30 April 2022

Difficult times ... and an escape hatch!

Fish bone, bowel blockage by adhesions, retirement and closure of clinic after 38 years.  

Dear colleagues, 

In October 2021 at a siblings reunion dinner I swallowed one or possibly two fishbones with my first excited mouthful.  After long Covid lock-down and with family I suddenly developed the dreaded sensation of a sharp foreign body in my throat.  And when it did not go away I booked myself in for a gastroscopy three days at Bowral Private Hospital.  However, to my surprise, nothing was found.  Subsequent examination at St Vincent's in Sydney was equally unremarkable.  CT scan, MRI scan (a punishing experience) and subsequent oesophagoscopy under anaesthetic were also all normal yet I knew there was still a bone (or two) there in the lower gullet or upper chest region.  Eventually, by the middle of January this year, the foreign body seemed to have either dissolved or moved on.  But I had more to worry about.  

The 'normal' rigours of running a solo medical practice were added to by the pandemic.  Apart from the daily threat to staff and patients, I was obliged to enter every patient's details on Service NSW Covid-safe web site by the close of trading, even on my 'days off'.  Getting 95% of our patients vaccinated was a challenge which we were also equal to.  Yet the enjoyment of running the practice was considerably impacted by all of these contingencies as well as the requirements of registration, accreditation, fire compliance, pest report, safety drills, etc.  So I decided to pull the plug and tell my staff it was a very sad day but we would be closing down.  Telling the patients was also tough.  Prior to that I had an assurance from the owner of a nearby large addiction clinic that they could manage to take most or all of our 165 opiate maintenance patients.  

An old adage is that people often develop illness, injury or other misadventure straight after retiring.  So it happened that just 8 weeks later I developed a bowel obstruction requiring urgent laparotomy with two weeks recuperation, somewhat cramping my style and confidence.  I thank the staff of Bowral District Hospital for magnificent care from the Emergency Ward to the operating theatres, intensive care and general wards.  Night staff especially were caring and prepared to go the extra distance in customised advice and support.  It must be especially exacting looking after fellow health workers and I was not an 'easy' patient by any means.  

So at some point I need to look back on my early general practice and expanding addiction cohort after I became one of the first NSW GPs to prescribe methadone.  One of my early patients was a doctor from a medical family.  He had been debarred over some drug use matter and never practised again, despite doing well on methadone for many years.  He joined the church and became a vital volunteer yet he lacked the confidence to return to medicine despite my encouragement.  He taught me a great deal about addiction when there were few sources. 

An elderly musician and composer retired to the Redfern flats and became my patient for her last years.  One morning on a home visit she presented me with a three page piano piece written in my honour.  One look at the manuscript showed it was far too difficult for my modest keyboard talents and it was not for another 25 years that I heard it played by a professional.  It is absolutely charming, original and possibly even an 'Alter ego' of myself (which was its title).  [contact me if you wish to hear it] 

Other remarkable events happened with regularity in our practice, many of which one could not predict in a century of guesswork.  Unfortunately many such details may give away identities and are too personal to be revealed.  One very early (1980s) GP patient was a truck driver who inadvertently caused a massive traffic jam by blocking lanes on the Sydney Harbour Bridge.  He just walked in that afternoon and revealed what had happened and that he needed a certificate for a few days off.  His truck was in a mess yet he was remarkably untouched, at least physically. 

Successes?  What is a success regarding addiction?  Survival is pretty important.  Keeping out of trouble, avoiding harms, looking after families, work, study and social integration are also admirable. 

The majority of our patients were on social security benefits and did some family responsibilities, part time work, hobbies or volunteer work.  Yet I also had many patients who worked, paid taxes and were part of the movers and shakers of our society.  One became a member of a Royal College while another obtained a PhD.  Others included successful lawyers, a police officer, business people, motor mechanic, retailers, teachers, nurses, graphic artist and other key community workers.  No politicians … but several highly placed public servants.

No clerics, rabbis, reverends to date but one most interesting and troubled long-term seminarian studying divinity at a major institution. 

More on Abrahamic religions later from this card-carrying atheist.  

Andrew Byrne ..