Summer 2020. Covid had wreaked havoc with outpatient appointments, but the correspondence in Ted’s notes told a different story. His cardiologist’s mounting frustration was evident in each successive letter: investigation after investigation had drawn a blank. Dr C—’s final missive admitted he’d run out of ideas: Ted’s chest pains defied diagnosis. He hadn’t explicitly discharged Ted, but us pushing to get a further appointment was unlikely to get us anywhere.
“Let’s look at your medications,” I said. “Sometimes when there’s a puzzling symptom it’s a drug side-effect.”
What Ted was taking was very different to what was on his records. Dr C— had prescribed eight different pills for heart failure and atrial fibrillation, but Ted had stopped or reduced various of them to see which might be making him faint and dizzy. Like so many patients, he’d been given little idea what each drug was supposed to do. I went through them with him. I think he liked that. Rather than blithely insisting he should be taking them all, I was expecting him to be the arbiter.
Over the years since, on each visit to his warden-aided flat I’ve got to know him better. He is mentally sharp but physically disabled and depends on others visiting him. I’ve met his friend Jean many times, and a sister twice. There are adult children and other siblings but I’ve never come across them.
There have been a few acute admissions when his heart failure has decompensated, or when the blood supply to his legs has become critically poor. The vascular surgeons can’t operate on the blocked leg arteries; he would never survive surgery. Our district nurses come regularly to dress his gangrenous toes. “I’m dying from the feet up,” he told me once. Painkillers have at different times caused confusion, falls, and acute kidney injury.
Breathing is his biggest problem; he is left gasping after getting up to buzz me in with the entryphone. I’ve introduced the latest heart failure treatments, but effects have been marginal. Jean’s now housebound in a neighbouring town. They have thrice daily FaceTimes. More than once, Ted’s wondered about going into a nursing home. But he owned and managed them for 30-odd years. He knows how they should be staffed and run, and he knows he’d never find one like that now.
Often over the past year, he’s said he wished he could “take the white pill”, or that on my next visit I’d bring a shotgun. I’ve never got to the bottom of his chest pain. At times, I’ve wondered if it might be “heartache”, grief at what life has become.
Last December, he took himself off all medication. He announced it with relish, noting my failure yet again to come armed with a 12-bore. On my last visit, he was 79 days in and going strong. For the first month he felt better than he had in years. His failure did then decompensate, provoking a brief admission. His one concession has been to take a water tablet again.
“My first wife was a registered nurse,” he explained, when I said I’d have to write his case up. “We ran the home together. The number of times she’d take one look at a new admission and say to the doctor: ‘Doctor, please stop all their medication.’ And they’d come off everything and be so much better.”
He has diagnosed what ails modern medicine. “Everything’s decided on hundreds, thousands of people,” he told me, an astute summary of clinical-trials design. “That can’t possibly tell you what to do for any individual.” He looked at me over the top of his glasses. “There’s only one Ted, after all!”
The last time I visited, he asked how the write-up was going. I had to admit I hadn’t yet started. I will take a copy of this on my next house call and leave it with him to read. I hope I’ve done justice to his character and wisdom.
[See also: Child vaccination uptake is falling once again]
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This article appears in the 20 Mar 2024 issue of the New Statesman, Easter Special 2024