Monday, January 09, 2006

The Five People You Meet In Mordor


Briefish missive, hopefully more in the next few days.

Saw a kid today at SMACHEAD and he looked somehow familiar. So on the way home I stopped off at Florey (I had to do a bit of paperwork) and checked up his name on the records.

Yep, seen by me four years ago. Today a strapping lad of nineteen, with hair like Absolom and consuming much more than his recommended daily allowance of amphetamines.

But back then he was fifteen, and a much less substantial figure, and reminded me of one of the few times I have laughed when someone has told me their troubles.

He was brought in to the ED by his mother (one of those chilling examples of genetic prepotence: same red hair, same jutting chin, same 'they say I'm paranoid' outlook), having being the victim of an assault.

It was, on the face of it, a most distressing case. Young Heath had been waiting at the traffic lights on his bicycle outside the local pub, about five in the afternoon. Suddenly the doors of the Devil's Armpit flew open and a very large and angry man, whom Heath had never seen, flew out and for no reason vigorously attacked him.

A brief melee followed, during which Heath sustained a blood nose and a ringing eardrum, and at the end of which the man disappeared - fleeing the scene on the child's bicycle.

"Good Lord. Beat you up and stole your bike?" I said, peering up his nose with the auroscope*. "How terrible."

Heath nodded, and his mothers lips became even more pursed.

"Have you gone to the police?"

Mum nodded.

"Good" I said. "The guy who attacked you - did he say anything?"

"Hardly anything."

I switched orifices and peered into his ear. "What did he say?"

There was the briefest of pauses, and then the wronged child spoke up. "He said "That's my bloody bike"."

"Aah." There was a longish pause, during which Mum refused to meet my gaze. I stood back, stared at his eyes. "Right, keep your head still and follow my finger with your eyes. That's a bit of bad luck. How long had you had it? Your bike, I mean?"

"Only a couple of hours" he said, in injured tones.

"Birthday present?"

"I just found it that morning."

"Aah. Found it?"

"Yeah, abandoned..."

"Bit of good luck" I said. "Where was it?"

"Just lying in some guy's front yard. Abandoned."

There was another pause, during which I may or may not have murmured, "No further questions, your honour." Mum studied the wall, the kid looked back at me with that wide eyed (well, one wide eye, one swollen closed one) expression kids use when they want you to believe something that would tax the credulity of a cartoon animal.

"Okay, most of this is superficial bumps and bruising. You'll be a bit stiff for the next couple of days, but you should be okay."

"What about the police report?" asked his mum. "They'll need to see the notes."

"I'll document everything," I said. "Everything relevant, anyway. If the police want it, they can subpoena it. They take these kind of assaults quite seriously," I said. "Leave no stone unturned, that kind of thing. I'm sure justice will be done." Heath began to look concerned. I patted him on the shoulder.

"Don't worry," I said to him as they left. "Truth will out."

The whole "for no reason, some guy" thing reminded me of what we worked out once were the Five People You Meet In Mordor. I should point out here and now that a disproportionate number of people I meet in my work who have problems dealing with other people, or indeed problems dealing with reality, who have unreasonable expectations and non-negotiable demands, who have much to say but little to offer... many of these people are my fellow doctors.

But not all of them are, and having just spent the morning with the Demon Dentist of Fang Rock, here are my five people you will meet again and again and again at Mordor... or any sizeable Emergency Department.

Person One is, as stated, the innocent young male assault victim. As the story goes, he is engaged in some harmless or even praiseworthy pursuit: attending the opening of an art gallery, say, or helping out at an Inner Slytherin soup kitchen. Suddenly, "for no reason, some guy" leaps on him and assaults him, and he limps or flees or is carried in to see us.

It is notable that none of the assaulters, and none of the assaultees who in any way contributed to whatever violence ensued ever present to Florey.

Occasionally, of course, it's not "some guy", it's "a bunch of 'black guys'". The police have got to find this group of Aboriginals and stop them. They are giving their fellows a bad name.

So, Number One is the "Young Man Minding His Own Business When Suddenly..."

Number Two is the "Man or Woman Impervious To Reason". I saw an example of this within the last week. The teenager, hobbling out of the doors of the ED on crutches, mobile phone in one hand and cigarette in her mouth, speaking to persons unknown "Yeah, and they say it's some kind of blood clot or something...".

I.e.: Something you have now, that could conceivably kill you now, that is caused by smoking, that you are telling someone about... while smoking.

And I know stopping smoking is hard, but for Gods sake - maybe an hour or two while we wait to see if you need an embolectomy**.

There are also the "Woman Who Doesn't Understand Where Babies Come From" presenting for her eighth emergency contraception pill in three months, the "Man Who Doesn't Understand Why He Shouldn't Drive Home To Get Pyjamas On The Same Day As His Big Heart Attack" and "The Man Who Says He Will Kill Himself If He Doesn't Get Help Soon, But Not Friday Because That's Pay Day, And He's Getting A Carton. Maybe Sunday".

All this giving up smoking stuff reminds me of one of the very first patients I saw, and still one of the more unorthodox medical presentations and responses I have ever seen. We were set out to sit in on GPs ofices in the first month of medical school. Only the very best GPs volunteered for this presumably unrewarding duty, and some of the best GPs had ... unusual ways of doing things.

I was in Dr Cantharides office in an old practice in the Hills, looking and learning when a sixty year old couple brought their father/father-in-law in.

"We want you to tell Dad to give up smoking," they quivered self-righteously.

"How old is he?" said Dr Cantharides.

The old man opened his mouth but his son-in-law spoke. "Eighty-four."

"And how much does he smoke?"

"Three cigarettes a day. Every day."

