I was spending a few weeks working in a very pleasant rural practice. It was nice to have a break from the poverty-fuelled social problems of the inner cities. I had dug out a few ties that I had long since stopped wearing and also rediscovered my best posh accent that I had last used for my medical school interview in 1996. Surrounding the surgery was a collection of very pleasant villages with big houses and twee thatched cottages. It was foxhunting and green welly territory. During a sweltering few weeks in July, it was a pleasure to be cruising around the countryside doing my home visits rather than stuck in city traffic jams cursing the lack of air conditioning in my car.
Driving down a small country lane, I came across a row of small run-down bungalows. They looked a little out of place in contrast to the rest of the local housing. They were the area’s small quota of council housing that the rest of the village tried to ignore.
The patient I was visiting was called Mr Hogden. He lived quietly with his sister in one of the less well-kept bungalows. He was only in his early forties but hadn’t left his bungalow for nine years. The medical notes seemed to suggest that this was due to a history of agoraphobia, but more obvious on meeting him was that there would be no way Mr Hogden would have fitted through the door. He was fucking enormous.
Mr Hogden resided in the smallest room of the bungalow. It was about the size of a double bed and was taken up entirely by Mr Hogden himself sprawled out on the floor. He had long since broken his bed and now spent his time on a very old, filthy looking mattress on the floor. Each of his limbs was made up of several huge rolls of fat with a hand or foot poking out at the end. His head emerged out of a humungous mass of lard that was his torso.
The sight of Mr Hogden sprawled out on the floor was a bit of a surprise but it was the smell that I really struggled with. The bungalow was like an oven in this hot July sunshine and there was only a tiny window in the room that barely let in any air or light. Flies were buzzing around in their hundreds and as my eyes slowly adjusted to the dimly lit room, it became apparent where they were coming from. Unfortunately for Mr Hogden, the flies had found that the warm sweaty crevices between his rolls of fat were a perfect place to lay their eggs. Emerging from his legs and body was a legion of maggots. The sight of the maggots and the horrendous smell were almost too much for me and despite priding myself on a strong stomach I had to do my utmost not to vomit.
‘You’ve got to help me, Doctor,’ Mr Hogden pleaded with me as he watched me take in the horror of his predicament. Despite the terrible state in which he was living, this was the first time that Mr Hogden had called out a doctor in the last ten years. He had managed to get to the toilet and back up until now and he simply spent the rest of his time lying on his mattress watching a tiny television that was mounted on the wall of his bedroom. His sister brought him his meals and Mr Hogden had quietly grown enormous without bothering a soul. Until now that was. This was yet another of those moments where I felt completely useless and, like all good cowards, I fled. To be fair, what was I going to do? I could have crouched down and picked the maggots out of Mr Hogden’s groin creases but I would have vomited. The flies would have fed off the regurgitated contents of my stomach, only adding to his problems.
I called the district nurses. I felt bad. I did. Really. No, I did. I warned them what to expect and when I bumped into them a few days later, they were amazingly stoical about the whole clean-up operation. They put me to shame. I went back to see Mr Hogden the next week. The maggots were gone but he was still lying on the floor of his squalid little room. We had a chat and talked about how we were going to sort things out. His expectations were low. All he really wanted was to be able to spend his days sitting in the lounge on a sofa and watching the television like a normal person. He was too heavy for the current sofa — hence the filthy mattress on his bedroom floor.
I was feeling guilty about my near-vomiting experience during our first meeting so decided to make it my mission to get him a new sofa. I phoned round endlessly and eventually social services agreed to supply a specially reinforced sofa for the bungalow. I had absolved myself. A few weeks after the sofa arrived I received a phone call from a hysterical Mr Hogden. ‘Please, Doctor, come round, please.’ Worried that the maggots were back, I avoided lunch and headed over. Mr Hogden was sitting on his brand-new sofa and had been there since it had arrived. Unfortunately, the effect of now sitting upright meant that his huge weight was now all being placed onto one pressure point on his bottom. He had not moved from his sofa since it had arrived and had developed unpleasant pressure sores on his bottom. The material of the sofa had gradually begun to stick to the infected sores and Mr Hogden was phoning me to tell me that he was now completely stuck to the sofa and couldn’t move at all.
I couldn’t quite comprehend what he was telling me over the phone, but as I arrived I saw that he was quite right. The material of the sofa and the sores on his bottom had become one. It was impossible to see where Mr Hogden ended and the sofa began. It was not a pretty sight and he had the same pleading look in his eyes that I had witnessed during the maggot incident. He was in a great deal of pain and I was feeling helpless again. I couldn’t believe that he had let his sores get so bad without calling anyone. He really needed to go into hospital but this was easier said than done. The first job was to cut him out of the sofa, which required a fair bit of teamwork, a set of garden shears and a very strong stomach. The next task was the more difficult job of physically getting Mr Hogden to hospital. I had ordered a specially reinforced ambulance with a strengthened trolley but, unfortunately, despite best efforts, Mr Hogden just couldn’t be fitted through the door. Four paramedics, a nurse, a medical student (I had to bring him along to show him that general practice wasn’t boring), several of Mr Hogden’s neighbours and I all tried to find different angles or ideas to get him out of the bungalow. In the end the fire brigade had to be called to cut out a wider door. They were reluctant and made Mr Hogden sign a disclaimer promising that he wouldn’t try to sue them for damaging his bungalow. Eventually, we got Mr Hogden to hospital. The next day my placement ended and I’ve no idea what happened to him. I hope he’s lost some weight and perhaps gained some quality of life.
Small talk
Drew was a very good-looking guy. He was in his early twenties with big muscles, perfectly chiselled features, blonde hair, blue eyes and a probably fake but nonetheless healthy-looking tan.
‘I’ve got a painful testicle, Doctor. Wondered if you’d have a look at it.’
I was the only male doctor to have worked at this practice for over a year and my first few days were spent seeing a queue of relieved men worried about their genitalia. Some had been worried about their ‘bits’ for months but had been too embarrassed to expose themselves to one of the female doctors.
So there I was, gently rolling Drew’s testes between my fingers, looking for lumps. It can be a slightly uncomfortable situation for the patient in every sense of the word, so I decided to try to make a bit of small talk to put him at ease.
‘So Drew, what do you do for a living?’
‘I’m a film actor.’
‘I thought you looked familiar. Have you been in anything I might have seen?’
‘That depends, Dr Daniels, I only really do gay porn.’
‘Ah, probably not then, no. You… erm… must have one of those familiar-looking faces I guess. Definitely wouldn’t have seen you in a film. Nothing against porn or anything, except the degradation of women and all that… well, not many women in your films, I should imagine…’
There was now only one person in the room who was uncomfortable and it wasn’t Drew. I really should remember to limit my small talk topics to the weather and city centre parking problems.’
Notes
It is always drummed into us how important it is for us to keep clear, coherent and detailed medical notes. These are apparently real extracts from medical notes. They have been doing the rounds as an e-mail.
1. She has no rigours or shaking chills, but her husband states she was very hot in bed last night.
