It has taken me many years to accept that, as a doctor, I cannot fix the problems of the world, that problems can have a purpose and that the best I can do is help alleviate distress and support each person's efforts to live the best life they can, in a less than perfect world.
Moira is 83 years old. She has a number of illnesses and is a carer for her equally elderly and even sicker husband. On one of her visits to me she complained of a sharp stabbing pain in her neck that kept her awake at night. As she removed her jumper, I observed her slow painful movements and her attempt to minimise her discomfort. I had my own ideas about why she was in pain.
She was worn out looking after her husband. She was always on the alert for him, always on hand to attend to his needs. At night she slept, with one eye open, her hearing aid dialled down, but always on. Despite my gentle suggestions that she should consider a short period of respite care, or ask another family member to take over at night, she refused. This was her gift to her husband. At this point in time this was what gave her life meaning.
As her GP, it was my job to support her and not invalidate her efforts by telling her that she should not be doing it. This was how I would best help her.
And so I attempted to procure all the resources available to her; home help, as many hours as she could get - this amounted to a half an hour a day; an occupational therapist assessment, to advise on physical aids - this was going to take a while; a medical report for a housing grant that would allow the structural changes to facilitate disabled access - this would take even longer, probably too long for either of them to benefit; a referral to palliative care for when the time came that her husband needed 24-hour nursing care.
If this man and woman wanted to spend their last few precious years in their own home, then the least I, and the society we live in, could do, was to get them the supports they needed.
Moira is not lonely in the traditional sense. The quiet presence of her husband is all she needs for now. She muses that she is not sure how she will cope when he is gone. So, I tell her she cannot deal with that now. It is in the future. It is not possible to cope with what has not yet happened. "Best stay in the present," I say. "that's about all anybody can be expected to cope with." She laughs. "You have a way with words, doctor," she says. "Best stay in the present, indeed. Speaking of which, I better get back to my post so I'll take my prescription and something for that pain."
Margaret and her husband Jim, live in an isolated farmhouse. Their children have all emigrated. Jack, a computer scientist, works in London. Maeve, an engineer with a family of her own, works in Australia. Sarah moved to Canada when she finished her nursing degree and John has just relocated to Boston on a two-year post-graduate programme.
Margaret and Jim are proud of their children's achievements and grateful for the Irish educational system that allowed them all to get good jobs. But despite remaining active and engaged in the community they miss not having their children and grandchildren around them. The hardest thing is not being able to connect via Skype. They hear their friends talk about how they witnessed their grandchild's first steps or heard their first words and feel a pang that they are missing out. A good internet connection would make all the difference to help fill the void. They try not think about the future alone in Ireland without their family.
I went to visit Brigid in her home as she could not to get to see me. I turned off the main road on to the by-road to her house. "It's the fourth on the left, once you turn into my lane," she told me. As I drove slowly down the lane I counted three houses, all quiet and still, the entrance gates overgrown with brambles, the front gardens devoid of swings, trampolines or goal posts.
Turning into Brigid's house a large fat cat circled the yard watching my approaching car. I turned off the engine and stepped out of the car, noting the clear sound of birdsong uninterrupted by farm machinery, traffic or human discourse.
Brigid had told me how one by one her neighbours had died and their houses had been left empty. None of the children reared in these houses were interested in settling back here with their families. Brigid was the last person to live on this lane. The Ring a Link bus, the free service that offers transport to people all around the countryside, no longer stops at the end of the road and Brigid has to ask her daughter to bring her out to the shops or the doctor. She no longer goes out much and finds the days long and evenings lonely. Life has lost its sparkle. She was used to people coming and going in and out of the house. This recent deeper quietness of the countryside is unfamiliar to her.
William, a man in his late eighties has decided that whatever happens, he will not be going to hospital again. "Sure, you will look after me doctor," he says. William had two hospital admissions the previous year. He was not afraid of hospital, but while he was in there he worried continuously about his faithful sheep dog, Sam.
Since William's wife died a few years previously, Sam had become his constant companion. He was so unhappy in hospital that he left against medical advice, fearing that he would never get better without Sam at his side. "Have you thought about who will look after Sam, if anything happens to you?" I asked him casually one day as he repeated his wish never again to be referred to hospital. "I have that all sorted," he said. "But he is old too and not in the best of health, so I suspect he won't be long after me." William needed Sam. Without him he had no reason to cling to life.
I am always on the alert for loneliness. Sometimes it is easy to detect, as in the case of Margaret and Jim, Moira and William, but sometimes I find it in the most unexpected places; in people surrounded by family and friends, but who do not feel understood or cared for. I no longer try to fix any of this, I simply remain alert and imagine that the touch of my hand, as I take a blood pressure or a pulse could be the only touch that person experiences from one doctor's visit to the next and I pause in the hope that my touch might help them not feel so alone.
Dr Lucia Gannon is an Assistant Programme Director with the South East GP Training Programme and was a GP Clinical Tutor for University of Limerick Graduate Entry Medical School (GEMS) from 2010 to 2018. She works with her husband at Killenaule Surgery, Co Tipperary. All in a Doctor's Day: Memoirs of an Irish Country Practice (Gill Books) by Dr Lucia Gannon, is out now