I glanced over at the wizened old figure, big blue eyes downcast, and felt a flash of sympathy. Poor old bastard, it was probably his only pleasure. I looked up at Dr Cantharides.

"Mr Seymour," he said. "Eighty-four years old."

The old man nodded.

"Fought in the war, then?"

"Infantry," grinned the toothless man. "Then mechanic on the tanks for a while, up in Darwin."

"What'd you do after the war?"

"Mostly worked on the railroads. Out on the Nullarbor."

I had this brief, vivid mental image of this man, fixing tanks in the tropical heat, facing machine guns in the jungle, hammering railway spikes in the desert. Building a country and making it safe.

There was a long pause. Doctor Cantharides spoke. "Any weight loss, worsening cough, chest pain?"

"Fit as a mallee bull," said the man.

Dr Cantharides sighed, opened his mouth, closed it, turned to the children, then turned back.

"Well, sir," he said. "I have, as I am sure you are aware, a medical duty to perform here. Nicotine is an evil drug, responsible for many young lives tragically cut short, and many otherwise healthy and productive men being condemned to a life of invalidism. I feel it is my medical duty to warn you that if you keep smoking like this, you'll drastically shorten your life, and risk no longer being able to work. You may even have to accept some kind of pension."

He paused for effect, leaned forward and pointed directly at the old man's chest. "If you keep on like this, you won't see one hundred and fifty."

There was a pause while I bit my lip.

"I don't think this is a laughing matter," said the son.

"I bloody do," said Dr Cantharides. "The guy fought in the jungle, for God's sake. In fact, Mr Seymour, have this." He reached into his drawer and pulled out a cigar. "It's Cuban. Got a light.. hold on," and he started to hoke around in his drawer "I had an old lighter around here somewhere..."

Anyway, the conversation became considerably brisker after that, and in the end Dr Cantharides suggested that they may have more luck with, as he put it, "some other doctor. Somewhere else. Not here. Goodbye"

Thanks for listening,


*Source of the worst doctor joke ever:
Nurse, fetch me my auroscope!
But Doctor, I don't even know what star sign you are!

** Admittedly, pretty extreme. But it was apparently on 'House' last year, so it must be true.


Blogger Prom said...

Aren't 3, 4 and 5 the same as 2 - impervious to reason?

So we have the innocent person in Mordor and all the illogical ones as well. Got it.

3:01 AM  
Blogger Foilwoman said...

I love Dr. Cantharides. He's now my other sexiest man on the planet (along with Judge John E. Jones, III of the Middle District of Pennsylvania). Nothing like a healthy 80-ish person with their vices.

My mother's father was told, at age 79, after a lifetime of a Danish diet (butter, sour cream, lots of potatoes, certainly fresh vegetables and fruit, but also lots of cheese and pork) and a lifetime of physical activity (still breaking and training horses at age 79, gardening, hiking, swiming, ice-skating), and still a physically powerful bull-like man with none of the shrinking of the elderly one normally sees (all the calcium in all that cheese, I suppose), was told he had hardening of the arteries and was at risk for a heart attack. He was told to give up pretty much all his diet except the fruits and vegetables, and all his activities, except working at his draughtsman's table desigining inventions no-one ever took an interest it. He said, "Suh, suh." (Danish, for "Yeah, right, you young whippersnapper") and continued to ride horses, garden, play roughhouse with me (10 at the time, and not small) and other large-sized grandchildren, and generally remain physically active.

This was before medical directives. When he did have his heart attack (age 82, after a nice big Scandinavian breakfast of eggs, herring, numerous stinky cheeses, which followed an energetic early morning swim and weeding in his garden), my grandmother called the doctor and said he wasn't breathing. The doctor, in a moment of true wisdom said -- "We can probably revive him, but I doubt he'd want that. Wait a minute to call the emergency services, so that the resuscitation efforts will fail." He never did without his cheese, his morning swim, or his horseback riding, and we were happy that he never had to do so.

3:42 AM  
Blogger Chade said...

It's funny how these stories make you chuckle. The fact that the children were so worried that a man of 84, a pretty good innings as far as things go, could possibly develop cancer or something and cut his long a diverse life short is amazing.
As the Doctor knows, I'm not one for the Puritan healthy life. But, seriously, a little perspective. The guys 84. Why would he want to change?
My grandfather died in his 70's weeding the Garden with his wife. Had a stroke right then and there with the roses and in all that he held onto his wife and told her not to call the ambulance until he was gone. He said he wanted to die in the home he had built, with his loved one close by rather than in a hospital being prodded and probed. Made sense to me.
15 years later, My grandmother went in the same house having just relieved herself. Made me think that in the end, if you can die happy you've had a pretty good life.

9:08 AM  
Blogger Foilwoman said...

My plan is to be pretty careful (although enjoying good exercise and lots of cheese and butter), at least until the Gaah Girl is 30. Then I'll be 73. Then I'll eat and drink and do what I want exercise-wise, and when I keel over, I'll hope nobody finds me until I'm good and gone. No half-life like radioactive carbon, thank-you-very-much. Massive myocardial infarction at some time after age 80. That's how all my grandparents (who have died, Nuclear Grammy is still going strong at soon-to-be-94) have kicked the bucket and it seems like a good plan to hope for some genetic continuity.

2:26 PM  
Anonymous Camilla said...

I loved the Dr Cantharides story! Good for him.

3:20 AM  
Blogger Foilwoman said...

Oh, and what's a "mallee bull"? Some type of male bovine, or something else?

5:28 AM  
Blogger Chade said...

Mallee bull, as fit as a : very fit and strong. The Mallee is very arid beef country in Victoria/South Australia.

Hope that helps

8:33 AM  
Blogger Foilwoman said...

Thank you Mr. Eglinton. You are too kind.

3:11 AM  

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