M E N T O R

Is there a doctor in the house?
The rest of the conversation falls away as meaningless chatter. Behind every
pause or slipped sentence I am wondering if this is the face of the disease.
My grandma was diagnosed
with vascular
dementia and my
family do not know
what this means. Not only do they
not understand the definition of the
problem (I partially blame the team
responsible for her care for this) but
also what shape her future is going
to take. What this means for me is a
host of phone calls and difficult conversations.
This is not new to me; I
received them in that proto period
of uncertainty before her diagnosis
took shape. The reason that I am
the one contacted in such an event is
that I’m the go to guy for my family’s
medical problems.
None of my family have any sort of
medical background and, despite
this modern age of medicine overreaching
itself and appearing all
over the media, they do not understand
what is happening. Why is she
behaving in that way? What can we
do to help her? In just five years of
medical training, I’m not sure I have
the answers, but it doesn’t stop the
phone from ringing.
Many of you who are applying, or
who have already applied, to read
medicine will have done so with the
same trouble I had. Medical experience
is invaluable for interviews and
personal statements alike. Of course,
it is only when you think back that
you realise how little you actually
knew. It is not just that you are unaware
of the vastness of the ocean,
you’ve never even seen the sea. All
the same, that modicum of information
is gold dust. However, if you
don’t have a close relative or a friend
who is a doctor or nurse or GP receptionist,
you may find yourself
George Aitch
shut out. I ended up working as a
healthcare assistant for a year (which
I enjoyed very much) to furnish my
CV. It was a leg up but meant I had
to defer my application.
At the other end of things, I expect
to finally graduate this summer. For
my family this means I am basically
a doctor, unless I am telling them
something that they don’t want to
hear:
‘I don’t think you have appendicitis.’
‘What would you know, you’re not even a
doctor yet.’
In August I attended my first family
wedding, which was lovely. All of my
relatives under one roof and a real
chance to catch up. People asked my
sister where she was applying to university
and my brother what it was
like to live in Hungary. When it got
to my turn everyone wanted advice
on their latest joint replacements or
this funny rash which had come up
on their arm. Resisting the urge to
roll my eyes, I dispense advice and
discuss problems. By the way did
you see that article I wrote about
volunteering in Guyana? No? Never
mind, back to your mother in law’s
cataract surgery then.
When it comes to GP visits, my family
fall into two different camps. First,
you have my dad. You have all met
this type; he ‘saves up’ his visits under
the misapprehension that he is doing
the doctor a favour. If you have him
sat in your waiting room, you can bet
that he has a rolled up piece of paper
in his pocket with all of the problems
he has suffered from in the last year.
It is impossible to get him to see a
doctor when anything happens. My
mum is the opposite. Whenever she
gets a blood test or result back, I am
the first to know. Luckily for all of us,
neither of my parents have anything
seriously wrong with them and are in
great health. Part of me is proud that
they put their trust in me (in a really
minor way), but it would also be nice
if both of them had more sensible
approaches to their health.
This won’t stop when I qualify, it will
probably get worse. I already have
an extensive background in telemedicine
via Skype and FaceTime. Has
anyone else had to diagnose a rash
via Whatsapp? If you’re really worried
then why not see a doctor? I say endlessly,
but it feels bad just telling them
to Google it. In fact, I’m sure I saw
something about that in the news a
few months ago…
We’ve long been aware that something
has been wrong with my
grandma; getting to her age tends
to have a few consequences on your
health. However, during a hospital
admission for a fall my parents and
aunt and uncle became concerned
about a change in her behaviour. As
is usual, they called me asking what
might be wrong. Cue an hour long
chat about delirium. Though when
it came to discharge these problems
did not go away. Being at the other
end of the country I asked them to
push for a psychiatry review, some-
And so I explain to my
kind and loving grandparents
the underlying
process behind vascular
dementia.
thing that none of them were keen
on.
