took a closer look. ‘No, we don’t believe in vaccines,’ Mum replied matter-of-factly. I was shocked. I had mostly worked as a GP in working-class areas and never come across anyone who didn’t vaccinate their children. This day I was working in a leafy north London suburb and discovered it was almost the norm here. A lot of what we do as doctors is patch people up and keep them going for a few extra years. There is a lot of listening to people’s general health grumbles, giving a bit of reassurance and sending them out of the door with a pretty ineffectual tablet. Medicine is better than it was a hundred years ago but the main reason people live longer and only very rarely die in childhood is due to improved sanitation and nutrition. Clean running water and an abundance of food have saved far more lives than doctors and our medicines. Having said that, I believe the one great achievement of modern medicine is the widespread vaccination of children. Vaccines are cheap, safe and have saved millions of lives both here and all over the world. Measles used to be a major killer in the UK and it has now become a disease that I had only ever read about in textbooks. Despite working as a paediatric doctor both in England and Africa, I had never seen a real life case of measles.
Until this day, that is. Here it was in front of me, the widespread rash all over the body and the classic lesions in the mouth. I ‘Googled’ measles and, sure enough, Sebastian’s rash looked the same as the one on my computer screen. My final test was to grab Sue, our oldest receptionist, and bring her into the room. ‘Is this measles?’ I asked her. Taken aback but flattered to be asked her medical opinion, Sue took a quick glance and said, ‘That’s it. All four of my kids have had it.’ There it was: measles, a disease that killed millions of children before widespread vaccinations almost eradicated it completely. As a doctor who had only practised medicine in the twenty-first century, I should never have seen this disease. Measles was back and had become a disease of the middle classes. A disease of Hampstead, Wimbledon and Harrogate — so frustratingly unnecessary.
I was actually quite angry. Sebastian’s mum was unrepentant. ‘I think it is important for my child to build up his own natural immune system. He is on a special whole-food diet that boosts it naturally.’ I was fuming now. ‘The immune system is very specific,’ I tried to explain calmly. ‘The only way that Sebastian can become immune to measles is to either have the vaccine or to have the disease itself, assuming he survives it. He can eat all the organic dates and wholemeal rice in the world, it won’t give him immunity to measles, mumps, rubella, diphtheria, tetanus, meningitis C, whooping cough, haemophilus influenza and tuberculosis. These really aren’t nice illnesses, you know!’ It was not the time to be angry as Sebastian was quite unwell. There is no cure for measles but having no experience of the disease, I wanted the paediatricians to check him over. I sent them up to the hospital with strict instructions for Mum to keep Sebastian isolated from the other children in the waiting room.
Not all children can have vaccines. They can be harmful to children who have diseases of their immune system such as HIV or those having chemotherapy for cancer. Previously, these children were protected because healthy children were all vaccinated and so a disease outbreak was prevented. Now that healthy children such as Sebastian are no longer being vaccinated, these vulnerable children are at risk. The last thing a child on chemotherapy needs is a bout of measles. Vaccinating isn’t just about protecting your own child.
Darryl
‘What can I do for you today, Darryl?’
‘’Allo Dr Daniels. How are you?’
‘Fine, thank you, Darryl.’
‘I ’ope you’re ’aving a good day and that.’
Darryl was a local thug who had somehow avoided ever having been locked up despite years of fights, assaults and petty crime. He tended to be rude and demanding so his less than impressive attempt at being charming meant that he must have wanted something.
‘I need a letter to say I couldn’t go to my community service last Thursday.’
‘Why was that?’
‘I had bad flu.’
It annoys me when people say they have flu when actually they have a bit of a cold. However, it wasn’t the time to correct Darryl. He was significantly bigger than me and I have naturally cowardly tendencies.
‘Are you still unwell?’
‘No, I’m better now.’
‘Well, why didn’t you come in at the time you were unwell?’
‘I phoned up the receptionist and she told me that there were no appointments available except for emergencies. She also told me that my symptoms were probably viral and I should take some paracetamol and go to bed.’
We had clearly trained our receptionists too well and now Darryl had worked out how to get out of his community service without getting in the shit.
‘I didn’t want to waste an emergency appointment and that.’
How noble of you, Darryl. Such a shame that your high sense of altruistic morals couldn’t have been better demonstrated when you were kicking the shit out of some poor lad who’d accidentally spilt your pint. (I thought this rather than said it, for obvious reasons.)
I really didn’t want to write a letter for Darryl. I also had had a bit of man flu that Thursday. I had ventured in and spent the day feeling miserable. I didn’t see why Darryl couldn’t have done the same. I imagine he had a few beers the night before and decided to give the leaf sweeping a miss for the day, knowing he could hoodwink some foolish GP into writing a letter to get him off the hook.
‘My probation officer says I need a letter and that. I’m on my last warning for missing community service days. They’re threatening to take me back to court and put me away.’
So there I was, writing a letter as if to excuse my child from doing PE at school:
Dear Probation Officer,
We both know Darryl is an unpleasant little scrot who will do anything to slime his way out of trouble and get out of doing any work. He tells me he had a bit of a snuffly nose last week (boo hoo) and now wants me to write a letter so he doesn’t have to go back to court to face a breach of his community service order.
Please send him straight to jail and lock him up for ever as I am in a particularly unsympathetic mood due to the fact that I’m running late because of time-wasting twats like Darryl.
This was the letter I would love to have written. One day I will write it and bask in momentary satisfaction before they suspend me for unprofessional conduct and Darryl comes to my house and beats seven lumps of shit out of me. I hoped the probation officer would read between the lines of the more mundane letter that I actually wrote:
Dear Probation Officer,
Darryl tells me that he couldn’t go to his community service last Thursday as he had symptoms of a viral infection. He was not examined at the time and his symptoms have since resolved.
Nothing in this letter required any small degree of medical knowledge or skill, but the very fact that it was written by a doctor rather than his aunt Doris meant that Darryl would probably get off the hook with the court and avoid going to jail.
The pat dog
