Lights Out

Lights Out
Pamela Maunsell
As you've been handed this video you already know I'm dead, and that I died by my own hand. It was 'Time for lights out' as Iris, one of my favourite patients, used to say. But before I vanish completely, I feel the need to justify my actions, partly because no one knows what I've been up to (a chance to brag as well, perhaps) and partly to prevent any misinterpretation of my actions should they come to light by other means.

It all started with Graham.

As usual, he was late for his appointment. I spent the time printing out prescriptions.

He knocked. 'Come in Graham', I shouted, loud enough for anyone in the waiting room (and probably next door) to hear, but oh no, as always, he'd stand right there till I got up and opened the door for him.

I reviewed his notes, 'Roll up your sleeve, please.'

'Why?'

'Because I need to take your blood pressure.'

Could he do that simple thing? Hell no, he sat there like the dummy he was and waited for me do it for him.

BP normal as usual.

All his tests were normal, every single one of them, every single time. Actually it was uncanny how normal they were. Usually, once a doctor starts prodding around he'll find something to fuss over but not with Graham. Yet here he was for his 2nd visit of the week and it was only Wednesday.

I looked at his notes. 'I see you've visited the counsellor and the podiatrist this week too.'

'Yes,' he answered. 'But my feet still hurt.'

There was nothing wrong with his feet; there was nothing wrong with Graham. He was just a time waster. A time waster who prevented me from seeing genuinely needy people and who must have cost the NHS thousands of pounds. I despised him, and I had despised him for so long that I'd finally decided to do something to bring the situation to an end.

'We've got to get to grips with your problems Graham, and I think I've got the solution for you. I have been asked to trial some new medication. It's very expensive and I'm only allowed to offer it to one selected patient. If you want to be that patient we'll need to start straight away, and you will need to commit to attending this surgery every weekday, for the next three weeks.' I knew he couldn't resist that.

Graham nodded 'If it helps medical science, I'm willing.'

I gave him a consent form to sign.

'Right, sit yourself in that wheelchair and roll up your sleeve.' To my amazement he did!

I gave him the injection 'It'll take a few minutes to kick in. Just sit quietly.'

I went back to typing referrals.

Five minutes later I asked Graham how he felt.

There was no response.

'I know you can hear me Graham, but you're going to find it hard to move. Don't be alarmed, all your vital organs are working. We have to wait a bit longer for the full effect, and whilst we do I'm going to tell you a story.'

Graham didn't move but some dribble started from one corner of his mouth.

'I want to tell you about Iris, Graham. Iris was the total opposite of you. Whereas you are mean spirited and egotistical, she was warm and generous.

'I met her 20 years ago when I started at this practice. Her husband had just died, and she had had a series of chest infections, I'm sure they brought on by the associated stress. However, within a few months she'd picked up her life again and was a productive member of society. You, in contrast are a lazy, selfish, greedy, 42 year old, little boy who sponged off his mother until she died and is now sponging off the state. You are utterly convinced that every professional in this town was specifically trained to help you and only you. Well Graham, we're sick of it.

I paused to centre myself.

'Anyway, back to Iris. As Iris grew older her osteoarthritis spread. She had one joint replaced and then another. She was a model patient, always doing her exercises, attending appointments and cooperating in her treatment. Always with a smile on her face. But arthritis never goes away and within a few years she was bed-ridden, and I was making house calls.

'She'd be lying in a huge, old-fashioned bed with the lightest of duvets covering her frail body. She'd look up as I entered and greet me warmly. When the pain got too much, I'd up her medication, but there's a limit on what you can give and even mixing and matching drugs didn't really help.

'Eventually, her mind turned to her own death and then from contemplating it, to welcoming it.

'Now, if she had the sort of condition that relied on medication to keep her alive, she could simply have refused to take it, but if she refused her meds she'd only end up in excruciating pain. Her only option then was a more active form of suicide, and her only means was to hoard the tablets I gave her. Now, I'm not saying that this is what she would have done, but I refused to even give her the opportunity. I didn't want her burdened with even considering the possibility. Instead, I insisted that a carer come in twice a day.

'She tried to explain to me, that it wasn't just the pain that made her want to die, but that she was distraught at how much of my time she was taking up and how she was wasting the NHS's sparse budget. I tried to reassure her, but she wasn't convinced.

Then one day she said to me 'It is time now doctor. It is time I moved on.' And she looked at me through her still beautiful, dark brown eyes and told me without a word that there was to be no more discussion and that I was to help her.

' "It's time for lights out."

'I refused. I couldn't do this to a patient, not any patient. It went squarely against everything I believed in, everything I'd been trained in.

'Her quiet response of "I understand doctor" was heart-breaking, and I turned away quickly so she couldn't see the tear forming in my eye.

'It was 3 months till I gave in. She didn't nag or complain or even ever ask me again but we both knew what she wanted and in the end I couldn't bear watching her struggle to stay cheerful despite her pain.

' "Soon," I said to her, "Be patient."

' "Thank you." She responded quietly and relaxed back into her pillows.

'I started writing her clinical notes in a way that would cover my back should there be an inquest. As an example, I added in severe chest pains together with a refusal to see a cardiologist.

'Every visit she would ask me simply "Today, Doctor?" and I'd reply, "Not yet, but soon."

'Then one morning, when the pain was really bad, I answered instead "Yes, If you're sure."

'She nodded and smiled, and I leant forward and kissed her wrinkled forehead. 'Goodbye Iris.'

' "Goodbye doctor, thanks but it really is time for lights out."

'She died peacefully. There was no post mortem.

'And so you see Graham those are the actions of a truly good woman.

'I spent a long time reflecting on her death, a nightmare when I was forced to compare myself to Harold Shipman. I knew his patients hadn't asked for death, as Iris had, but it still felt all wrong.

'Strangely, the more I thought about Iris, the more you came to mind - her antithesis. You're not old, you're not even ill, there's nothing wrong with you but last month you made 12 visits to see a doctor, four to the counseller, one to the podiatrist and another to the dietician, and that's a quiet month for you.

'So I thought, well if Iris wanted to save NHS resources, how much more could I save with you.

'Yes, Graham, I did tell a bit of a porky when I said your vital organs would go on working, actually they'll stop in about 20 minutes and death will follow very quickly after that.

'Your body? Well you're in a wheel chair for a reason Graham. I'm taking you down to the basement now, where you'll die alone. I'll move you to your house once surgery is over. Of course your notes for the last few visits show suicidal tendencies, along with a referral to psychiatric services, which I sent off yesterday. My notes will be supported by those of your counsellor, the lies you told her are about to back fire. Light's out Graham!

After Graham it got easier. I usually terminated a hypochondriac about once a quarter. I can't even remember their names now, well how could I? But I guess there were about 80 in my own practice. Four a year for 20 years, and I always managed to slip in one or two whilst I was locuming elsewhere.

But it's over now. No, I didn't slip up , I didn't get caught, not one family suspected foul play. They all believed their hypochondriacal relative was really ill, so weren't surprised at their sudden demise.
No, I've just got tired of it all, I've seen the first signs of motor neuron disease and I'm no Iris.

I know some of you watching this video will be appalled by what I've done and I can understand that. If I was in your shoes I would think the same but it seemed amazingly different from where I sat. Once I'd got started in seemed to be the most logical thing to do. I've no regrets.

But now it's time to go. I've chosen morphine for myself, my favourite drug.

Lights out.