Then suddenly, following a review
by the hospital staff, it all came out:
grandma’s gradual decline which
grandad had done everything to
mask. This recent fall was the tip
of the iceberg and he was running
out of his ability to cope. Being the
stoical type that he is, he never mentioned
what was going on and so we
never realised how difficult things
were becoming for both of them.
Now, one month later, grandma has
a diagnosis of vascular dementia
and I am on the phone with them
trying to put a brave face on it yet
give an accurate explanation at the
same time, all the while trying to
keep my emotion out of it. Needless
to say it is difficult.
What can you say? Dementia is as
a good as a terminal diagnosis (the
average life expectancy from diagnosis
is four years). This is the elephant
in the room. They know it
and I know it. Grandma has had to
watch her brother and sister suffer
with the same thing for a number
of years now. She dreads ending up
like them and we both know that it’s
inevitable. This is the curse of medical
knowledge; analysing with terror
every symptom and biopsy result,
scan and blood test. Not only can I
provide a realistic perspective on unfolding
events, but every worst case
scenario also flashes before my eyes.
It’s an extension of hypochondria.
And so I explain to my kind and
loving grandparents the underlying
process behind vascular dementia;
how it is distinct from Alzheimer’s,
how her recent short term memory
loss and anxiety have been caused
by a series of strokes affecting small
blood vessels in her brain. I compare
it to grandad’s TIA which he
had a few years ago. She is quick to
cut across me and point out that her
condition isn’t going to get better. I
can’t think of anything to say.
Already they have begun to plan
for the latter stages of the disease;
today they visited a day care centre
for people with dementia. Grandma
restates her fear of ending up like
those with advanced disease. I try
to reassure her but it’s an acknowledged
truth between us that one day
she will find herself in that position.
The thought of slowly losing your
memories and sense of self is terrifying,
even more so when faced with
the certainty that it will happen to
you. I cannot begin to understand
the place that she must find herself
in. I hope that I may never have to.
The rest of the conversation falls
away as meaningless chatter. Behind
every pause or slipped sentence I
am wondering if this is the face of
the disease. She forgets that I’m not
a doctor yet and in the back of my
mind I turn over how innocent this
lapse in memory might be. I am an
adult and a realist; I know that nobody
is around forever, but I was
hoping for a less cruel exit. The end
of the phone call is austere. Being
cheery seems inappropriate, as does
the usual ‘it was lovely to hear from
you’. Neither of us says it. I mention
that I’ll call back in a week or two
when they know more and we say
goodbye.
I can’t help what is set in stone. What
I can do is make the remaining time
more bearable: call more often and
check how she’s doing, that sort of
thing. It’s very do-able. The news has
destroyed me inside, I knew it would
from the first moment of my mum’s
voicemail message. The worst part is
repeating that same phone conversation
twice later to the rest of my
family.
Herein lies another challenge to
those entering a medical career,
one of many: the puzzling knot of
separating the personal from the
professional. Adopting the cool clinical
manner whilst still empathising
with the person in front of you is a
paradoxical skill which takes experience
to master. Breaking bad news,
discussing serious complications,
possibilities and anything with gravity
or even putting up an emotional
barrier for therapeutic reasons all
require it. The first experience we
might have of this could be in the
dissection room. The body in front
of you is a delicate learning tool but
first and foremost it used to be a person,
one whose generosity should
command respect.
With this in mind, I continue to be a
medical dictionary for my family. As
I write, my mum asks which meningitis
vaccines my sister should have
before going away to university.
When I go home for Christmas I am
sure that it will rear its head. On top
of that, mum will continue to keep
me up to date on my grandma’s advancing
dementia and I will try to
interpret everything that is happening.
Remind yourself that you were
once ignorant of the ocean and then
think how much wisdom you can
impart from just your short voyage
out of port. As a final year student I
have already accrued more medical
knowledge than most will gain in a
lifetime and I should feel incredibly
privileged. My parents have had to
support me, I suppose it is only fair
that they get something out of it.
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