Tauseef Mehrali on casting the safety net

Tauseef MahraliIn his brilliant surrealist novel Death at Intervals, José Saramago conjures up a dreamlike, yet all too soon nightmarish, scenario wherein the people of an anonymous landlocked European country simply stop dying. Death, the scythe-wielding skeletal spectre, quite literally goes on strike. She gives up her day job to pursue a romantic, bordering on voyeuristic, interest with a middle-aged cellist. Funeral directors, nursing homes, hospitals and insurance companies soon all begin to feel the impact of progressive months with the death toll at zero. Saramago challenges the desire within all of us to distance ourselves from the inevitable.

I finished another duty doctor shift on Friday evening and thought to myself how convenient it would be, medico-legally at least, if death took a similar short sojourn just for the weekend. In tribute to Roger Neighbour, I safety netted the febrile 22-month old, the young lady who had lost her voice, the teenager with the innocuous playground injury, the post-menopausal woman with musculoskeletal chest pain as well as several telephone consultations including a schizophrenic patient who was convinced her next-door neighbour was plotting to murder her. Recently I’ve been wondering exactly what size and gauge of safety net to use, and where and when to use it. Too leaky and a patient’s potential deterioration may be missed; too water-tight and a patient could be overburdened with information or plagued with anxiety.

I’ve just returned from my first spell of annual leave in the new job. Colleagues and patients alike made polite enquiry into my holiday destination and tried not to look too perplexed as the words Saudi and Arabia emerged from my mouth in response. Almost without fail, a long explanation that I was leaving for the hajj, the Islamic pilgrimage, would follow, along with reassurance that I would do my level best to avoid getting trampled. Thankfully I was still on twenty minute appointments.

The hajj itself was spectacular: the huge crowds, the breathtaking diversity, the inspiring camaraderie as well as the opportunities to simply take stock and reflect. It was also far more physically demanding than I had anticipated which will make me completely review the advice I offer elderly pilgrims-to-be attending their GP surgery for the obligatory prerequisite meningitis vaccines. As with all such trips word soon got round that I was a doctor and official pilgrim status was soon supplemented with an unofficial roaming medical role. Thankfully there was a team of dedicated group doctors but the irresistible urge to just run your problems (past, present and future) by a doctor proved too much for many. I found myself on the receiving end of queries concerning, among others, the pros and cons of facemasks, the fine-tuning of menstrual patterns and the workings of the left and right cerebral hemispheres.

The fact that I ended up taking antibiotics (as do most hyper-anxious western pilgrims) for a suspected chest infection did nothing to stem the flow of enquiries. The indications for starting antibiotics in the hajj setting are far removed from those in inner-city London. As one of the group doctors put it, “It’s all about Haemophilus, baby!” Although viruses do get a look in, the desire to enable pilgrims to complete the rites and rituals and the existing epidemiological literature mean that antibiotics are necessarily readily prescribed. The bulk of my unofficial role subsequently consisted of counselling patients on exotic macrolides about their new metallic taste disturbance.

Most consultations that I witnessed whilst on hajj would end with the patient praying for the doctor’s good fortune, long life and safe return home. At such times, I wondered who’d done the safety netting.

Tauseef Mehrali is a GP registrar.