Tales of Dr Grumble

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Miss Thorne looked awfully severe. They used to be talented, observing, educated men. But now any whipper-snapper out of an apothecary's shop can call himself a doctor. I believe no kind of education is now thought necessary. Eleanor was herself the widow of a medical man, and felt a little inclined to resent all these hard sayings.

But Miss Thorne was so essentially good-natured that it was impossible to resent anything she said. She therefore sipped her wine and finished her chicken.

"How Grumbling Affects Relationships"

My grandmother Thorne had the best teeth in the county, and carried them all to the grave with her at eighty. I have heard her say it was all the carrot-juice. She couldn't bear the Barchester doctors. Even poor old Dr Bumpwell didn't please her. Robert Morley 13 claimed that 'Tooth worry is sometimes triggered by pain, when it is usually of a temporary nature and may subside after a visit to the dentist. Leonard Woolf 14 recommended 'Work is the most efficient anodyne — after death, sleep, or chloroform — for pain, whether the pain be in your great toe, your tooth, your head, or your heart.

Count Vronsky in Tolstoy's 15 Anna Karenina found an effective way of sublimating his dental pain ' He could hardly speak for the agonising pain in the big tooth which filled his mouth with saliva. He was silent, gazing at the wheels of the approaching tender gliding slowly and smoothly along the rails. And all at once a different feeling, not an ache but a tormenting inner discomfort, made him for an instant forget his toothache. At the sight of the tender and the rails, and under the influence of the conversation with someone he had not met since the catastrophe, he suddenly recalled her — as much as was left of her when he had rushed as one distraught into the railway shed and seen her mangled body, still warm with recent life, stretched out on a table shamelessly exposed to the gaze of all.

The head, which had escaped hurt, with its heavy plaits and the curls about the temples, was thrown back, and the lovely face with its half-open red lips had frozen into a strange expression — pitiful on the lips and horrible in the fixed open eyes — as though she were repeating that fearful threat — that he would be sorry for it — that she had uttered at their last quarrel And he tried to remember her as she was when he met her the first time — also at a railway station — mysterious, exquisite, loving, seeking and bestowing happiness, and not cruel and vindictive, as he remembered her at the last.

He tried to recall his best moments with her but those moments were poisoned forever. He could only think of her as triumphant in having carried out her threat to inflict on him futile but ineffaceable remorse. He ceased to feel the pain in his tooth, and sobs distorted his face. Prichett 5 employed his powers of concentration to overcome his toothache. I spent the day scrambling up a dry torrent-bed and then walked for miles in the pinewoods there and came down at some small posada to eat a poor thin garlic soup and two "pairs of eggs," as the Spaniards say.

The light in the rough inn was too feeble for reading by; I had to share a room with three labourers and their wives, who kept the windows closed; and in the night my toothache was agony. I walked off the next day with a face blown up like a football. The heat was violent. The only diversion of the walk was half a mile of processional caterpillars as fat as my fingers, who were travelling up the road, head to tail. I killed a few; they joined up again and went on. I sat for hours in a small railway station until the Mixto came along.

It took something like six hours to get to Madrid, shunting and unloading at every station. So I read La Busca with desperate concentration to conquer the pain of the abscess. At last there was an explosion in my head. I spat out a foul liquid; the abscess had burst. I don't think I have ever read a novel with such care, looking up every strange word in the dictionary. Corbet Woodall's 16 toothache miraculously disappeared when he discovered the alternative skills of a Tunisian dentist.

It always starts with toothache, and this happened once when we were on holiday in Hammamat, Tunisia. We had arranged to share a taxi one day with some friends from the hotel to go into Tunis and see the remains of Carthage, which are beautifully preserved, and well worth seeing. The evening before, I contracted a really vicious toothache, and we reckoned on finding a dentist in the main street of Tunis, down which we drove the following day, my tooth giving me hell. Quite suddenly, my toothache disappeared as quickly as it had started. Forster 18 recounted a superstitious cure.

Yes, pig's teeth. They had been stuck in as a superstitious preventative against toothache. People would come and chew the bark and so obtain alleviation from their pangs. This had stopped in my day, and presently the bark grew over the teeth and hid them and finally the tree was cut down. But the house it overshadowed with its primitive magic still stands, and some of you may have guessed the house is Howards End.

The minister's wife effectively cured George Birmingham 19 of his toothache. Like many ladies, trained and untrained, she had a taste for amateur doctoring, and never shrank from a heroic remedy. I remember going to the rectory once to conduct a class for Sunday School teachers.

