Continuing on from last week’s post, Reflections of a Breast Physician, I thought I’d write more doctor memories. Before I started at the Breast Clinic, I worked as a GP at a practice that was about as far removed from the private-billing Breast Clinic as you could get …
It was a general practice within the grounds of a hospital. We took the overflow from the Emergency Department, the ones whose problems could be dealt with by a GP, and, as the only practice in the area that still bulk-billed, we saw the mentally ill, the homeless, the drug-addicted, all of those who couldn’t afford to pay to visit a doctor. We had patients who booked appointments, but also many who walked in off the street.
The building which housed the practice was shabby and in need of refurbishment, but there was no extra money. The patients were needy and required lengthy consults, consequently, there was minimal financial return and we ran at a loss. We were always asking for grants and constantly under threat of closure. The hospital next door, however, needed the practice to stay open; in fact, they wanted us to open longer as we eased their load.
Some of our patients came every day. Like Les. Each morning, Les arrived at the hospital ED. Each morning, the staff turned him around and sent him down to us. Our nurses washed and fed him, his only meal of the day, one of the doctors reviewed him, and we sent him on his way, back to his homelessness. Until the next morning, when he, and we, would do it all over again.
Another of my regulars, Delia (not her real name), came in every week. She was taking female hormones and awaiting gender-reassignment surgery. She kept finding lumps in her blossoming breasts. She came in with wig and thick layer of foundation over her five o’clock shadow, and would strip off her floaty dress to reveal skimpy lace panties, her balls bulging either side. I’d check her breasts and tell her that I felt no lump. Hand to rouged cheek and with flutter of pastel-shadowed lids, she’d tearfully thank me for reassuring her. I suspect she never really felt these lumps, but just wanted to talk to another woman about the problems we females face.
We were also the accredited practice for the brothel down the road. Their workers needed STD and HIV checks before they could start, and follow-ups every six months.
I tried to see the girls as having a choice and being self-empowered. One Uni student told me that she earned more in one night at the brothel, than in a week working in a supermarket. Fair enough, I told myself. But the truth was, I was never completely at ease with it, although I tried hard to hide that.
A couple of my patients’ stories rattled me. Like the mother and daughter who came in for their STD checks together. I really struggled with that: It was too far outside my perceptions and experience of motherhood.
I remember another girl in her early twenties, who left her large and impoverished family in the Philippines and came to Perth to marry an older Australian man. He turned out to be abusive and she left him. On the next visit, she came in with a friend, also from the Philippines, who was already working at the brothel. She came prepared – with her working name and certificate ready to be signed. During the examination, I looked up to see her crying. I stopped what I was doing and said, ‘You don’t have to do this. There are other jobs …’
She wiped her eyes and shook her head. ‘No. I will do it.’
I did her six-monthly checks and each time I saw her she became that bit more blazé, that bit more hardened. It became a job like any other. Then she got a boyfriend, fell pregnant, miscarried. A few years after I’d left the practice, I saw her at a park, pushing a baby in a stroller, an attentive man beside her. She looked happy and I hoped she was.
There were women who came in bearing bruises from their partners, both inside and out. They said things like, ‘This is it. I’m not going back.’ I’d organise emergency accommodation, book them in for counselling, and arrange to see them again in a couple of days. They wouldn’t turn up. The next time I’d see them, they often didn’t mention the previous consultation and acted like it had never happened. Sometimes, they’d say, ‘I know I shouldn’t have, but I went back …’ Sometimes, they felt the need to justify their decision – financial reasons, or ‘when he’s good, he’s really good,’ or ‘he’s promised to get off drugs’. I’d try to hide my disappointment behind a mask of nods and smiles and let them know my door was always open.
There was often a kerfuffle in the waiting room, and from behind my closed door, I’d hear the yelling and screaming. Usually because of drink or drugs. Not infrequently, I copped a mouthful of hot words from a patient for not writing a prescription for their drug of addiction, and I’d walk to the door and ask them to leave. After they’d gone, I’d sit until I stopped shaking.
We had things stolen, often brazenly – they’d walk into Reception, tootle around the other side of the desk, scoop up a handbag and walk straight out. We each had duress buttons under our desks that we could press if we felt endangered. I never needed to press the button, but sometimes I kept the door open while I saw a patient. A few times, I stopped while examining a prostate because the patient was masturbating. I told them I was leaving, and they were to be gone when I returned. Then I left and tried not to melt into a haze of humiliation.
It wasn’t an easy place to work. The patients’ lives were often tragic, and as a doctor, I felt helpless and powerless. Rarely did a patient have a normal straightforward problem, and how refreshing it was when they did. Most of the time, their problems weren’t physical and went far deeper than I could hope to fix. Sometimes, the patient didn’t believe they had a problem, or they didn’t want to fix it. I felt as if I was just holding their hand fleetingly, then sending them back out with a band-aid and a pat on the back, the problem as deep and unfixable as ever.
I only worked there for three years. I pulled up outside the surgery one day and looked over at a drunk male swaying as he piddled against the wall and I thought, I can’t do this anymore. I started breast work soon after that and dealing with patients with breast cancer was much easier.
There are doctors and staff still at this practice who do this type of work, day in and day out, and for many more years than me. There are doctors in practices all over Australia who do this type of work every day. I don’t know how they maintain their mental strength, their optimism, how they don’t take the problems home with them, and how they don’t burn out …
During those three years, I glimpsed a sadder, lonelier side of society.