Domhnall MacAuley: Ghosts in the consulting room

Domhnall MacauleyMy consulting room is full of ghosts. Shadowy figures whose tears or trauma hover over the patient’s chair. The room has a memory and sometimes shares its thoughts. A word on the computer screen or a half remembered name brings back images, voices, fragments of forgotten conversations. I can see the faces of old friends hearing bad news, their bravery or despondency, resignation or anger, and remember lost pieces of their last weeks or months. That ghostly picture might be of the first time I felt a mass, or listened to their chest, and knew instinctively a family’s life would change forever. Or, perhaps, when someone returned from hospital and, though they didn’t know, you could tell by the sequence of tests that the outlook would be gloomy. Maybe it was some major life event, a pregnancy, betrayal, a family feud, an old friend bedridden and confused in their last few days, or the remnants of an unexpected death. Patients leave behind an image of their lives. Lives forever frozen in that moment- hazy photographs of their past.

Those ghosts that are still alive are the most intriguing. Every month we get a list of patients that have left the practice. Sometimes the reason is clear: a death, students moving to university, or patients whom we know have moved to another area or who are seeking a new life abroad. But, every now and then there are patients that make you wonder. As partners, I know that we all take note, might quietly review the patient’s note for clues, discuss it sometimes at a practice meeting. Was there a problem, did we go wrong, let someone down, or miss an illness? The biggest mysteries are those patients you have worked with, worried with, helped (you hope), and tried to sort their problems. Time, effort, and angst. Shared burdens, solving problems, disentangling seemingly insurmountable difficulties. And, then they leave. It used to bother me.

Years ago a senior partner told me it’s because you know so much about them. People want to leave behind their past, escape whatever illness, injury, or psychological trauma they shared with you. They are alive but want to leave that time behind. And, you live with the ghost of their previous life.

Domhnall MacAuley is primary care editor, BMJ