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I was suffering from raging toothache and told Mrs Robinson that I feared the teachers would profit very little from my instruction that day. She undertook at once to set the matter right. This she did, not by extracting the tooth, though I do not think she would have shrunk from that if it had occurred to her as desirable, but by giving me a bottle of chloroform and ordering me to sniff at it till the pain stopped.

The remedy was most effective. I ceased to suffer, but I do not know what the assembled Sunday School teachers thought of me. I went sound asleep before I had spoken ten sentences and was only awakened with the greatest difficulty. The most drastic cure of all was suffered by the poor perch in James Russell Lowell's 20 poem. Come, let me just nip off your head, And, when a new one comes, the pain Will never trouble you again Maugham WS The summing up. London: Wm Heinmann Pan London: Hamish Hamilton Ltd London: Victor Gollancz Ltd London: Allen and Unwin London: Chatto and Windus Greene J The Greene Paradise.

London: Marion Boyars Greene G A Sort of Life. London: Bodley Head Graves R Goodbye to All That. London: Jonathan Cape Blunden E Undertones of War.

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Middlesex: Penguin Gibbon M Inglorious Soldier. London: Hutchinson Burgess A Earthly Powers. London: Hutchinson and Co Trollope A Barchester Towers. London: Collins Morley R Book of Worries. London: Weidenfeld and Nicolson London: Hogarth Press Tolstoy LN Anna Karenin.

Woodall C A Disjointed Life. London: Wm Heinmann Heath-Stubbs J A Charm against the toothache. Penguin Birmingham G Pleasant Places. Lowell JR Verse and Worse. London: Faber and Faber Download references. To obtain permission to re-use content from this article visit RightsLink. Article metrics.

Advanced search. Skip to main content. Abstract This selection of literary extracts deals with the subject of toothache from the point of view of the sufferer. Key points In Brief Literary references illustrating the patients' perspective on toothache. Main Until the last decades of the twentieth century, few individuals went through life without, at some stage, suffering the pangs of toothache. Philosophy and toothache The philosophy of pain is likely to be of more interest to the philosopher than to the sufferer.

Juvenile pain Childhood experiences of toothache left a lasting impression on Graham Greene 7 'Post-six too are my memories of being ill — it happened often, but only the dentist left unhappy memories. Toothache in the trenches First World War literature abounds with accounts of toothaches experienced on the battlefields of France. Curious cures Some interesting cures for toothache can be found in the pages of literature. An old wives tale E. Sedation The minister's wife effectively cured George Birmingham 19 of his toothache. References 1. Google Scholar 2. Google Scholar 3. Google Scholar 4.

Google Scholar 5. Google Scholar 6. Google Scholar 7. Google Scholar 8.


Google Scholar 9. Google Scholar Google Scholar Download references. Rights and permissions To obtain permission to re-use content from this article visit RightsLink. About this article Publication history Received 11 February Accepted 18 March Published 15 June British Dental Journal menu. Nature Research menu. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick … although we prefer to use only the good passport, sooner or later each of us is obliged, a least for a spell, to identify ourselves as citizens of that other place.

Susan Sontag, Illness as Metaphor. Doctor-patients are reminiscent of our ancient forebears, Shaman and traditional healers. They were a special caste, uniquely able to access both human and spirit worlds and act as intermediaries between them. It took special powers bought about by careful selection, arduous training and demanding rituals, sometimes-involving hallucinogenic drugs to be able to do this. The Wounded Healer in medicine and theology is one who has special healing powers by virtue of their experience of illness.

In the traditional African Xhosa culture, becoming a healer is a process that involves experiences of illness, physical injury and pain. One of the Xhosa rites of initiation is Thwasa, a state of illness. The person experiencing it will undergo ailment and pain of body and mind and be made to suffer stomach aches, nervousness, and severe ache in the back, as well as possible periods of unconsciousness. During these attacks, this person might also become emotionally withdrawn and be troubled by dreams. Thwasa is crucial for becoming a healer.

In Xhosa culture, it is believed that a person is chosen to protect and heal people by becoming an igqira healer , and his ability to enter a state of Thwasa is both a part of his training and an indication that the ancestors have preferred him. I undertake to protect my partners from the consequences of my being ill. These include having to cover for me and paying locums.

I will protect my partners by working through any illness up to the point where I am unable to walk. If I have to take time off, I will return at the earliest possible opportunity. I expect my partners to do the same and reserve the right to make them feel uncomfortable if they violate this contract. In order to keep to the contract I will act on the assumption that all my partners are healthy enough to work at all times. This may mean that from time to time it is appropriate to ignore evidence of their physical and mental distress and to disregard threats to their wellbeing.

