When I was in lower sixth form my school was invited to partake in a local inter-school public-speaking competition. This had been running for a few years but this was the first time it opened to state schools, so it was a great privilege to be asked to represent my Sixth Form.
The group, The Gabblers’ Club, meet once a month in a Bristol hotel and have a dinner (perhaps herein was founded my love of fine dining) and then there is after-dinner speaking from the students, for three minutes each, on topics allocated the previous month.
It was a lot of fun! I gained confidence in speaking, in listening, of constructing points. Some speeches were serious, some beautifully surreal. Each was something worked on hard and crafted by the student.
The club still runs today. I think the author and comedian Mark Watson took part a year or two after me, for the record.
At first I was very nervous, it was such an alien idea, standing up to speak, often within imposing private rooms of local hotels, with peers you didn’t know, teachers you didn’t know and the odd local reporter, barrister, business person. Over the few months I did it I grew to really enjoy it and get a kick from it. The concern that everyone was hanging on my every word was over taken by the thought that ‘only I know what I’m going to say next,’ which is a help if you find yourself in front of an audience. I loved it. At the final competition of the year I came second, which I was very pleased with.
For the final we could take a date! This was very exciting to a geeky sixteen year-old from dull Somerset! I asked a friend of mine, a girl from school (she had been in running for school representative too so it made sense)
Great evening, did the speech, everyone went home.
Two years later at a party I bumped into this girl again, all very friendly. She introduced me to a friend of hers, saying something like, ‘Malcolm gets super-nervous’. I blushed at the thought, feeling it a tad unfair, but let it ride. Why cause a socially embarrassing situation?
I was a pretty anxious youngster in my teens, that’s for sure. My OCD tendencies come out near an exam (rechecking gas and locked doors more) but for the most I think they are toned down to a modest, sensible paranoia. š
My friend, however, seemed to recall me as a very anxious sort, and by way of introduction recounted the evening of this public speaking competition. She described the two of us in the back of my parents’ car being driven to the venue. She did an impression of me squirming in the seatbelt, repeating, “I don’t want to go-can we turn back?”
The friend laughed.
I smiled. It did *sound* a bit like me perhaps, but maybe from five years previously. I felt uncomfortable, but, well, y’know, social embarrassment and all.
Later that evening, possibly even in the car in the way home, the hippocampus sparking a memory as it often does, I figured out why this story of me didn’t ring.
It never happened.
We *had* planned to go in the same vehicle, but due to some preparations on the day I had gone ahead separately! I was never in the car with this friend on the way to the event, just didn’t happen. I could prove it, there are photos and videos.
My good friend had made up entirely a false memory of the events. To the extent of an action and phrases I had said and was using this by way of introduction for me.
Yeah, smarts a bit.
Now this story might come across as bitter, it’s really not. I learned that day something really important; that our memories change. My friend was convinced of the story she told (and I’m sure would argue with me if challenged today). The memory and recall was wrong but thoroughly convincing for her. This occurred without coercion or stress, it just happened and the correct information was not retained.
Cancer.
There. I said it. At medical school we receive some training in breaking bad news. Some of mine was great, we had proper actors brought in and everything. This training continues throughout and in fact during my exit Consultant exams I had a station of breaking bad news to a actor playing someone who had lost their child in an RTC. She was exceptionally good. I think she might have actually cried. I know I almost did. But then I blub at that clover ad where the guy is eating the sweetcorn surrounded by his family. Gets me every time. Anyway, it was all fine. I passed the OSCE.
A big thing we’re taught is that once you say the word cancer, nothing else in that conversation is remembered. In breaking bad news terms you can’t expect any more information to go in. Kind of makes sense.
What if the patient says Cancer?
I had a chap a few years back ask me, directly, on arrival, if he had cancer, “I’m worried it’s the big C, doc”. Examining him I suspected it. Had a radiologist do a quick ultrasound and he suspected it too. When the patient asked me again, I had to tell him it was a possibility.
The family were rightly concerned. They asked many questions, all of which I answered as truthfully as possible, each with the caveat that, ‘we don’t know if it is cancer, of course,’
Appropriate further investigation was made. I was pleased with what I thought was an early pick-up by me, supported by the radiologist, and I felt I’d given the family time (albeit in an Emergency Department) to absorb the info and ask as many questions as they liked. I thought I’d done a good job.
I was slightly concerned that I might have been too optimistic. I kept saying,’it might not be, we don’t know yet’ and it occurred to me that this might cause problems when the diagnosis was bleak.
I kept an eye on the details of this patient by means of follow-up. Subsequent CT was all normal. The clinical suspicion and what I’d seen in ultrasound with the radiologist turned out to be nothing! I was pleased. I liked this chap a lot.
The complaint came later. I thought I’d given them false optimism. No, they recalled that I’d marched in, told him it was cancer and that we’d see him in clinic. Then I’d told them to go home. The complaint said I’d given a percentage likelihood of death. This had, understandably, upset them greatly. I’ve never done this in my life, firstly I wouldn’t know it and secondly it’s not appropriate without diagnosis in an ED. Other things were written that I knew were just not correct.
But there it was in black and white. Things I had said. That was their memory, their collective memory as a family, of a dismissive way in which I had treated them.
What do we gain from this?
Strangely, when I see docs saying they don’t want CCTV in the workplace, I kinda think they haven’t had an episode like this. I’m not sure I’d want every consultation recorded, but it would help a lot when people disagree over events. But that’s another discussion. And why you should always write notes at the time.
The main lesson is that of sympathy for memory. My school friend imagined a complete scenario with events and people and details and believes it. Tell someone they have a potentially terminal disease (even after they’ve asked you) and you’ve got to expect that, not only will retention be poor, facts may evolve and change and even be fabricated. That’s not the patient’s fault. It’s not anyone’s fault. That’s just how memory works sometimes. “I have no recollection of that event” as they say at government enquiries.
What did I learn? What would I do differently? I can’t lie if I think someone has a problem and they ask directly. I can only give honest information with as much support as I can.
I was really upset with this complaint at the time, as a relatively senior Registrar I thought I was handling things well. But it’s not about blaming the patient-I’m sure under duress, or even less, my recall of events might change too.
Or at least, that’s what I remember about it.
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“…well I don’t remember forgetting that…”
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This case is not about anyone you know or have ever met. Treat it as a work of fiction with inspiration taken from many sources, my own and others’. Non-contemporaneous.
idratherbeinresus 