junior doctor

it hasn’t been easy lately for mr. leyland. his wife and he have separated. i notice the weight of my body, a tired mass heavy on the chair. it hasn’t been easy. my parents have separated. i feel a separation within too, as if the two hemispheres of my brain no longer want to stay with me, and instead spring and uncoil. mr. leyland is tired. he has a headache. ok mr. leyland i understand, but just getting back to your bowel motions for a second. you mentioned that you noticed some blood in your stools the other day. can you tell me more about that. mr. leyland has two children. a son and a daughter. his son has just graduated from high school. his son hates him. mr. leyland doesn’t understand why. he reckons it is just teenage angst. i have trouble with my mother. i don’t hate her, but i don’t show that i love her. if i don’t show love, and i don’t feel love, does that mean. i cannot think about it now. i cannot break down in front of mr. leyland. i’m here to listen not to cry. mr. leyland tells me that his headache is worse. ok mr. leyland we’ll give you some panadol now. sue do you think you could get mr. leyland a couple of paracetamols i’ll chart some as well. mr. leyland hello mr. leyland. you were just having a little nap were you. when did you first notice blood in your stools. three weeks ago ok. what else has been going on. mr. leyland’s daughter. no mr. leyland i mean what else has been going on physically. mr. leyland noticed changes in his bowel motions. when did that start. mr. leyland reckons it started about three months ago. mr. leyland has also been feeling tired for about a year, and it has been getting worse. silence. the clock ticks loudly and it jolts me back to my heaviness and the weight of me in my chair. i want to go home. i want to feel the warmth of love’s arms around me. but i have to see mrs. cockrane and johnny who has been vomiting and the three-year-old who fell down the stairs. a baby cries into my brain and it shatters something inside. mr. leyland has been talking. mr. leyland’s daughter is very pretty. mr. leyland’s daughter loves dancing, and i really should see her dance. mr. leyland’s daughter is truly beautiful. i can’t be bothered with medicine any more. i don’t care that i have fibromyalgia and chronic fatigue syndrome and i’m always dysthymic and i have had sharp spikes of pain in my chest lately that i think is musculoskeletal but i’m praying it’s not cardiac i have a strong family history of heart disease and i don’t even want to start thinking about my mass and how my waist circumference is getting close to a hundred centimetres if it goes over a hundred centimetres i’m at risk of type two diabetes mellitus i think i may have depression i also have trouble with relationships and my family life and i may have juvenile rheumatoid arthritis although unlikely but damn my ankle hurts and my knee and my neck and my spine i just want someone larger than me with large firm confident strong hands to grab me and click click click me back into place. anyway. i can’t be bothered about mr. leyland’s bowels his headache or medicine or white coats or hospitals or old people who’ve smoked for fifty years or three-year-old boys who are abused by their sick fucked up fathers who then tell us that william fell down three stairs and ended up with two black eyes multiple bruises over his body and fractured ribs of various ages. or mr. leyland’s daughter. even though she is beautiful. she walks into the room. mr. leyland smiles and tells her that he’s talking to the doctor could she just give him a few minutes. mr. leyland would like to start painting. mr. leyland thinks it would be a good way to pass the time. it has been a few years since i painted. that painting of me melting in a pool of blackness still haunts me over my desk. small wonder that i can’t sit at it and study without the demons sitting in front of me looking at me with grins on their dark faces. do you talk to your wife much mr. leyland. mr. leyland doesn’t talk to his wife much, nor does he see her very often. it seems like everyone is angry with mr. leyland. mr. leyland tells me that he feels like an island alone in an empty ocean. i am silent. what a poignant description of – me. mr. leyland senses my heaviness and i sense that my chair may break any moment and he laughs nervously and i laugh nervously too. mr. leyland is crying. mr. leyland does not want to die, he has so much to do, so much to make up for. mr. leyland wants to see his son graduate from university. i want to tell mr. leyland that i feel his pain, as much as total stranger can. i want to tell him that i know he doesn’t want to think or talk about what’s happening with his bowels. i want to tell him that everything will be all right. i cry too. i want my father to see me grow up. i want my mother to see me blossom one day. i want her to know that i love her. i want her to know that her life was not all in vain. mr. leyland tells me not to cry. mr. leyland says it’s ok. i pull the curtains in the room and also before my eyes. i cannot cry in front of mr. leyland. i cannot break down. pulse eighty regular good volume. blood pressure one thirty over eighty five. jvp plus one centimetre. no signs of dehydration. cardiovascular system normal. heart sounds dual. no murmurs or added sounds. respiratory system normal. good bilateral air entry, no crackles. abdominal exam, slightly distended. soft. tenderness on light palpation right iliac fossa. hard tender mass felt in left iliac fossa on deep palpation. the tears flow freely now. rectal exam, small amount of dark old blood. silence. i hear pigeons erupting into flight from the square below. i feel the entire weight of my body focus now onto the palm of my left hand which is now resting lightly on mr. leyland’s abdomen. mr. leyland asks me why i am crying. his tears are still moist on his cheeks. i see his daughter looking through the window. she wonders why we are crying.