I will also expect my partners not to remind me of my own distress when I am working while sick. Last Wednesday as I cycled to work, I rode far too fast over the cobbles at the end of the street, barely meters from my surgery. I went flying. My left hand hit the cobbles, hard. It hurt a lot more than I was expecting. I arrived and scrubbed the dirt out of a bleeding hole in my palm and asked our practice nurse to help me put a dressing on it.

But most of the pain was coming from the base of my thumb, and I suspected strongly that it was fractured broken. I had an evening surgery with 15 booked appointments; three of them were patients with severe learning difficulties here for an annual check up. So I took two paracetamol and saw my patients. I finished at 8pm and cycled home — about 25 minutes in the dark. I did the same thing when I fractured my scaphoid a few years ago. In Norway, a survey revealed that 80 percent of doctors had reported to work while sick with illnesses for which they would have advised their own patients to stay home.

Two-thirds of these illnesses were considered contagious. Many would deny that they judged others in the same way, but doctors who have been patients give us reason to doubt that. Despite the biological substrate of clinical depression or the genetic underpinnings of alcoholism, many physicians still believe these disorders are evidence of a lapse of will or moral failure , especially when they appear in other physicians.

The divide, and the associated fantasies are nowhere stronger than in mental health. Perhaps unsurprisingly then, the majority of the doctor-patient narratives I found were about mental illness. Doctors have the same rates of depression, schizophrenia and bipolar disorder as their patients but are much more likely than their patients to commit suicide; female doctors are two and a half times more likely than their non-medical counterparts. The Australian Beyond Blue study last year showed that one-in-five medical students and one-in-ten doctors had suicidal thoughts in the past year, compared with one in 45 people in the wider community.

Doctors with mental illness appear to be particularly vulnerable, as described by this psychiatrist with psychotic depression,. I had become a psychiatric patient and am embarrassed to say the stigma made me feel physically sick. As a psychiatrist it is deplorable that I had such negative cognitions about mental illness. I can put some of it down to my depressed thinking at the time, but not all of it. Despite the Royal College of Psychiatrists anti-stigma campaign and some eminent psychiatrists and celebrities being candid about their illnesses- stigma is alive and well.

I fear about being so open about the psychological aspects of my illness because the stigma I apply to myself is likely to be applied by others. Writing this and being so open about the conflicting emotions that it entails has made me question my own sanity on more than one occasion!

Shame is associated with drug and alcohol abuse, both of which are more prevalent among doctors than their non-medical peers. Shame also causes social withdrawal and isolation and stops us seeking help when we need it , because we are too strong, or not worthy;. Shame is feeling that I am not worthy of love, care and attention … Underpinning shame is excruciating vulnerability, the fear of being seen as we really are. Sometimes it is a more-straightforward denial that stops us seeking care, as explained by this GP with bipolar-disorder,. The view is quite different from this side of the sanity divide.

Chances are that we think that we are only stressed by work, and are distressed by our perceived inability to cope. An insiders guide to depression. Many doctors spend so much time at their work that when they are unable to continue because of sickness, and are cut off from their busy peers, they become lonely and depressed. The physical effects of illness compound this, as these two young doctors with metastatic cancer explain,.

Lancet I dread small talk. Before I got ill, I was exactly the same. Who wants to talk about the precarious nature of life and death when you could be networking? Anna Donald.

Grumbles from the Forest

One time medical student and now full-time patient, Anya De Longh described the contrast between being a medical student and a patient in an outpatient clinic,. In my first rotation, orthopaedics and rheumatology, I lost track within the first week of how many outpatient appointments I sat in on. I have one appointment with my consultant a year, and spend weeks planning and preparing, then a month recovering emotionally. Dr Kate Granger, revealed in several passages in The Other Side how shockingly often healthcare staff failed to introduce themselves, such as on this occasion when she was admitted to hospital with an infection due to complications from her chemotherapy,.

I am laid on a trolley in the emergency department feeling extremely unwell. My temperature is 39 C and my pulse is It is about 36 hours since I underwent a routine extra-anatomic stent exchange, and I have developed sepsis. A young surgical doctor clerks me in. She does not introduce herself at all. Over the 5 day admission I lost count of the number of times I have to ask staff members for their names.

It feels awkward and wrong. In my experience, medical students rarely ever fail to introduce themselves, but once they become infected with the culture of working life, they we slip into bad habits. She explains;. If being ill has taught me anything about being a doctor it is the importance of seeing a patient as a person and not merely a condition or disease sat in a hospital bed. It is amazing what you learn about people if you just ask. I have looked after a world record breaking knitter, an Olympic cyclist and a lady who had eleven children in the last few months.

