By Dr. Glenn Colquhoun
The High Chaparral
For most of my career medicine has not been so friendly. I have struggled with doubt. I
have always felt that at any point I might do the wrong thing. For a long time this meant
that consultations were noisy with my own thoughts. Life was lived in two parts. In one I
would go to work and be unsure and struggle with the waiting room and paper trails and
fires popping up. In the other I would imagine. I would dream that I could fly. I would
soar up over the world like a young seagull and look down and be amazed. Moments
would open up like a ranch slider. Inside I found they were timeless. Poetry was good
and medicine was bad. I joked that poetry was the first girl I ever loved, the one I always
wanted but never felt confident enough to ask out, and that medicine was the girl I got
pregnant behind the bike shed and thought I had to make an honest woman of.
A few years ago I began to compile a book based on the stories of a group of patients I
saw over the course of one day in general practice. For a year I visited as many of them
as I could and asked them about their lives leading up to that consultation. I saw them in
their homes and among those things they cared about, then afterwards flew up into the
sky like a seagull with an old piece of string and looked down. When I came to write
about them I saw them with wet eyes – the sort of love that poetry demands of those
who write it.
I noticed that in consultations after that my head would calm sometimes and I would see
my patients’ faces slow down while they were talking. I was reminded of that day
outside the lecture theatre at Auckland University. Now wrinkles began to shimmy on
the faces of my patients. Parrots or bellbirds or fantails would appear on their shoulders
and dead people shuffle shyly out from behind them. Some would hide beneath their
skirts or behind their trousers and others would trail warily after. Some would haunt and
others would protect.
I came to understand that the anatomy I had learnt about at medical school was limited.
Ache and memory gave human beings other anatomies that were entirely specific, and
with increasing confidence I began to palpate these like the quadrants of the abdomen.
After a while I realised I had ghosts of my own and that they were present
in my consultations as well. I kept stumbling on them red-handed.
Card games would spring up in the corner of the office. My wrecked old dad, my
estranged wife, my bright and shining daughter would take the spooks they met on the
other side of the room by the hand and do the real medicine while my patient and I were left to talk about more important less important things. Often they would look at me and
shake their heads as though I was their ghost, a distraction or apparition from some less
These ghosts are with me still. Their medicine is usually either play, i.e., card games,
Ludo, mini-golf or indoor bowls, or conversations over food, i.e., biscuits, tea, potato
chips or jet aeroplanes. Even now one or more of them will follow a patient out the door
to offer them a cup of tea or slice of cake or game of pool. I am too stubborn and fallen
to call this prayer, but perhaps it is. I call it ghost talk. Poetry showed me that a person
is the tip of a fabulous iceberg. The shape we see is the line the pen has drawn onto the
map but it is determined only by the state of the tide at any given time. Beyond this
everyone has a layer of continental shelf.
But I am a GP who has spent his life working with Māori and young people, so I
suppose this sort of medicine has become important to me. I don’t often find myself
wrist deep in an abdomen or busy correcting acid-base equilibriums. Sometimes we
need to be mechanics. People are wheezing or bleeding or in pain. Stuff is dripping out
of them that shouldn’t be. Our physiology and our randomised controlled trials hold
there like Newton’s laws of physics. But on the magic edge of medicine other wonders
play out. Medicine blurs into the spirit and here medicine is as old as the hills. It is black
magic and weirdness. It is a type of quantum medicine where illness, happiness and
longing tangle and weave, blinking in and out and in and out of existence.
There are times for me in the consultation when the intimacy of two human beings
talking rivals the intimacy of the creative moment. In fact, I have come to understand the
consultation is a creative moment. It seems after so many years of chasing my
childhood sweetheart I have found her hiding in the eyes of that girl behind the bike
shed. I have expected for years that medicine should leak into my poetry but never
dreamed that poetry might leak into my medicine in such a way. On my best days there
is no separation at all between both disciplines. I feel as though I have discovered a late
love and, like all of those who have, it is all the more sweet for taking so long to wander
A non-randomised uncontrolled trial
It has taken a long time for me to rebel in medicine. It is full of high priests and
orthodoxy and impetus to act in the way it does because of impetus to act in the way it
does. And there is so much to learn that you might always be distracted learning it and
rarely step back and question. My doubt has been busy with self-doubt. And I have
always had writing to run to anyway when it gets too much. But for a long time I have
grown frustrated by the ten-to-fifteen-minute model of medicine in primary care. It has
always seemed to me designed by designers, and without imagination. And I have been
slowly frustrated by a medicine that usually expects patients to come to it and rarely
reaches out to see people where they are.
