Ben Hoban is a GP in Exeter.
It was a Tuesday, I think. Morning surgery had come and gone with the usual mix of phlegm, tears and frailty, and my last patient was sitting in front of me, like a steely-eyed sentry guarding the road to a hurried lunchtime sandwich. Well then, let’s see.
“I can’t find the words, doc.” He was middle-aged, medium height, a little overweight, with no obvious scars, tattoos or other distinguishing features; casually dressed, nothing that really caught the eye, and only the occasional entry in his notes for low back pain or coughs and colds. He looked frightened.
…my last patient was sitting in front of me, like a steely-eyed sentry guarding the road to a hurried lunchtime sandwich.
“Can you give me a smile, please… now lift your arms… super.” Not a stroke, then.
“It’s like I’ve lost my voice, could it be a virus?” Nothing wrong with his voice though.
“I’m not myself, but I really can’t say who I am…” Sounding a bit more mental-healthy now. I tried to remember if that Primary Care Network thing was still running, or was it only on Wednesdays?
“Why don’t you tell me how it all started, and we can go from there?” Nice open question, I told myself. Why isn’t there ever a registrar around to be impressed when I get that stuff right?
“That’s just it, doc, I can’t say! I feel like here I am, and I’ve got something, but it’s all a mystery to me.” Something shifted in my head, and I heard the sound of a penny dropping in a bank vault deep underground. I rummaged around in my desk for the Campbell-Frank Analyser and applied the scalp electrodes and mask with trembling hands. As I looked at the display, I realised that neither of us had said anything for a while, which kind of made sense. The dramatic axis was indicating non-resolving tension, but with a trope/antitrope count close to zero and a plot trace that could barely make the effort to flatline: total narrative failure.
People often think of GPs as being a bit wishy-washy. You know the sort of thing, you go in with a chest infection and they want to know how you feel about it. It’s a fair cop really, but what they don’t get is that actually most of life is like that. It’s not just what happens that matters to us, but what it means, how we make sense of it, how it fits into our story. When patients complain, it’s not usually because anyone’s done anything outrageous, but because the facts end up organising themselves into a narrative with elements like “I kept asking for help” and “no one listened to me.” When I was growing up, there was a craze for those choose-your-own-adventure books that let you decide what happens next and turn to page so-and-so; I think there’s something similar on Netflix now. It was fun to be the hero in the story, although I had a habit of landing on page whichever-it-was with the words “Your adventure ends here.”
“Okay, it looks like there’s a problem with your narrative organ. It’s actually quite common, and plenty of people have a mild form without ever realising it. Yours is much more severe though, and seems to have come on quite suddenly, which explains why it feels so jarring. It tends to affect people with a very concrete outlook, and there’s a strong association with over-reliance on conversational clichés. What’s the last thing you can remember doing before you made your appointment?”
“Well, I was on the phone to my brother because he’d had Severe Chest Pain and got Rushed into Hospital in case it was a Massive Heart Attack. It turned out to be a False Alarm, but he told me to Get Checked Out, and Better Safe Than Sorry.” I winced at his relentless capitalisation. “Do you think I need a Scan?”
“Sorry,” I replied. “I’m Just a GP, I can’t request that, but you can Go Private if you want to.” I blamed my own capitalisation on an empty stomach; I could feel myself getting tetchy.
Okay, it looks like there’s a problem with your narrative organ. It’s actually quite common, and plenty of people have a mild form without ever realising it.
“If you want to make better sense of your experience, you need to start connecting things with each other, go from A to B to C and so on. A bit of metaphor usually helps glue the different parts of your story together, if you know what I mean.”
“Can’t you just give me a pill or something? I tried using a metaphor once, but it got wedged.”
“I’m sorry, I don’t think a pill will help, but now that we know what the problem is, there are a couple of other things you could try. I can send you a link to some exercises online and refer you to a narrative therapist, although there is a bit of a waiting list.”
“Let me just get this straight then, doc: my brother has a close shave with the Grim Reaper, I try to look after myself and do the NHS a favour by making an appointment with you instead of going to A&E, and the best you can come up with is some old rubbish about telling a story?”
“Yes, that’s fantastic! See how well you’re doing already? Just keep it up and come back and see me again in a week.”
I never did see him again to find out how his story went on, but sometimes it’s enough just to know that you’ve helped someone, right?
Author’s declaration of interests: “If the Campbell-Frank analyser were real, I would have shares in the company that made it.”
Featured image by Alina Grubnyak at Unsplash
Wonderful!