7th January 2000

Well it's been heck of a week. I opened my new firm with the wonderful news that I was on call that entire day, ie I had to stay back *late* on the first day. in the A&E department. I also discovered that geriatric patients can be rather trying on a doctor's patience. I'm currenly engaged in the process (battle more like) of clerking this delightful old lady who unfortunately is more keen on telling me about her lunch than she is about telling me what's wrong with her. Oh it was chicken, it was lovely and fine, and oh it was chicken. Or else she keeps saying It's different, it's different, can you see it's different? and rips up her skirt to show me a scar on her thigh. That was yesterday. After one and a half hours of repeatedly asking her But Mrs B why are you here in hospital? What seems to be the problem? etc ad infinitum (Mrs B had brief 10 second periods of being fully lucid every 10 minutes or so) I thought I'd elicited all the history I could, patient was found on this date presenting with this condition ettcetcetc. Then her friend Mr X comes along and I decide to ask him what's actually wrong with Mrs B, and in five minutes he tells me what Mrs B couldn't in one hour fifteen minutes. Two hours into the session I'm running out of daylight and patience so I finally tell Mrs B I have to go now, and she snaps awake and says you're sweet. you're nice. you're different. it's different. it's different can you see...?

So I've made a favourable impression on an old demented woman. Is that what I've spent the last half-hour trying to do? ugh. but somehow I leave the hospital feeling happy.

Today, Friday I return to clerking Mrs B, this time I'm trying to do a physical examination on her and I realise how hard it is to get a demented old lady to obey your verbal commands, and I realise how much of a doctor's examination of the patient relies on the patient understanding the doctor's orders and carrying them out. It takes me about half an hour to manage to get her to flex her left arm against the resistance offered by my hands. I ask her to do the same with her right arm, and she replies with there was two of them, but I can't seem to find out where they've gone? She becomes agitated. That's her catchphrase for today apparently, there was two of them. I realise she's talking about the pills the nurse brought her, in a little cup; two little orange pills which she couldn't figure out how to swallow. The nurse gave up eventually and took the pills away, and now she's distressed and keeps apologising to me. Perhaps I look like that five foot seven blonde nurse with the long flowing hair. A five-seven female doctor breezes past, she's tall and gorgeous and chinese. How come I've never seen her around before. She gives me a oh you poor thing look and wanders off. I return to my struggle with sanity.

Half an hour later I still haven't managed to get Mrs B to repeat her arm-flexion trick on her other arm. She's just not clicking today, she wants to keep telling me about the two of them, that she can't find anymore. I ask her to shrug her shoulders against my arms. She suddenly snaps to and says shrug my shoulders? Both of them? Together? My heart does a leap. I say yes, both of them. She says oh there was two of them, but I can't...

I finally give up. Examining her is going to take me more man hours than I have in one lifetime. Perhaps I'll just cheat and fill in my clerking form according to her medical notes. I've got a niggling suspician that's what all the other doctors have been doing anyway. I try to give her a comforting smile although inside I feel like lying down on her bed and going to sleep - it's a draining business, ineracting with a lovely old demented woman. She smiles back radiantly and asks me I've seen you before, haven't I?

Someone once told me that she prized her intellect and rationality, above all else (and she had a lot of all else). I have to agree with you. Perhaps those years gained on me did give you a headstart after all. When I grow old, I really hope I retain my intellect and capacity to reason. How distressing it must be to be perfectly sane in your head but keep getting prodded by a medical student who obviously can't understand simple english. And to wonder why the rest of the world can't understand what you're saying when you're being so simple and clear for their benefit. can't you see I need to know where my two pills are?

I tell Mrs B I'm going to get her two new pills now, and walk off.

Somedays it's a really tiring and draining job, but I know I'm going to go out with friends later and laugh to them about it all, and that I'll remember she called me a sweet young man and laugh all the more.