Rude health: Bleeding gullets
A post-mortem shines further light on the death of a favourite Kennedy, says Maurice Gueret, who is no Top Doc himself
The death of former Liberal Democrat leader Charles Kennedy continues to make headlines. His family went public with the post-mortem findings, perhaps because of unhelpful speculation on social media as to the precise cause of his death.
They confirmed that Kennedy died from a "major haemorrhage" that was "a consequence of his battle with alcoholism". No further detail was given, but a medical eye cast on things might surmise that his lonely death in his Scottish-highlands bungalow was due to ruptured varicose veins in his gullet. They also claimed the life of Beat Generation writer, Jack Kerouac, at 47. Oesophageal varices are strongly associated with advanced liver disease. The lower part of the gullet is a pressure point where two large river systems of the body's veins coalesce. Scarring in the liver causes the pressure to rise in these channels and may cause blood to burst from the lining of the oesophagus. What complicates the condition is that a body with a liver damaged by cirrhosis is not so good at getting the blood to clot. A bleeding ulcer lower down the gastro-duodenal tract may also cause a major haemorrhage, but these usually give more advance notice of intentions than ruptured varicose veins. I should add, any vomiting of blood (haematemesis) is a medical emergency.
Tributes to Charles Kennedy from across the human spectrum were quite extraordinary in their love, warmth and praise. The pity, as always I suppose, is that he never got to hear them. In some of the press coverage, there were clues as to that vulnerability of all great men who choose to climb summits. One political correspondent, Gaby Hinsliff, tellingly described her visits to Kennedy in his Westminster office. In the days before smoking bans, there was always a cigarette dangling from his hands. She remembers one thing through that thick, blue haze of smoke - his hand movements. The very first time she interviewed him at length, about the Iraq war, she noticed that his hands trembled throughout the meeting. It was in contrast to everything else as his voice was entirely calm, his arguments were fluent and his judgment was sharp as a pin. The journalist wasn't sure if the hand tremor was a spot of nerves or a sign that the previous evening's alcohol was wearing off. With hindsight, she now says that it may have been a combination of both. Hinsliff went on to describe how many comedians drink alcohol to maintain the easy confidence that audiences assume comes naturally. It's surely no coincidence that politicians and comedians have full bar facilities in the workplace.
I was writing just three weeks ago about linked or companion selling. This is the practice of slipping a few extra items in with your prescription, as recommended by your friendly local pharmacy. I do hope the practice is not widespread. I am told that the Pharmaceutical Society was made aware some years ago that one chain of pharmacies in the country had weekly 'linked selling' sales targets for its employee pharmacists and locums. The practice ceased when noise erupted about professionalism in the guild. I do wonder about regulations for shop assistants who are not qualified pharmacists. Many students work part-time in chemist shops, and recently I heard how one was trained in the sale of over-the-counter medicines. The acronym used to train the girls was TSP. This stands for Treat, Soothe and Prevent. So when a patient came in looking for a particular treatment item or T, pharmacy assistants were expected to recommend two other purchase recommendations, an S to soothe and a P to prevent. Apparently there were mystery shoppers too, just to make sure the staff didn't slack and followed store guidelines. Wouldn't it be nice if a few mystery shoppers went in to act on behalf of the consumer now and then?
There was a very sad case in the news recently about a 92-year-old lady who threw herself from a bridge in the UK. She was a well-known Poppy Appeal seller in her locality, and fond of good deeds and charity work. It was discovered after her death that she had 27 direct debits to charities, the bulk of her pension. Older people seem to be targeted mercilessly by chuggers, cold-callers and mass-mailers. When they sign up for one, it seems that many other charities get wind of their generosity, and the begging intensifies. I wasn't aware that those who do contribute in this way are frequently asked to increase their monthly contributions. Free gifts are also being used to encourage direct-debit agreements. Charities know well that many older people abhor the idea of something for nothing, and will often respond with kindness to even the most menial of presents. Guilt often prevents older people from cancelling things they regret signing up for. Banks must be well aware of the vulnerability of some of their customers to charity overkill. They might do more to highlight abuses with a reporting system in place when the number of direct debits mounts up.
A medical colleague was amused recently when he was introduced on the radio as a top doctor. He didn't object, but in truth he's never claimed to be anything of the sort. He's an ordinary common-or-garden variety, with the same dangling stethoscope as the rest of us. It highlights an annoying media tendency to name any old quack who will talk to them as 'Top Doc', 'Marvellous Medic' or 'Sublime Specialist'. It doesn't affect me at all. This Grumpy Git of a GP hasn't gone on the wireless since they took the wires away.
Dr Maurice Gueret is editor of the 'Irish Medical Directory'
Sunday Indo Life Magazine