7. This Man Should be Dead!

“I haven’t seen this man in 6 years,” the consultant told me. “He should be dead!” he jovially remarked.

Spoiler alert — he’s not dead. But the consultant only knows this effectively through hearsay — he is reliant on the practice to pass on any information about him.

The patient in question is infected with Hepatitis B Virus and has cirrhosis of the liver — end stage liver disease where the liver is so scarred and damaged that it can barely function. On top of that, the man in question is homeless and still drinks heavily, as well as his history of injecting drugs. HBV, cirrhosis, homelessness, and not seeing a specialist? There is not a hint of exaggeration when the doctor says he should be dead. Nor of malice, nor even of surprise; there is no miracle healing occurring, and the circumstances to the patient’s continued albeit slightly improbably existence are not surprising to the doctor, if slightly extreme.

“I leave his drugs for him in that cupboard, there. I don’t need to say hello to him, I just need to make sure he is safe. I know all about him and how he is getting on from his notes, but I can’t remember what he looks like.”

The patient has a relationship with the practice and comes in regularly for all sorts of treatments and services — rarely on time for an appointment, but the many drop in services and direct contacts ensures the connection. The GPs assess his conditions; the nurses take his blood tests, the specialist plans treatment for this one specialist condition. Multidisciplinary meetings that could contain centuries worth of professional training and experience in the people involved arrange funding and agree long term plans. It’s an unusual and complex system and it leaves no room for silo working, without involving colleagues, but it delivers an exceptional outcome in prolonging life against the odds of both nature and society.

But here is an important point, easily missed — if this patient did not care for his health, if he wanted to die, he would not have taken daily tablets for 6 years and sought enough healthcare to keep him alive. Many mainstream patients struggle with daily tablets, let alone a man who cannot reliably give the time nor the day. He is engaged and motivated to care for himself, but lacks the skills and stability to achieve it conventionally, the discipline to stop drinking and the structure to actively seek all available healthcare. Nevertheless, an adapted service that seeks to care for him and maintain a relationship has kept him alive.