May 7, 2011 in Dag

The House Call

It was the first house call I’d made in a very long time.

I’d been in general practice for fifteen years but things had gotten a little slow. Changes in demographics, people said. A new generation of young folk moving into the area, with a preference for big faceless medical clinics rather than a small, friendly local practice. I didn’t know much about that. But I did know that for the first time ever I was starting to have trouble making my ends meet.

A good friend had suggested locum-ing as the solution. “Hours aren’t great but it’s good money,” he advised. “If you do it for a couple of months, you might not have a life but you’ll clear up those debts, no problem.”

So here I was, knocking on a strange door in a strange block of flats in a suburb I didn’t often find myself, particularly not at eleven o’clock at night. As I waited for a response, I tried to prepare for this novel experience. Practising my bedtime manner. Repeating over and over in my head the different ways I could introduce myself. Introductions had long since ceased being a requirement of my regular work. Every one of the small roster of patients I saw had been on my books for over ten years. Obviously this was part of the problem.

As there was no reply from inside, I knocked again. Eventually I heard a faint voice coming from somewhere on the other side of the door:

“It’s open. Just come in.”

I turned the handle, pressed open the door and stepped into the flat. I could see straight away that it was a male’s apartment. The floor was littered with old newspapers, football magazines and empty beer cans. I made a mental note of this to myself. The name of the patient I was here to see was Pat, an epithet that was highly non gender-specific. Now I had a better idea of whom I was to be treating.

But when I arrived in the only bedroom within the flat, I was surprised to find the occupant of the bed was in fact a woman. She would have been somewhere in her late forties or early fifties, with shoulder-length brown hair and a friendly, although rather worn-out, face. However the most striking thing about this woman was her size. Lying flat on the bed, her sheets rose almost two metres above the level of the mattress, giving the appearance of a head sticking out the entrance of a brightly coloured igloo.

Stepping into the room, I tried to appear relaxed. “I’m here to see Pat,” I said cautiously.

She nodded and then opened her mouth to speak, but before any words could come out she sneezed loudly.

Relaxing at her affirmation, I pulled up a chair and sat beside the bed. I introduced myself and then opened my briefcase to take out my consulting pad and pen.

I checked my notes. “And you’ve had a problem with a lingering cold?” It was half question, half statement.

She nodded again. “For almost a month now. It just won’t go away.”

“I see.” I quickly considered the best way to take this further. Most likely the underlying problem wasn’t the cold itself. But how to break it diplomatically? It had become such a sensitive issue in these politically-correct times. I decided to follow my instincts; something about her told me she was an open sort of person and direct was the best way to go. Besides, in her condition she’d probably heard it many times before.

“I’ll see what I can do. I’m afraid your weight is probably a factor in the difficulty you’re having trying to throw off this infection.”

I paused, waiting to see whether I’d caused any offence. Fortunately my first impressions were correct. Far from being upset, she actually grinned. It was the reply that followed that threw me for a six.

“I’m not overweight.”

“You’re not?” I tried to make my response more of a polite comment than the exclamation it probably turned out to be.

“No,” she chuckled. “It’s okay, everybody makes that mistake. I’m definitely not overweight. I’m actually pregnant.”

Pregnant! That changed everything.

“This is a real concern,” I said. “It may be best to get you to a hospital for some proper checks. When are you due?”

She shrugged her shoulders. “Don’t know.”

“But you must have some idea. How long have you been pregnant for?”

“Twenty-seven years,” she replied casually.

“Twenty-seven years?” I repeated. “But that’s ridiculous, Pat.”

“I’m not Pat,” she said. “I’m Julie.”

“But I’m here to see Pat. Has there been a mistake?”

“No. No mistake. You are here to see Pat.”

“Who is Pat then?”

“He’s my son.”

“Well where is he?”

She pointed at her stomach. “Right here.”

At that point, I was just about ready to get up and leave. As far as I could tell, she needed a psychiatrist, not a doctor. It was only her beseeching and imploring, coupled with some fairly serious sniffing and coughing, that convinced me to stay. And that’s how I got to hear the extraordinary story of Julie and her twenty-seven year-old unborn son, Pat.

Pat was not Julie’s first child. Her daughter, Emily, had just turned three when she received the joyous news that baby number two was on the way.

At first, everything seemed to be going as per normal. She went through the regular battery of tests and ultrasounds, all of which showed that the baby was developing quite naturally. She did suffer from a slight case of morning sickness but that had cleared up by the end of the first trimester. Therefore she was not at all concerned when she hadn’t felt even the slightest twinge of labour three weeks after the due date had passed. After all Emily had been late as well. So although her obstetrician strongly recommended that she be immediately induced, she strenuously opposed any such interventions.

“The baby will come when the baby is ready,” she had said in response to anybody who offered her advice or opinions.

After another month, with the obstetrician now reduced to a nervous wreck, she finally consented to another ultrasound. To everyone’s great relief, this revealed a perfectly healthy, though somewhat cramped, two month-old baby. And although she had originally planned to defer on finding out the gender of the child until after the birth, she figured that she’d waited long enough. As a result, she was delighted to discover that her second child was almost certainly a boy.

