and tomatoes can be, the patient winks at me. We have both realised that there is more than enough room for two large handfuls of chunky chips and a dollop of cheesy mayonnaise.

He had forgotten his wife’s cousin’s birthday.

Wednesday 22nd June 1988   Morning surgery 10:40.
Today, we saw a man who was worried about his memory. He spent 10 minutes (a whole appointment) telling us everything he had forgotten in the last 3 days. He had started by forgetting to hang his towel on the radiator after his shower. He had left it on the floor by his bed. I didn’t mention that I often do the same because my Dad prefers me to sit quietly when I am in surgery. He couldn’t remember if he was on page 235 or page 238 of ‘Great Expectations’. He said he was one of those people who won’t turn the page corners down. He had forgotten that his wife’s cousin’s birthday was on 23rd of May. He had bought her an expensive, silver brooch last year so he was very surprised that it had slipped his mind this year. Then, he had been trying so hard to remember whether his wife wanted porridge, as usual, for breakfast or tropical muesli, that he had burnt his own toast.
Anyway, those are just a few examples of what we had to listen to. I could sense that my Dad was getting more and more impatient.
At last, he finished. My Dad shook his head, and then made a show of looking at his watch.
“Look, Mr Wilson,” he said, “I don’t think that you’ve got too much to worry about. Come and see me again when you can’t remember what you have forgotten.”

I find it very irritating.

Wednesday 15th June 1988   Morning surgery 09:40.
“My name is not Dr Desmond, Mrs Parry. It’s Dr Dennis, Dr Desmond Dennis.”
“I am sorry, doctor.”
“Yes, people often call me Dr Desmond and I find it very irritating. It’s because I have got two first names, of course, and no proper surname.”
“Of course, doctor.”
“That’s why we decided to call Dennis, Dennis Dennis. We wanted to make sure that he never had the same problem.”

Happy birthday, Dennis!

Tuesday 14th June 1988   After dinner 20:15.










Today is my fourteenth birthday. I had asked my Dad for a typewriter but he bought me an auriscope. Declan got me a box of wooden tongue depressors!! Mum gave me a shirt and tie.
“You need to look smart for your patients, Dennis.”
At least I had a black, moleskin journal from Dr Lois Lewis, and a pen.

I really don’t like piles.

Sunday 12th June 1988   After dinner 19:30.
I told my Dad that I thought I had piles. He just laughed.
“Dennis,” he said. “Doctors in training always think that they have got terrible illnesses. I thought that I had had a stroke on my very first day in medical school. In fact, it was just a bad migraine. I sent myself into hospital three times during the first term with suspected appendicitis. Then, at the end of the year, I had a full blown heart attack only it didn’t show up on any of the tests. I am afraid to say that, at one point, I even thought I had a twisted ovarian cyst. That shows you how stupid I was.”

I don’t like piles.

Wednesday 8th June 1988   Morning surgery 10:25.
I don’t like piles. One of my teachers came in today and, as it turned out, he was suffering from piles. After my Dad examined him, he insisted that I had a look. He said it would be good experience for me. I don’t think that it was a good experience for me or my teacher. I won’t be able to look him in the eye when we have our next chemistry lesson.

Confidentiality is pretty important as far as piles are concerned.

Another case of indigestion.

Wednesday 1st June 1988   Morning coffee break 11:45.
My Dad has just seen another man with indigestion. We were all very concerned. The practice manager rang up halfway through the consultation to check that everything was alright. The nurse popped in at the end and insisted on doing an ECG. My Dad tried to resist this but the nurse was adamant.
This time, I don’t think that there was any doubt that the diagnosis was indigestion. It was obvious; even to me.

The nurse rang the patient later that evening. Everyone was relieved when she reported that he was fine.

They wouldn’t let anything like that happen.

