The Gift (Tim Troughton)

Troughton, Tim St John

She trundled into the consulting room, the soulful brown eyes, the jaded coloured garments and the ambience of sadness and loss. Her little daughter was tucked up in a baby seat beside her as I listened to yet another harrowing but increasingly familiar tale of atrocities in Sierra Leone. The brutality of seeing family murdered, the estrangement from a village, a community and a nation. Her eyes looked down when I asked about the baby’s father; she had been raped. She mused on the loneliness of existence in this foreign and fume-filled city that was London, England.

We are privileged as family physicians to practice the art of closed questioning, a kind of gentle but purposeful interrogation to help separate facts and establish context, to diagnose. “Finances” were short, money was hard to come by as her political status was not yet approved in Britain. Merely affording a journey to the immigration office was a challenge.

At the second or perhaps third visit, my heart was increasingly stretched with compassion whilst a form of conflict consumed my mind. How can I help without being seen to help, how to avoid crossing boundaries, setting unwanted precedents? What would colleagues and colleges think? The heart softened while the mind searched for an answer, and for the first time in my career I reached for my wallet in an adjacent drawer and out of her view quickly transferred some bank notes to an envelope. I explained I would ask a local church to help.

A few weeks later she returned, I quizzed her – had she gotten help? She confessed the ‘church’ money had been used to feed her and her baby as her breast milk was drying up due to lack of food. Here in one of the world’s wealthiest cities, abject poverty and hunger was staring back.

I did not see her again for some time. Others would come and go presenting with symptoms which belied somatisation of unspeakable traumas. They came from Syria to Columbia, from Iraq to Uganda, from Kosovo to the Sudan, all with stories of sudden and traumatic loss through guerilla warfare or civil strife. Is this what medical training was for? To be a good listener, order tests in due diligence knowing intuitively they would be normal? They came after all to see a physician, not a priest.

This season was brightened by the teaching of medical students (or “doctoroblasts” – the jocular epithet one Belfast lecturer had bestowed upon us.) These were usually in small groups of two or three assigned to the inner-city GP office, and sometimes much larger groups taught in the Guy’s and St Thomas’ university campus for role-play discussion or OSCE preparation. Somehow explaining the basics of electrocardiography, how to isolate the “P’s” of chest pain, fine-tuning the cranial nerve exam or imparting acronyms for added heart sounds was perhaps in retrospect more for my benefit than for theirs. At Queen’s they prepared us so well for that which was objective, not what was subjective, they prepared us for mental health problems and pharmacotherapy, not how to counsel victims of gang rape and torture. One did not need to travel the world, in London the world had moved in and many of them were running away.

About six months later, she returned. Her countenance was glowing not sad, the baby was thriving. I quizzed her – did she acquire immigration status? Yes, she was officially legitimate and enjoyed recourse to public funds, she was fed and felt safe, she had even made friends. At the end of our brief visit, she reached into her bag and produced a gift for me. I unwrapped it somewhat awkwardly, a plastic wrapped set containing a bottle of cognac and two matching brandy glasses. It is not often as GP’s we are lost for words, I was speechless. My mouth dried up and eyes moistened. I scrutinized her face in poorly concealed disbelief, the cost of the gift would pay her groceries for a week and I mumbled something to that effect. For some reason, the distant memory of an old Sunday School story flashed by, when King David’s mighty men risked their lifeblood to acquire Bethlehem well water for their beloved king. He knew its worth, and didn’t dare drink it, instead poured it out with a prayer to the Hebrew God.

The brandy gift set sat in a corner at home for many months. I could not bring myself to open it. In the course of time Canada was calling, the stress of caring for the stressed was taking its toll. Whatever enabled big city living, exhausting commutes, the ever present threat of violence and the nature of inner-city work, was fast running out.

I left the gift with a pastor.

It somehow seemed right.

Theme: Community | Communauté
Theme: Health Care Delivery | Prestation des soins de santé
Theme: History | Histoire
Theme: Patients | Patients
Theme: Relationships | Relations

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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