I have also been inspired by others – the quiet and gentle rebellion of old teachers like
Professor Sir John Scott, who retained their humanity in all the busyness, and the new
anger of colleagues in primary care such as Lance O’Sullivan.
Most recently I have come to believe that the stories my young people tell me demand
some response from my profession. They are at times a plea to the world of big people
to bring some explanation or justice or relief, however naive that might be. Not to
respond is a defeat in the natural order of things.
In 2012 I took some time out from medicine. I resigned from the clinic I had worked at
for many years because they wanted me to see more patients. My sessions usually ran
over time anyway, and I felt too old and stubborn to change. I wrote for much of the year
and let medicine tick. By the end of that year the distance had made me want to
practise medicine the way I wanted to. I knew I could rely on being employed for two
days a week by the local youth health service, but I also knew that, no matter how
understanding my funders, this would come with expectations about time and location,
and so I took a job for another two days a week as a youth worker in the same area.
From that time on I have been employed by two different organisations under two
different contracts with wildly differing pay scales, but in reality I do one job. I see young
people. We have clinics in the community and in two of the three high schools where
the best of the old model can be retained, but I am also free to leave the clinic each
week to follow up young people who need more time to talk or a ride to the hospital or
who need to know that they are worth a big person checking on how they are doing.
I get to help out on a local alternative education programme for students who have been
excluded from mainstream schools, and I run a creative writing group for those who
share a similar wound. I can see young people individually or in groups. I can see them
for two minutes, ten minutes, thirty minutes or an hour. I can bake with them, eat
burgers with them and watch movies. I can knock on their doors and explain again what
they are bound to have forgotten the first time round. I am poorer but richer. Some joy
has returned to medicine for me.
I think about patients outside of work now and wonder how to reach them as though I
am stuck on a line in the middle of a poem. Medicine has entered my imagination. My
room has filled up with toys and models and props that explain the abstract to more
concrete minds. My subconscious is figuring out what to do next in cases where I am
stuck. This has only ever happened in poetry, answers to problems appearing days later
when I thought I had given up on them. I have stockpiled a shelf full of books to give
away to young people who might find something they can identify with in a particular
story. To be able to hand someone a book instead of a script for fluoxetine or
methylphenidate or something to help them sleep and say ‘this is a story you might like’
seems a great freedom.
Many of the young people I work with have my cellphone number. For years I guarded it
as though it was some sacred barrier that could not be crossed. I am discovering that it is much more convenient for my patients to have it. No one has abused it. Texted
consultations have evolved in which patients are more direct in what they want to say
than they are when they are face to face. In the context of being able to see them face
to face later, it is a useful adjunct.
I’m not sure if any of this will make a lot of difference to youth health in the Horowhenua.
In fact I know that most of it won’t. It will improve some access to primary care for some
people, but so many of the young people I see needed to be seen ten years earlier than
they were, and their families needed services that engaged with them in caring,
constructive and enduring ways. But it is, I suppose, a personal response to the limits
we have allowed to build up around primary care – my own small non-randomised
uncontrolled trial. Strengths in young people can sometimes be seen only by being with
them outside a clinic. This is important because so often the path to establishing the
confidence and engagement of a young person is through growing their strengths rather
than concentrating on what is wrong with them. When we do not see people in their
contexts, we do not see the medicine they possess that can help them get better.
Copyright © 2016 Glenn Colquhoun
Extract from Colquhoun, Glenn, Late Love: Sometimes Doctors Need Saving as Much as Their Patients, 2016, Bridget Williams Books, Wellington, pp.23–30.