Wednesday 25th May 1988   Morning surgery 09:50.
“Hallo, Mr Rhys. How are you?”
“I’m fine, Doctor. You wanted to check my blood pressure.”
“Yes, I did, didn’t I? How is Mrs Rhys?”
“She is improving. She’s not bad at all. The ambulance is very comfortable.”
“The ambulance! What do you mean?” My Dad picked up his mug and took a sip of his tea.
“She’s still in the ambulance.”
“She is still in the ambulance?” My Dad coughed and spluttered. “Has she been there since I sent her in on Friday?”
“Steady on, Dr Dennis. She is alright. It’s a new thing they are trying. You said yourself how short of beds they are.”
My Dad put his tea down.
“They’ve got five patients parked outside Casualty. They have all got their own ambulance. Mr Bacon has been there for over a week. I pop in to see him. He’s got no family.”
My Dad smiled grimly.
“Mrs Rhys is very well looked after,” Mr Rhys continued. “Of course, the two ambulance men are there all the time.”
“Of course.” My Dad repeated quietly.
“One of the nurses from Casualty usually visits twice a day. The consultant is coming tomorrow. He is going around all the ambulances.”
My Dad nodded. His face was beginning to go red.
“They have said that, if she continues to improve, they will take her for a little drive on Friday. She is really looking forward to that. Obviously, it’s ideal when she wants to go home.”
“Ideal?” I don’t think my Dad was concentrating. His face had gone from red to crimson. He had picked up a wooden tongue depressor  and was tapping it irritably on his desk.
“Well, yes, she is already in the ambulance.”
“Of course,” said my Dad.
“The only problem,” said Mr Rhys, “is when they need another ambulance.”
“What do they do then?”
Mr Rhys looked embarrassed. His face flushed but not as much as my Dad’s. “I don’t know. I didn’t like to ask, really. I hope no one’s died because of my wife.”
“Of course not, Robert,” my Dad snapped. “They wouldn’t let anything like that happen.” He broke the tongue depressor in half and threw it at the bin.
“No, anyway, she’s doing well. Apparently, it was just a minor heart attack.”

My Dad forgot to check Mr Rhys’ blood pressure and Mr Rhys forgot to remind him.

A huge, angry boil.

Saturday 21st May 1988   Portmere vs. Welshpool 14:30.

Portmere vs Welshpool










It was Portmere’s final game of the season. A tough home fixture against Welshpool. Declan and I settled into our seats. I always enjoyed those last few moments before the match started.

In front of me were two bald men. One had the name, Phil, tattooed on his neck. He turned towards me, stared and then snarled. “Here, Alun. I thought it was him. It’s that new doctor I told you about.”
Alun gave me an equally unfriendly look.
“I had to see him with the nurse on Wednesday. He wouldn’t give me antibiotics. He said a cream would do.” Phil turned right round. On the left side of his nose was a huge, angry boil. It had a glistening, yellow top that looked ready to explode.
“You made a bit of a mistake there, didn’t you Doc? Can you see how big it is, now? I told you I needed antibiotics.”
I went bright red. Declan sniggered.
“You can watch yourself too, my little mate. I don’t suppose the Doc’s got any idea how to treat a black eye, either.”
As soon as the two men turned away, Declan disappeared.

Portmere won 3:1 but I did not really enjoy the game.


Is he dead, Dennis?

Sunday 15th May 1988   After dinner 19:00.
“Is he dead, Dennis?” My Dad was getting impatient.
Declan frowned.
“Of course not, Dad. He’s fine.” I pressed the stethoscope more firmly against Declan’s chest.
“Well, if he’s not dead, you must be able to hear his heart.”
“I can’t.”
“Listen carefully, Dennis. Lub dup . . Lub dup . . Lub dup . .”
“I can’t hear it, Dad.”
“Hold your breath, Declan. Is that any better? Lub dup . . Lub dup . . Lub dup . .”
“No. Maybe, it’s this old stethoscope of yours, Dad.”
“My stethoscope is fine, Dennis. I have been using it for years. It was one of the best stethoscopes that you could buy. The fact is, some young doctors struggle with auscultation. We will just have to keep trying.”

My Dad looked at my brother and sighed. “You can breathe now, Declan.”
I am not sure whether Declan will ever learn to use his own initiative.

Dr Lois Lewis.

Wednesday 11th May 1988   Morning surgery.
I had been hoping for a day off. My Dad was going to a conference in Cardiff.
“I have arranged for you to sit in with Dr Lewis, this morning, Dennis. It will be good for you to observe the methods of a recently qualified general practitioner. You will probably find that she does things very differently from me.”