The disease focused clinicians may see these facts as irrelevant, but I think they are central to understanding the person, how their pathology impacts on them and why they are special to their family. When was the last time you stopped and had a conversation with someone on the ward just for the sake of having a conversation? We all blame being too busy on not doing this but are we really? Having a chat can be therapeutic in itself.

I know this. A few months ago when I was struggling with the uncertainty of my prognosis and the effect this was going to have on my career I had a long chat with my Oncologist. There was no examination, no diagnosing, no investigations and no prescribing; just talking.

And it helped. It really did. Kate Granger. Continuity of care , the deliberate organisation of patient care so that the same doctors and nurses attend to the patient, was mentioned by several doctors. Lack of courtesy is just one aspect of poor care. They were astonished by that. The following morning I notice that MRI is written next to my name on the ward white board. At first I wonder if this is just an administrative error and it is actually meant to say ultrasound. I get claustrophobic sat in the back of a three-door car so the thought of having an MRI is not a pleasant one.

The next thing I know a porter has arrived with a wheelchair to take me for the mysterious MRI. I question if it is a mistake so we read the medical notes. A discussion between my Consultant and the Gynae-Oncology team is clearly documented the previous evening suggesting an urgent MRI abdomen and pelvis in addition to the rest of the management plan. As I have no other choice I sit myself in the chair and am wheeled off to the scanner. My heart is pounding the whole way. The Other Side. When I fractured my finger last year I watched a junior orthopedic surgeon attempt to put a wholly inadequate splint on it and even when challenged, he persisted.

Among the narratives I have read, communication skills are at least, if not more of a concern than clinical skills. I strongly resented the secrecy of my colleagues, which implied either that I had never heard of the fact that man is mortal, or that they considered me a highly neurotic individual who could not be told the truth, this I am decidedly not. The result of this secrecy was that for a number of years I never again consulted a doctor. Things were little better 30 years later as Campbell Moreland, the young GP with metastatic testicular cancer described,. In March, , I underwent chest tomograms and a creatinine clearance test.

I suspected lung secondaries but was not informed. I asked a junior doctor about my X-ray results. He went to the X-ray department, came back, and told me the films were normal. I know this was a blatant lie, as did he. My trust in him was irreversibly damaged. If it is bad news do you want to discuss it? First thing today I have been crying. It is the day of the MDT meeting, I am frightened and it feels as though nobody is talking to me.

I know my MRI report is available, but again no-one has taken the time to discuss this with me so I know it must be bad news. Other doctors who had been patients appreciated the anxiety patients suffered whilst waiting for results,. Many ill doctors now came to identify more with their patients e. Medical knowledge also makes doctors more aware of the limitations of medical care. Of particular note, doctors choose less intensive treatment at the end of life than they recommend for their patients.

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Faced with a terminal diagnosis some doctors turn to alternative therapies and become more interested in the spiritual aspects of care. Their scientific training did not inure these physicians against irrational, nonscientific beliefs and behaviors. They often perceived medical knowledge as overrated, and magically imbued.

Despite this age of ever-increasing scientific knowledge, magic endures. Dr Anna Donald blogged for the British Medical Journal about her experience as a patient with metastatic breast cancer. She was an exceptional academic in the field of evidence-based medicine, and yet her blogs are full of descriptions of prayer and meditation. She described the value of massage and alternative diets, and became a firm advocate of Emotional Freedom Technique EFT.

Our professional identity shapes what are often destructive attitudes towards ourselves and our patients, especially when the diagnosis is unclear, the symptoms hard to treat and the prognosis poor. Protests from patients that doctors are too busy to talk or that we lack sympathy or empathy are often met with defensiveness and excuses, but doctors who have experienced the isolation, fear and despair of serious illness are keen to emphasise the importance of humanity in care.

Our colleagues who have suffered as patients often feel compelled to report back, and what they have been telling us has been remarkably consistent over the years. It is time we paid more attention. I conclude with a quote from GP, Dr Liam Farrell , who wrote about his experience of, and recovery from addiction,. Superb article by the late Professor Keiran Sweeny who was diagnosed with Mesothelioma, followed by video interview below. Mystery Shopper. When Doctors become Patients. Book by Robert Klitzman. Dr Anna Donald. From the Other Side. Series of blogs for the BMJ during and up to her death from metastatic breast cancer.

When GPs burn out, why does the medical profession continue to let down its own? Do you have your own doctor, doctor? BJGP Beyond the stethoscope. Restoring hope, heart and healing in medicine. Croaky blog. Stress and depression among medical students: a cross-sectional study. Physicians can be better doctors by being patients.

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