Drink

Playing with truth is a dangerous game. I was at a party a few weeks ago, and when they suggested Truth or Dare, I lied, said I had to go to the bathroom, and hid there until it was all over.

Truth is good and I don’t deny it. I’m sure that Truth is the name of the moral high ground, which I catch glimpses of and should be proud that I know where it is, at least. I do try and tell the truth, especially since it’s something my priest, mother and teachers have always said I should. But what I’ve learned is that there are very few absolutes, and even less dead certs. You see, I never find a straight answer does, even for an easy clinical question. I answer everything, honestly, in terms of probably, usually, often or mainly, except for the recurrent favourite, of I just don’t know. I think it’s all rather too honest. It makes me all wishy washy when I really wanted to be making a stunning histological diagnosis at forty yards, in between assertive defibrillating and first -pass intubating, just like the doctors on ER. Instead I have become a woman whose vocabulary sounds like it came straight out of an MCQ paper, but whose time in the confessional is just getting longer and longer.

Oh yes, they said on the VTS, dealing with uncertainty is part of the job, this is what GPs do. But I’m growing bit too happy with it, I think; at least rather too much than should be expected for a trained, honed professional with access to ECG machines and blood tests. I’m now rather attuned to it. I’m comfortable with risk assessments. I like the soft, downy wooliness of the hedging diagnosis so much, in fact, that I find I have kicked my shoes off under the table as I vaguely give the odds. And I am startled whenever I find I have something truly definitive to say.

A few weeks ago someone asked me if I thought that her unusual –okay, frankly, bizarre- symptoms were because she had a rare disease, or because she was loopy. My patient asked this question with such a fearless and straightforward simplicity that I was rather taken aback, and wasn’t able to speak for a minute. Fortunately I couldn’t articulate my innermost thoughts, which were crystal clear, and went along the lines of ‘should I bundle her in the car and drive her to psychiatry right now?’ Instead, when words came out, I went with the automatic line about how, well, I just didn’t know. This was fortunate, my standard answer emerging, because the rare disease was diagnosed and nicely treated without recourse to inappropriate referrals anywhere. I didn’t tell my initial thoughts to anyone, but I ended up looking like a remarkably good diagnostician for the first time this year. Which, morally, is almost as good as telling the truth.

So you see, honesty is all about the timing. If I was really, really honest, I would be not just morally bankrupt, but destitute. People don’t always want the truth, at least not all of it, all at once. It’s trying to find the correct amount of truthfulness to spike a bite sized, easily digestible portion of dialogue that I find hard. I don’t believe that complete transparency is always desirable (John and Edwina I could have happily lived without ever knowing. Case in point). Surely honesty is a grey scale, starting nastily at the stark naked end, that you can dress up until you can hardly feel teeth bite. Clinically, it’s a horribly difficult business.

Unfortunately, patients haven’t learned this, as a reciprocal skill, and are in the habit of being, at times, painfully honest with me. Since qualification, I have been told, variously, that: my hair is too short, too long, and that dyeing my hair would result in divorce. I have been accused of looking (separately) terrible, pale, exhausted and in dire need of make up.

But there is worse. Leaving the surgery late, I ran into the dry cleaners. I was harassed as I piled my clothes onto the counter; the girl behind the desk looked at me askance. Other customers were waiting; there is no privacy when one is pulling dirty laundry onto a counter for inspection by a sullen adolescent. And believe me, it was an inspection: more thorough than the nit nurse, more methodical than a Cochrane review. She wanted to know exactly what each stain was on every garment; she wrote it down on a bit of paper that got longer and longer; the customers behind me listened, captivated. It was painful, and I was dishonest. Somewhere along the way I lost my footing on the moral high ground; I slipped and fell, but, hey, I enjoyed the trip. I paid cash, gave my name as Lewinsky, and sent my husband to collect the stuff when it was ready. Honest.