By the end of the first year, and with no further sign that the child had any inclination towards coming out, Julie decided it was time to bestow a name. She choose Patrick as it had been the name of her much beloved paternal grandfather. She even approached the local church about having the boy baptized, but to her great disappointment they would not agree to performing the ceremony on an unborn child, even one who was now over a year old. In disgust, she cut off all ties with the church, the first, but unfortunately not the last, schism her unusual condition would precipitate.

As Pat grew, Julie tried to give him as normal an upbringing as possible. A good education was particularly important to her, but finding the right institution did turn out to be problematic. He was briefly enrolled in a number of different schools, both within the public and private systems, but unfortunately none of them met his very special needs. By around the middle of grade two, she finally gave up and Pat spent the rest of his childhood in home schooling. This seemed to suit him well and he showed a particular aptitude for mathematics, although his reading skills were never better than average.

While educationally things were going well, the situation began to take its toll on Julie’s family. Both her husband and daughter began to become impatient and to harangue Julie at every opportunity, insisting that it was time Pat finally be born. To this, Julie always maintained the same reply:

“He’ll come when he’s ready.”

This definitely did not mollify her husband. He claimed that Julie was babying the child, not allowing him to grow up and become a man.

“You keep treating him like this, and he’ll end up like some sooky little mummy’s boy,” he complained.

Stung by this criticism, Julie did everything she could to ensure that Pat had suitable ‘masculine’ influences. Although trying out for any local sporting teams was obviously not an option, she made sure to take him to the cricket and football at every opportunity. Still, that was not good enough and the two divorced over ten years ago, although the settlement turned out to be quite amicable and her ex-husband regularly came over to watch action movies on DVD and play video games with his son.

More hurtful to her were the conflicts with Emily, who for years whined and moaned that Pat was the favoured one and that Julie was always putting herself out to look after him at the expense of her elder child. Regrettably, the rift that developed between mother and daughter was never mended and to this day the two do not speak.

At around this stage in her recollections, Julie lit up a cigarette and began to draw deeply on it. I indicated that in her current condition, I did not think that smoking was advised. She nodded in agreement.

“You’re right. It’s a disgusting habit. I’ve been trying for ages to get him to quit. But he tells me he can’t. He just doesn’t have the willpower.”

I was surprised to hear this because otherwise willpower did not seem to be something Pat was lacking in. Despite all the setbacks and complications described previous, he was able to do well enough in his final exams to gain a place at university, where he completed a degree in computer science and information technology. Since then he had never had any problems with gaining employment, mostly via extremely well paid, short-term appointments.

Julie has, quite rightly, derived much satisfaction from Pat’s unconventional path through life.

“The greatest day of my life was when he moved out of home and found his own place to live,” she said proudly. “They say so many kids of his generation are still living at their parents’ houses when they’re thirty. But Pat moved out when he was only twenty-three.”

Since then he’s been able to build up quite a social life, even establishing relationships with a number of girls, although he has struggled to maintain these in the long-term. In fact his last girlfriend only just walked out a couple of months ago. Julie had done her best to convince her to stay but unfortunately, the young woman was deeply unsatisfied with the direction the relationship was heading.

“It’s just not good enough,” she had said. “He keeps saying that yes, one day he will be born, but he never tells me when. I feel like he’s just not prepared to make a commitment to me.”

“He’ll come when he’s ready,” was the advice Julie had given to her. It wasn’t enough to convince her to stay.

“But what about you?” I asked when Julie had finished telling me her story. “You seem to have given up a lot for Pat. Don’t you feel like you deserve to have a life for yourself?”

“I don’t know,” she replied. “What’s a mother meant to do except look after her children the best she can. I know there are a lot of aspects of his life I have to put up with. The rowdy boy’s nights I don’t care for at all, especially all that drinking. I never could stand the taste of beer. And the filthy state he always leaves this place in. I’m constantly telling him, why should I have to clean up after you? You made the mess, you clean it up. But it never seems to sink in.”

There didn’t seem to be much left to say. Julie and Pat obviously had a relationship they were both comfortable with. Some might suggest it was unhealthily co-dependent but it seemed to work for them. I prescribed a mild antibiotic for Pat, after checking with Julie whether he had any problems with allergies or sensitivities. I also advised her on some over-the-counter medication that might be useful to help reduce his symptoms.

“Don’t forget to make sure Pat takes it easy and drinks lots of liquids. I would strongly suggest you take him to see his regular doctor if this cold has not cleared up by the end of the week. And probably best to make an appointment for you to see an obstetrician as well, just in case.”

“I see him every month. Have done for the last twenty-seven years,” she replied. “Still demands that I have Pat induced but I’ll have nothing of it.”

“You do what’s right for you. Just make sure you take care of yourself. And tell Pat he should be taking better care of himself as well. Easy on the beer and ciggies.” I packed up my things and stood up. I had been here far longer then I’d anticipated and there were numerous other patients I was required to see that night. Still, before I turned to walk out of the bedroom, I found I just couldn’t stop myself asking one more question.

“If you don’t mind me asking, do you think Pat will ever be born?”

Julie didn’t seem to mind. She smiled a long-practised smile and gave a world-weary shrug of her shoulders.

“He’ll come when he’s ready.”

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