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A difficult patient


EVERY doctor will have some patients who they will remember for ever, for positive or negative reasons. I had been warned by her oncologist that Gillian could be ‘difficult’ at times, so I was mentally geared up when she entered my ultrasound scanning room for an image-guided therapeutic procedure to give her symptomatic relief.

It was not that she was abusive or aggressive, but that she questioned and challenged everything. All staff had to identify themselves and state their function (this was before it was a standard requirement). I explained the procedure then spent the next ten minutes being cross-questioned as to the specifics. I quickly learned that my answers needed to be cogent and precise, and that the ‘trust me, I’m a doctor’ approach was of no value.

Some doctors find this difficult and threatening. I found it rather refreshing. Throughout my career I was regularly surprised by how seemingly intelligent people would show unquestioning obedience and compliance with utter nonsense in a medical setting. For example, on the instructions of an inexperienced nurse or aide they would remove all their clothes, including their underwear, and don a flimsy hospital gown when all they had come for was a scan of their neck. But the brainless Covid compliance means I am no longer surprised by anything.

I developed a good relationship with Gillian over the next months as she returned regularly for a repeat of the procedure. She knew when she needed it when she struggled to complete her regular early morning kilometre swim.

The background is crucial to this story. Gillian, in her early forties, was Jewish, an atheist and terrifyingly clever. She had studied philosophy in Oxford, the US and Berlin, and was currently a professor at a leading university working in modern European philosophy, social and political thought and theology. She had a particular interest in the Holocaust and had visited many of the infamous extermination camps. 

She had a complex life which she described frankly and elegantly in her autobiography, Love’s Work (Gillian Rose, Chatto & Windus, 1995).  She detailed her encounter with cancer and her treatment under the NHS, some good, much bad (I am relieved to say that I featured in neither category).

The sobriquet ‘difficult patient’ delighted her when I told her. After the publication of the book she presented my wife and me with a copy, signed ‘with great esteem and affection’. We read it aloud to each other while doing the ironing (it is a slim volume) and we were greatly affected by it. It is the most unusual book I have ever read.

One section in particular caught our attention. Towards the end she chronicles the tale of Camelot and King Arthur, who wished to end the fighting and feuds between the barons and lords by establishing the rule of law. He set up the Round Table of equality to encourage the best knights to join, one of whom was Launcelot. 

As the tale develops Launcelot and Arthur’s wife Guinevere fall in love, and the King discovers the truth. Gillian writes of his two choices: he could fulfil the law which he himself had set up and have Launcelot banished and his wife executed. In so doing he would preserve the law, the Table and the kingdom, but lose those he loved. Alternatively he could pretend not to know, but this would destroy the authority of the Table, and the kingdom. The story ends in great sadness and shows the vulnerability of love within and without the law which, she argues, is the bedrock of ancient and modern philosophy.

It was my wife who had the sudden insight, and we wrote to Gillian thanking her for the book which we enjoyed, and pointing out that Arthur had, in fact, a third choice. What he could have done was to pronounce judgement on his wife and her lover, then offer to die in her place. In this way he would fulfil the law, save those he loved, and preserve the kingdom. We concluded by stating that the biblical allusions were obvious.

Whether or not this was a Damascus Road moment, the idea clearly triggered her. Being Gillian, she went to the top and engaged with the Bishop of Coventry with whom she was already acquainted. And this brilliant Jewish atheist became a Christian – a wonderful example of the miracle of Christian conversion.

Events inevitably moved on and as her cancer became untreatable she was admitted to a hospice, where she expressed a wish to be baptised and confirmed in the Church of England. The event was set up for a Saturday afternoon in the ward, and she organised a small party with cake and champagne to celebrate. Since her friends were not religious they were invited to attend the party after the event. Being believers my wife and I were to be the only witnesses.

We were met at the door by a ward sister who told us that Gillian had suddenly deteriorated and was in extremis. The bishop had been summoned early to perform the baptism. We entered the room to find him praying over her, and the Provost of Coventry Cathedral holding her hand. That was her style. Within minutes she slipped into eternity. 

After eating a small piece of cake in her memory we left, but bumped into a group of her friends coming to the party. ‘Is it over?’ they asked. We confirmed indeed that it was over, and they were understandably upset.

Her well-attended funeral was held in Coventry Cathedral (where else). The eulogy was delivered by an academic colleague, and it well summarised Gillian’s character. She told us that in her university office Gillian had a reproduction on the wall of Fra Angelico’s The Annunciation which seemed to symbolise her ongoing search for deeper insight and meaning. 

As we left we reflected on the circumstances of her life and death, and in our proud non-conformist way we were strangely glad that God had taken her after baptism, but before they could make her an Anglican.

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Dr Tom Goodfellow
Dr Tom Goodfellow
Tom Goodfellow is a retired NHS consultant radiologist who had a specialist interest in paediatrics and cancer diagnosis.

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