What a morning!
Dr Lois Lewis is fantastic. All the patients love her. She is so caring. She greets each patient with a bright, cheerful smile. My Dad does that occasionally but it’s a real effort.
Dr Lewis seems to understand exactly what’s wrong and she always prescribes the best treatment. She even asked one little boy which flavour medicine he preferred and rang the chemist to see what was available in ‘cherry’.


Wednesday 20th April 1988   Morning surgery 09:05.
Croup is a completely different kettle of fish.

Imagine that you are 4 years old. You have had a slight sore throat and a cough. Your voice is a bit croaky. Apart from that, you feel fine. You go to bed as usual on Tuesday night.

You wake up in the middle of the night, terrified. You can’t breathe. You sit bolt upright. You want to call your Mum but you daren’t. You cough and then you manage to suck in a gasp of air that whistles through your swollen throat. You breathe quickly. Every breath in is a concentrated effort. Breathing out is easier.

Your Mum comes running in. She must have heard something. She looks as frightened as you. She sits on the bed next to you. She tries to reassure you but you can see her tremble.
“Trefor!” Your Mum shouts.
Your Dad looks half asleep. Your Mum suggests steam and he carries you to the bathroom and runs the hot tap. It does help. Gradually your breathing settles. When you get back to bed, you manage to rest back on a couple of pillows and relax. Eventually, you drop off to sleep.

Your Mum phones the surgery first thing in the morning and insists on an emergency appointment. She packs an overnight bag for you: a pair of pyjamas, two sets of underwear and a toothbrush.

Dr Dennis chuckles as he examines your chest. “It is just a touch of croup.” He turns to your Mum. “It always seems worse than it really is. He will be better in a few days.”
“He doesn’t need to go to hospital, doctor.”
“No, he will be fine. Tonight won’t be quite as bad as last night.”
Your Mum grips the handle of your overnight bag so tightly that her fingers turn blue. You feel sick.

A happy wheezer.

Wednesday 20th April 1988   Morning surgery 09:00.
Happy wheezers are great. They are usually about 2 years old. They’re coughing. They’re puffing away. Their noses are blocked or full of mucous. Their Mums are in a panic but they sit there, smiling, as if nothing’s wrong with them. That’s why they’re called happy wheezers.

My Dad wishes all his patients could be like happy wheezers: bravely smiling through times of considerable difficulty.

How do you know it’s not sciatica?

Wednesday 13th April 1988   Morning surgery 11:45.
“How do you know it’s not sciatica, Dr Dennis, if you haven’t checked my reflexes?”
“The pain sounds muscular, Mrs Vaughan. It does not sound anything like sciatica.”
Mrs Vaughan smiled at me. “Well, let’s say I saw an enthusiastic, young doctor like Dennis and he checked my reflexes. Let’s say my right knee reflex was normal and both my ankle reflexes.”
“Yes,” said my Dad after a long pause.
“But my left knee reflex was missing. That is the same leg that I am getting this awful pain in. Would you consider sciatica, then?”
“I hope that you haven’t tried to check your own reflexes, Mrs Vaughan, or made your husband check them.”
“No, I am just speculating.”
“An absent knee reflex doesn’t necessarily mean you have sciatica. Lots of people have missing reflexes.” My Dad tried to be reassuring.
“Anyway, I thought you could check my pulses at the same time.”
“Your pulses!” My Dad looked surprised. “This pain certainly isn’t due to bad circulation.”
“No, I don’t suspect claudication, doctor, but I would like to check.”

My Dad stood up and looked at his watch. “Right, Mrs Vaughan, you get up on the couch. Dennis can check your reflexes and your pulses. It will be good practice for him. I am going for my coffee.”
“Reflexes? Pulses? Me?” I started to protest but my Dad had already gone and Mrs Vaughan was taking her shoes off.

A painful toenail.

Thursday 7th April 1988   Minor surgery 15:15.
Of course, the excision of the sebaceous cyst made my Dad late for the toenail resection. He hates being late and didn’t wait for the local anaesthetic to work properly!

By the way, excision means removal and resection means removal.

A difficult sebaceous cyst.

