Love in a cold climate

At the end of a routine consultation, Mr Howard playfully announced that 'romance was in the air'. He said it with a wide smile, a twinkle in his eye and a wink. He is 85 years old. There was no hiding how delighted he was, and it made me grin from ear to ear to see it. How absolutely wonderful that this frail old man had found someone with whom to share his days at the ripe old age of 85. I couldn't have been happier for him. He offered to show me a photo. Reaching into his coat pocket he withdrew, not the gleaming photo that I was expecting, but a small white business card. A little unusual perhaps, but it did indeed include a tiny photo and he offered it to me with great relish. I was a little taken aback. I had, I'm afraid, been expecting a little old lady in a floral dress and sensible shoes. Instead I saw the face of a rather pretty Thai woman who I guessed to be in her late 40's. "She's only 48 years old" he told me proudly.

I hope that outwardly I managed to maintain my buoyant manner, but my head was full of worrying questions;

"What does she see in him?

Perhaps she's after his money?

Maybe a passport?

Does he know what he's doing?

Should I say something?"

I elected to keep quiet, but I have since been contemplating my reaction. Was I concerned purely because of the age gap, or was it because she was Asian? Would I have reacted in the same way if she had been British? Would I have felt differently if she had been French, or Indian? I had made an assumption, a judgement of her, based on a photo. A tiny photo at that. I now feel rather ashamed at the speed at which I had sized this photo up and placed her in a 'category'.

It's not the first time I've caught myself at this. Only a month ago I saw a rather grand lady, well spoken and well dressed, who had come in with an itchy rash. It looked like scabies, but it seemed so unlikely in this woman. As a result, I dished out the usual multipurpose, 'bit-of-everything-in-it' cream and asked her to return if it didn't improve. It didn't improve. After much procrastination, I reluctantly mentioned scabies, suggesting rather sheepishly that perhaps she might have been away somewhere where she could have picked it up? I was expecting to be met with outrage, but she didn't seem surprised at all. It made me wonder about the reality of her home life behind that grand exterior.

I've begun to realize just how many judgements we make about our patients from day to day. How intelligent is our patient, and how competent? How motivated, how sensible, how realistic, how honest, how vulnerable? When I think about it, nearly every clinical decision that I make is based on at least one such assumption.

Yet I am young, and my experience of this world is limited. All of a sudden I feel rather under qualified for the task.