prosthesis pt II / fit for purpose

Everything at the Speciality Rehabilitation and Mobility Centre feels bespoke; designed to be a perfect fit, from the orthoses to the wheelchairs to the consultants. Dr J is the embodiment of this. A dense undergrowth of wispy straight hair covers his chin, suggesting a mixed, likely half-Asian parentage. Another indicator of his age is a subtly receding hairline which seems to have reached an impasse at the frontal, topmost part of his crown. He stands tall at just over 6 feet, with what I can only describe as an unmistakably, incredibly dad-like physique (not exactly out of shape but not quite in it either) and looks like he would be just as at home in a pair of shorts as he is in his beige slacks. On a daily basis, staff and patients alike bear witness to his good-natured wit that seeks only to amuse, not impress - and in doing so always manages to charm. He mines his considerable wealth of anecdotes for entertainment value but also to help patients and junior doctors make informed decisions, sharing openly about his experiences and exchanges with certain patients, surgeons, prostheses, prosthetists, medical students, as an afterthought, casually quoting the numbers and evidence for or against a certain decision.

Sometimes, if you're lucky, he'll tell you about how when he was a medical student, part of their weekly teaching consisted of hearing a superannuated, imminently-retiring geriatrician begin to explain how to take a patient's blood pressure only to fall asleep midway every time, and how for those four weeks, they'd gather in that small room to always hear the beginning of the same talk but never the end. At his desk, he keeps a not-so-secret stash of flapjacks and chocolate brownies which he nibbles throughout the day and shares with secretaries and nurses and junior doctors. The overall impression you get is that he is both exceedingly youthful at heart, sincere, un-jaded, goofy at times, but also mantled with the restrained, indispensable wisdom that comes of being a certain age.

His locomotion is a unique composite of the geriatrician's amble and a surgeon's stride. His previous life as an orthopaedic trainee is obvious in his pragmatic, nuts and bolts approach to his patient's problems, but also sometimes in his communication. 'Ok. Go and see this patient and let me know.' It feels like an order, but a benign one, as in from a gym teacher or coach, authoritative but also avuncular.

Dr J's consulting style is the opposite of surgical. His patients tell him everything, and more often than not he lets them. They open up to him about legal battles, their marital problems, their daughter's upcoming exams. Interrupting patients when they get side-tracked is something I have come to regard as a minor and necessary evil, but for some reason Dr J almost never does this. At times he indulges in the digression. He listens intently, cracking jokes, offering sympathy, sitting in silence. Once they start talking, appointment times mean nothing to him. The way he devotes time and attention to each patient, you would think that they were his own mother or cousin, his own flesh and blood.

The further into community based medicine you delve, the less you deal with the purely clinical aspects of medicine i.e pathophysiology, pharmacokinetics. Instead, your day to day consists of negotiating the quandaries of how medicine fits into people's everyday lives - or rather how their lives have to change to fit around their illness / intervention. You come to realise that, unlike hospital medicine, there is no one size fits all solution. The best solution is always the one that's considered and designed for one person. You prop them up when they need help, you help them get back on their feet, get their independence back. But they'll always still need you, whether it be one or five or ten years down the line. For as long as they rely on their prosthesis or orthosis or wheelchair, they will also rely on you. It slowly dawns on me that the hospital was designed to discharge patients, whereas the SMRC was made to support them. At a vascular study day, Dr J described the psychological toll of an amputee witnessing other patients escaping hospital with their limbs intact. As the days go on, it seems more and more like Dr. J, with his surgical experience and indomitable concern for his patients' struggles outside of clinical medicine, was made to measure, custom built for this role, or perhaps it's the other way round. It's hard to imagine the SMRC without Dr J. It'd be hard not to feel like something essential was missing.

On my last day of placement, Dr J walks on a little ahead of me. He says quietly, almost to himself, 'Sometimes I worry that this isn't of much use for you lot.' Sensing a chance to express my gratitude, I say, 'Well, I feel like I've learned a lot about what the NHS provides outside of the hospital...' Before I can finish, he cuts me off with a witticism and a smile. 'Well, good - because that's exactly what you're here for,' he says, and then he wanders off into a doorway to wrangle a silver impregnated socket liner for his last patient. I don't get to say that by witnessing a different side of medicine, I've discovered a different side of what it means to be a doctor. I don't get to say that it's helped me discover again that medicine is an infinitely challenging, intensely humane, collaborative affair. Instead, I just wave and say, 'Thanks Dr. J.'