Thursday 7th April 1988   Minor surgery 14:00.
My Dad was performing minor operations this afternoon. He had a sebaceous cyst to excise from the top of someone’s head. It was about the size of a malteser. It took him an hour. A proper surgeon could have done a total hip replacement by then or made a good start on a coronary artery bypass graft.


Sunday 3rd April 1988   After dinner 19:00.
My dad has always had this big thing about confidentiality. You would think he was some sort of secret agent. He would never tell me who he had seen in the surgery, even if it was one of my best mates. He would never tell me what was wrong with anybody.
If I saw somebody limping around town and asked if they had a bad hip, he would get really annoyed. “I could lose my job if I told you that.”

Now, of course, I am on work experience and it’s all changed. He tells me everything. We usually discuss one or two patients on a Sunday evening after dinner.

An unexpected death.

Wednesday 23rd March 1988   Morning coffee break 11.45.
Yesterday, we had an unexpected death. Brian Blackwell was only 39 years old. All the staff at the surgery were very upset which is why we discussed it over coffee. My Dad had seen him on Tuesday morning and diagnosed indigestion. Mr Blackwell collapsed and died at 2 o’clock that afternoon. Dr Lewis and I thought that maybe my Dad had made a mistake, but he insisted it was indigestion. He said it was a very bad case: one of the worst he had ever seen.

I didn’t realise you could die from indigestion. My Dad reassured me that you could. He said that quite a few patients of his patients had died of indigestion over the years.

After that, every time I burped I checked my pulse.


A cough for two hours!

Wednesday 9th March 1988   Morning surgery 09.40.
My Dad is furious. He saw a patient this morning who had had a cough for two hours. He couldn’t believe it. It wasn’t a particularly bad cough. The man seemed quite put out when my Dad said he couldn’t make a diagnosis. But, he didn’t have any other symptoms to go on. The man’s nose hadn’t started running, his temperature hadn’t gone up and he wasn’t out of breath.

He coughed whilst my Dad was examining him. It sounded like a very ordinary cough.

The man had come in saying that he had a cough and, at the end of the appointment, my Dad agreed with him completely. “That’s all I can say,” he said. “You’ve got a cough.”


Wednesday 2nd March 1988   Morning surgery 10.20.
My dad is always asking people stupid questions about diarrhoea. How many times did you go today? How many times did you go yesterday? Was there much each time? Was it like water? What colour was it?

As far as I am concerned, if you have got diarrhoea you’ve got diarrhoea. That’s all I need to know.


Wednesday 24th February 1988   Morning surgery 09:40.

We saw a lady this morning with one of those small children who can’t keep still. He sat on the chair by his Mum for about 30 seconds. My Dad smiled and said Hi! The boy got off the chair and climbed up on the examination couch. He lied there and laughed, rolled off and started pumping up the blood pressure machine. He spotted the scales by the sink and jumped on those twice before turning the cold tap on and off. He came over to my Dad’s desk, picked up the telephone and started dialing. Then he was back on the chair, grabbing his Mum’s arm. She was trying to tell us about her headaches but she couldn’t concentrate and nor could we. That did not really matter as it was obvious that the cause of her headaches was running around the room and that no amount of medication was going to help them.

A bit more than a normal bladder infection.

Wednesday 10th February 1988  Morning Surgery 10:30.


Mrs Valerie Vaughan was on pins. She had just come in and was standing in front of the door which she had not closed properly.
“Take a seat, Mrs Vaughan.”
“I can’t, doctor.” Mrs Vaughan glanced at me, then turned to my Dad and whispered. “I might have to run to the toilet. I am passing water every 5 minutes. It’s really stinging.”
“Mmmm . . .”
“It’s acute cystitis,” she continued.
“A bladder infection?” I asked.
Mrs Vaughn frowned at me. “It is a bit more than a normal bladder infection, young man.”
“It is the same thing, Mrs Vaughan.” My Dad was looking at her records. “Right, last time you came to see me you had terrible headaches. How are they?”
“Fine, doctor.”
“And your heartburn?”
“Fine.” Mrs Vaughan was tapping one foot impatiently. She looked at her watch.
“Oh, and how’s that back of yours?”
“It’s fine. Look, doctor, everything is fine. Can I just have a prescription for this acute, severe cystitis?”
“Of course, Mrs Vaughan. I just wanted to check on how some of your other, recent symptoms were.” My Dad turned to me. “I always try to tie up any loose ends, Dennis.”

