‘You’re a star, thank you. Right, I’m out of here.’ She shoved everything on pegs then looked down at herself, confused, starting as she realised she’d hung up her own bag too. ‘For fuck’s sake,’ she breathed, looking at Mel and I. ‘It’s going to be one of those days, isn’t it?’
Despite being accosted by one of the teachers on the way out, to sign a consent form I thought I’d already dealt with, I still managed to arrive at work before everyone else, bar Cleo, the practice manager. I said hello to her, disappeared off to my office, started up the computer and logged on. Pulling up Christy Day’s record, I went straight to the cohabitants section, so I could see everyone living at the address and their dates of birth:
Gary Andrew Day, 23.11.65
Ruby Claire Day, 11.01.97
Jonathan Christian Day, 23.09.99
I stared at the names, until it dawned on me that I’d got everything completely wrong. Yes, the Days had a daughter, but she was twenty. Too old to be in school. She wasn’t the girl I’d seen.
They did, however, have a seventeen-year-old boy; Jonathan.
He was the Days’ son?
I thudded back in my chair in horror. OK, so he wasn’t underage, which was the main thing – but he was still my patient, and his parents were too.
Jonathan Day.
I had no recollection whatsoever of seeing him full stop at the surgery, let alone one-on-one in this room. I could, of course, check immediately – his notes were a click away. But I was well aware of the guidelines. I needed a legitimate reason to view his patient record, and the second I opened it, the access would be logged, a trail started and questions asked.
I had to close my eyes for a moment to try and take it all in. I was in no doubt about the General Medical Council guidelines for all GPs, which are very clear; relationships between current patients and doctors are unethical. We are expected to maintain professional boundaries at all times and never to exploit the ‘inherently unequal’ balance of power between a patient and doctor. The more vulnerable a patient is considered to be, the more serious the abuse of power, and the greater the threat to my position as a doctor.
Jonathan Day was only seventeen and would be considered a young adult – certainly vulnerable – but as I’d been totally unaware of his identity in Ibiza, sleeping with him couldn’t possibly be a punishable offence. It did, however, present significant problems that I was now going to have to deal with.
I leant forward and put my elbows on my desk, head in my hands, rubbed my temples and across my brow with my fingertips and tried to think.
Fuck, fuck, fuck.
‘Bit early for that sort of language, isn’t it?’
I jumped guiltily and swung round to see my practice partner, David, standing in the open doorway, smiling, which quickly turned to a frown. ‘You all right? You look like someone just died.’
‘I didn’t have time to put enough make-up on this morning, that’s all.’
Embarrassed, he smoothed down his tie. ‘Sorry. Have you got five minutes before kick-off?’
I hesitated. ‘Sure. I’ll be through in just a second.’
He looked at me curiously for a moment longer… but I stayed silent, made myself smile brightly and waited for him to go, until he shrugged and disappeared.
First things first. I turned back to Christy’s record. Christine Jane Day.
I took a deep breath and began to type up my notes.
Written retrospectively, home visit, seen 14.09.17 at 18.37. Patient had requested home visit as unable to come into surgery because of severe D&V. Unable to keep water down, day three of symptoms. On arrival, Mrs Day was dressed, mobile and on visual assessment appeared in good health. She offered me one of three glasses of poured champagne in her kitchen. She admitted she had ‘been a bit naughty’ and had called me out to discuss her Botox business. Her husband Gary Day was present and they verbally offered me paid employment. Mrs Day confirmed she felt that had she approached me ‘legitimately’ I would have refused to meet her, because it might represent a conflict of interest. I declined their offer and Mrs Day became verbally abusive, referring to me as a ‘snotty bitch’. I informed Mrs Day that as she did not require medical attention I would be leaving. I accidentally dropped my bag on vacating the property and damaged their floor, for which I apologised. I did not offer to examine Mrs Day, due to her aggressive demeanour.
It was a fair and accurate account, except, was ‘verbally abusive’ too strong? But then, she had sworn at me, and I needed to make it clear why I hadn’t examined her, other than giving her a visual assessment. I made no reference whatsoever to her son’s presence – because it wasn’t relevant to anything that had happened, nor at the time did I know his identity.
I exhaled heavily and went through to David’s room, pausing to knock on the open door.
‘Hello,’ he said absently, eyes on his screen and shirt sleeves already rolled-up. ‘Have you had login issues? I’m getting a system error message. I can’t access anything. Bollocks, bollocks.’ He reached under his desk and his screen went black as he turned it off at the wall. ‘When in doubt, switch it off and on. Techies get paid a lot of money to come out and do what I just did. Cross your fingers.’ He flipped it on again and peered anxiously at it. ‘Are you sure you’re all right? You seem stressed to beyond and back. It’s coming off you in waves.’
Deeply dismayed to hear that, I sat down. ‘I do actually need to run something past you that happened last night, just so you’re in the loop.’
‘Thought so,’ he said. ‘Go on then, hit me with it. Oh, this bastard system. Cleo!’ He yelled like a major general. ‘Are we completely down – or is it just me?’
‘Hang on,’ came a shout back from her office down the corridor. ‘I think it’s everyone. Bear with me.’
David looked at his watch. ‘Eight minutes until the phone lines open. God. So, what are you about to tell me that’s going to make this morning even worse?’
I cleared my throat. ‘I did a home visit last night, a woman with D&V. I’d tried to persuade her to come in, but she wouldn’t. I got there, and she was sat in her kitchen with a glass of Champs on the side for me, at which point she tells me she’s made-up the D&V and wants to offer me a job in her new spa, doing Botox and fillers.’
‘Bloody cheek,’ David snorted. ‘Her, not you. Why do I never get house visits where people offer me booze and lucrative private work?’ He pressed the enter button on his keyboard repeatedly. ‘Oh come on!’
‘So, I tell her I might have thought about it if she’d been upfront, but now, not so much, whereupon she tells me I’m a “snotty bitch” and that she thinks she might have made a mistake after all.’
‘Lovely,’ said David. ‘CLEO?’
‘I DON’T KNOW YET, DAVID!’ came back the equally cross bellow.
I continued manfully. ‘Her husband is there, trying to talk me round, but I go to leave and then—’
Cleo stuck her head round the door. ‘It’s the whole system, and we’ve got no Internet connection either.’
‘Fuck, shit and arse,’ said David. ‘Have we been hacked? Is it just us or bigger?’
‘No idea, but can we all just come through so everyone knows how we’re going to handle this and it’s not complete carnage this morning?’
David jumped up, my situation already forgotten, and followed Cleo out to the main reception. Within a couple of minutes, all seven of the GPs, the two practice nurses and reception staff were congregated.
‘We’ve no active records, obviously,’ Cleo explained, ‘so you’ll be pen and paper, and retrospectively updating as soon as we’re back up and running. Reception will tell you who you have for your next appointment when you ring through to say you’re clear from the last. Alex, you’re duty doctor today, aren’t you?’
I nodded.
‘OK, reception, can you draw up ONE list of the emergency slots, keep it at the front desk and block them out as the calls come in? Please make sure you work from the same master sheet so we don’t get any double bookings.’