The Tale of the Dry Nappy

The conversion of the NHS from an institution of noble aims and aspirations to a flogged mule of service-provision has had unexpected consequences. Gone are the legendary days of zombie-like doctors stumbling along corridors 72 hours into their latest shift courtesy of the European Working Time Directive. However, also gone are the expressions of gratitude and appreciation that would make the zombie feel like its work was worthwhile. Patients (deservedly) have rights but rights now far outweigh responsibilities (and medicine is not the only sphere where this holds true). The niceties that lubricate such relationships have been discarded and replaced by litigious expectation.

During a busy shift I can see upwards of a score of patients. You try and provide a caring, personal service but, with the likes of 4-hour targets, can't help feeling a little overstretched and hope that you're not holding back a smile or sacrificing banter for pure functionality. This is highlighted further by the fact that the patient does not have twenty doctors they are obliged to consult - you are the only doctor they will see. Your experiences of that particular on-call may blend into a montage of signs, symptoms and treatments but for the patient (and their family) that episode will have an individuality and significance.

I only came to appreciate this last weekend during a weekend of night shifts. I was asked to review a baby by the midwives, who having passed urine after birth had now gone for 36 hours without wetting a nappy. They assured me he was still opening his bowels and were certain it hadn't all got mixed up in the noxious concoctions babies' rear-ends can produce. They'd even left pieces of strategically placed cotton wool inside the nappy to capture any traces of moisture for posterity.

I consulted my registrar and trudged up to the postnatal wards to reassure everyone involved in what was rapidly developing into an anuric frenzy. I spotted the Arabic name on being handed the patient notes and greeted the baby's mother who was visibly anxious. Almost immediately her expression changed to one of pensiveness and then a look of recognition.

Arab Mother: Dr Mohammedali?
Me: Erm....No, Dr Mehrali.
Arab Mother: Yes, Yes. Dr Mehrali!

The panic siren was now sounding and the red lights flashing in my mind as it desperately tried to recall the source of the familiarity.

Arab Mother: (Now in broken English and Iraqi Arabic) You treated my son for asthma two years ago. He was very sick. May Allah reward you with goodness!

As she said this she deftly donned an almost opaque niqab or full-face veil. I began to recall the case, one of the first cases I saw after qualifying from medical school. The little boy was experiencing a moderate asthma attack which responded well to treatment - nothing remarkable there - but what made the encounter stand out was his parents' tolerance (and I think appreciation) of my broken Arabic with which I falteringly explained his condition, treatment and prognosis.

Me: Ah yes. I'm surprised you remember. How is your son?
Arab Mother: All praise is due to Allah! He is well.

I went on to examine the new addition to their family and lo and behold the baby's nappy was wet and a lesson was learnt.