A very pleasant, if unexpected, consequence of my new book has been the discovery of the age-old love that Irish people have for their donkeys, particularly those who live on long past their working days.
On the cover of What the Doctor Saw is a picture of my late grandfather, Dr William Coyne, sitting astride Neddy, the retired farm donkey at the asylum in Dundrum. There was a lovely incongruity to the fact that the chief psychiatrist was riding his charge around the grounds of Ireland's major hospital for patients with criminal insanity. I have been collecting stories of your donkeys in recent weeks, none more extraordinary than one tale from a psychiatric hospital in rural Ireland. A lady, whose father was resident medical superintendent (RMS) -- now, he'd be some class of clinical executive -- at a country mental hospital, tells me that the hospital she grew up in also had a donkey, which was cared for by a patient who was simply known to everyone as The Guy. The Guy had been a member of the Teamsters union in Chicago, and had arrived from the Windy City with an escort party, any one of which heavily outweighed him. By all accounts, he had been quite a naughty boy, and a real handful in Chicago. Much to the relief of his American minders, he was handed over, but he absolutely refused to have anything to do with the admitting doctor. The RMS was called and, as he entered the room, the little man looked at him and asked: "Are you the guy?" The senior psychiatrist nodded. "I'll only talk to the guy," the man stated. And, as good as his word, he completely ignored everyone else. From that day on, he was known to all as The Guy. My reader tells me that The Guy's job in the hospital was to look after fuel for the heating. She recalls the massive wrought-iron radiators that were always warm, and the cosy smell of urine, combined with furniture polish, is etched on her memory for ever. She remembers The Guy and his little donkey as always being grimy. He wore a baseball cap sideways, which he never removed. When the hospital installed oil-fired heating, The Guy retired, but was left to care for his donkey. When The Guy died, they laid him out, but he looked so odd without his baseball cap, they put it back on him. The donkey died when The Guy died. My correspondent tells me that care in the community is all very well, in theory, but suggests that there will always be a need for patients such as The Guy to have a refuge and something to care for in life.
An old school friend of mine, who did medicine in Dublin, has been working as a consultant microbiologist (bug specialist) in London for some years. He came across my growing collection of medical malapropisms (the funny things that some patients call their illnesses and medicines) and offered a rather good one of his own. He received a sample from the operating theatre that had been marked by a nurse as having come from a patient with a "baloney amputation". Further investigation of what sounded like a very foolish and deceptive operation to do, revealed that the patient had, in fact, undergone a below-knee amputation. Even health professionals can slip up in the blooper stakes.
And some more of them have come my way from GP colleagues. One Dublin family doctor told me last month about an interesting new medical condition that was reported to him. A male patient of his had a Dexa scan (a test for osteoporosis and osteopenia), and the report came back saying that he had osteopenis. I could make a cheap Viagra joke here, but never on Sundays. Another doctor asked her daughter to stand in for the holidays of her medical secretary. Dictation wasn't a strong point. She reported on a patient with a serious case of "lunge bar lower doses". We think she meant the curvy spine of lumbar lordosis. Apparently, she has something of a track record of malapropisms, once declaring the rotund family cat to be "obeast"!
Ailment of the week is sciatica, requested by an older lady in Donegal, whose recent MRI scan of her spine showed up a bulging disc that is causing pain in her left leg, numbness in the foot and, as if that wasn't bad enough, a limp. Now I could write a book about sciatica, and some doctors have, but, in quick summary, it's a condition that has its roots in irritation or compression of the long sciatic nerve, which exits the spine at the lower back. This is the thickest nerve in the body (there is one on each side), and it has its origins between five vertebrae at the end of your back. The nerve on each side passes deep in the muscles of your bottom, into the leg, and divides into other nerves halfway down the thigh. In the days before we had MRI body scanning, the diagnosis was principally derived from taking a good history of the complaint, close examination of ankle jerks with a patella hammer, and a test called straight-leg raising, in which the patient lies flat and the doctor lifts the whole leg to stretch and test the nerve. A good doctor will still examine for these and more. The most common cause of sciatica, though not the only one, is a prolapse (movement, slippage or bulging) of a jelly-like disc between two vertebrae. In most of the cases, conservative treatment will be the first port of call. Analgesic medication, muscle relaxants, rest, heat, TLC or chartered physiotherapy might be prescribed. In the more serious or recalcitrant cases, or in a case where a sporting career depends on a quick fix at all costs, the attentions of a spinal surgeon or a neurosurgeon may be necessary. Surgery with microscopes now allows surgeons to achieve a much greater number of positive results than they were able to in the past.