My Dad wrote a prescription and Mrs Vaughan hurried away, towards the toilet.

Wart clinic.

Thursday 4th February 1988   Wart clinic 15:00.
We spent the afternoon freezing warts. I love doing that. I tested the stuff out on my own hand first. A small circle of skin went white, like ice. It stung. My dad said it would probably blister tomorrow.

We treated loads of kids. My dad would hold them down while I sprayed the liquid nitrogen. Some of them cried. Some sat quietly and stared moodily at me. If they made a big fuss, my dad would explain that we didn’t need to carry on. He said that the warts would eventually disappear on their own but the mums always insisted on continuing the treatment, even if the kids were screaming.

Big white spots on her tonsils.

Wednesday 20th January 1988   Morning surgery 10:10.
A lady that we saw this morning had not really had much of a sore throat but, after she had cleaned her teeth, noticed big white spots on her tonsils. Of course, she came straight down.
My Dad and I examined her throat. It looked normal.
The patient wasn’t happy about this. My Dad pointed out that it is not easy to examine your own tonsils properly. It is almost as difficult as trying to look into your own ear. The patient did not appreciate his little joke.
In the end, we both had to examine her throat again before she would go away.

Waiting room 3.

Wednesday 13th January 1988   Waiting room 10:00.
The receptionist announced that my Dad was running late. She apologised and explained that he had been dealing with a serious emergency. She wasn’t quite sure when he would finish.
The elderly lady waved one of her sticks in the air. “I am happy to rebook tomorrow, my dear. It’s no good seeing Dr Dennis when he is running late. It will put him in a foul mood and he won’t want to listen to my problems.”
The small, pale boy with tummy ache obviously needed to see my Dad. His Mum explained this to the receptionist.
The thin, fidgety girl with long dark hair looked at her watch again. She muttered under her breath and walked out.


Waiting room 2.

Wednesday 13th January 1988   Waiting room 09:40.
The nurse appeared to be the only person working efficiently this morning. She was taking bloods, calling patients through, one after another, and greeting each with a cheerful ‘Hallo!’
My Dad’s young assistant, Dr Lois Lewis, had been seeing her first patient for over half an hour. She still hadn’t finished.
My Dad had not started surgery yet. He had three patients waiting. His 9 o’clock, the first, was an elderly lady; she had struggled slowly and unsteadily across the waiting room, leaning heavily on her two walking sticks. His second was a small, pale boy with tummy ache, sitting quietly beside his Mum. The third was a thin, fidgety lady with long dark hair who played continuously with her buttons and kept checking her watch.

Hot little children.

Wednesday 6th January 1988   Morning surgery 11:00.
“The whole population seems to think that every child needs to see a doctor every time they get a temperature. I have had enough of seeing hot, little children this week.” My Dad was looking quite hot and bothered himself. It had been a busy week.
“The parents are just worried about meningitis, Dad.”
“Your mother and I never took you or your brother to the doctor when you had a temperature, Dennis.”
“Yes but you’re a doctor, Dad, and Mum’s a nurse.”
“Well I never examined you and, in fact, your mother never actually checked your temperature.”
“You didn’t examine me, even if I was really ill?”
“I don’t think you were ever really ill, Dennis.”
“What about Declan? Is that why he had a burst appendix? Was it because you didn’t examine him?”
“No, Dennis. I have told you and your brother this lots of times. Declan had typical symptoms of food poisoning. No one would have suspected appendicitis.”

Happy New Year!

Friday 1st January 1988 13:00.
My name is Dennis Dennis. I am 13 years old. My dad is Dr Desmond Dennis. He is a family doctor. He wants me to follow in his footsteps. He says that his job is very satisfying.
I don’t really fancy becoming a doctor. I have tried to tell him, but he doesn’t listen. In fact, the more I resist, the more persuasive he becomes.
The other day, I told him that I was thinking of becoming a sports journalist and he said that he had arranged for me to spend some time in the surgery: a bit of work experience.