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Making a mountain out of a mole
DISSECTING ROOM
JABS & JIBES
LIFELINE Ann McPherson Ann McPherson has been a GP in Oxford since 1979, with much involvement in both adolescent and student health. She is the author of several “soft core” sex health books for teenagers as an alternative to Health Education Authority leaflets, and she also writes books on women’s health for GPs and women. Her professional concerns are patients’ views of their illness and quality of life after treatment, brought about by her own dilemmas of whether or not to have chemotherapy for breast cancer. Who was your most influential teacher? Prof Tom Pilkington, for being simultaneously infuriating, challenging, well informed, and amusing—there was never a dull moment! What event has had most effect on your work? I keep a black book of my “mistakes”, which I started as a houseman after sending a patient home without her diuretics, and she returned 2 days later back in heart failure. What would be your advice to a newly qualified doctor? Keep a sense of humour and a “black book”. What complementary or alternative therapies have you tried? None. But it does not stop me from discussing them with my patients: personally I still want more evidence. What or who is the greatest love of your life? My family. How would you like to die? Between freshly laundered linen sheets, and quickly. What is your favourite film? Brassed Off—one of the funniest and saddest films I’ve seen. The title aptly describes how I felt after 18 years of Conservative government in the UK, and shows the profound effect on communities (and health) of unemployment and social inequalities. What is your greatest fear? Being stuck in a chair-lift above a ski slope. What are you currently reading? Enduring Love by Ian McEwan— pertinent, since I have had my own personal stalker for 3 years.
150
Making a mountain out of a mole here are so many ways to die”, quips Yossarian, roguish star of Joseph Heller’s antiwar masterpiece, Catch 22. Yossarian’s enforced bombing raids during World War II—based on Heller’s real-life experiences as a bombardier—are the source of his heightened awareness, and fear, of death. Although I can’t make any claims to such (anti) heroism, work at The Lancet this past year has often reminded me of Yossarian’s quip. As a self-confessed hypochondriac, it was probably the wrong job to take. It was a paper on malignant melanoma that tweaked my paranoia. A few days later, during an afterwork swim, I noticed a mole on my thigh that seemed—had it?—to have grown much bigger. After a restless night, I rushed into work and grabbed the nearest medical colleague. “You’ve got to check my mole!” I said. “Er, okay”, he agreed. And after dropping my trousers in a secluded room, he sceptically advised me to seek a second opinion. After an appointment with my general practitioner, I found myself at the lesion clinic of my local London hospital 2 weeks later. It had been 2 weeks of crises and insomnia: I had checked my mole on an hourly basis, flicked through books to find out survival rates, and, during dawn each morning, made a mental checklist of 11th hour conquests—visiting the Pyramids, doing a parachute jump— before I finally croaked. My mole was benign; so benign that the doctor didn’t even bother with a biopsy. He just looked at it, like a mechanic checking a dodgy tyre, and stood up, hands on hips. “Nah, bit of trauma”, he said, ruffle-haired and chewing gum. “You probably just scratched it or something.” He gave me a leaflet and sent me on my way, telling me to stay out of the sun.
T
“
As I shuffled from the clinic, I felt subdued rather than elated. It might have been guilt: how many people in the waiting room, I reflected, had genuine melanomas—and real reason to fear for their health? It was then that I saw my absurd paranoia for what it was: a premature anxiety about death—brought on, I guessed, by my new job. Many believe that a mid-life crisis is the full acceptance of mortality, and consequent regret about past decisions made. To be young, perhaps, is to feel immortal, but awareness of death gets everyone in the end—some, I was discovering, earlier than others. The English poet Philip Larkin (miserable while alive) once likened human awareness of death to a distant mountain on the edge of our vision, growing slightly closer by the day. Through the phantom mole on my thigh, I realised, it was Larkin’s mountain I’d seen. But then I remembered the words of the great American novelist John Updike in a Guardian interview (July 21, 1995). “You can’t help being your age, so your prayer is to put it out of your mind and appreciate the moment. After all, it isn’t a very nice way to respond to the gift of life by being vexed all the time about its ending.” If Updike could muster such joie de vivre at 63, I thought, why am I being so morbid at 24? So come on, I told myself, walking out of the hospital— visit the Pyramids, do the parachute jump, get the most out of life. But as I strolled along the sunlit street, I spotted an obscure shape on the horizon. That’s strange, I thought, entering the darkness of the London Underground, I don’t remember any skyscrapers in this area? What was that thing I’d seen? Was that a mountain? Daniel Davies
THE LANCET • Vol 351 • January 10, 1998
JABS & JIBES
LIFELINE Ann McPherson Ann McPherson has been a GP in Oxford since 1979, with much involvement in both adolescent and student health. She is the author of several “soft core” sex health books for teenagers as an alternative to Health Education Authority leaflets, and she also writes books on women’s health for GPs and women. Her professional concerns are patients’ views of their illness and quality of life after treatment, brought about by her own dilemmas of whether or not to have chemotherapy for breast cancer. Who was your most influential teacher? Prof Tom Pilkington, for being simultaneously infuriating, challenging, well informed, and amusing—there was never a dull moment! What event has had most effect on your work? I keep a black book of my “mistakes”, which I started as a houseman after sending a patient home without her diuretics, and she returned 2 days later back in heart failure. What would be your advice to a newly qualified doctor? Keep a sense of humour and a “black book”. What complementary or alternative therapies have you tried? None. But it does not stop me from discussing them with my patients: personally I still want more evidence. What or who is the greatest love of your life? My family. How would you like to die? Between freshly laundered linen sheets, and quickly. What is your favourite film? Brassed Off—one of the funniest and saddest films I’ve seen. The title aptly describes how I felt after 18 years of Conservative government in the UK, and shows the profound effect on communities (and health) of unemployment and social inequalities. What is your greatest fear? Being stuck in a chair-lift above a ski slope. What are you currently reading? Enduring Love by Ian McEwan— pertinent, since I have had my own personal stalker for 3 years.
150
Making a mountain out of a mole here are so many ways to die”, quips Yossarian, roguish star of Joseph Heller’s antiwar masterpiece, Catch 22. Yossarian’s enforced bombing raids during World War II—based on Heller’s real-life experiences as a bombardier—are the source of his heightened awareness, and fear, of death. Although I can’t make any claims to such (anti) heroism, work at The Lancet this past year has often reminded me of Yossarian’s quip. As a self-confessed hypochondriac, it was probably the wrong job to take. It was a paper on malignant melanoma that tweaked my paranoia. A few days later, during an afterwork swim, I noticed a mole on my thigh that seemed—had it?—to have grown much bigger. After a restless night, I rushed into work and grabbed the nearest medical colleague. “You’ve got to check my mole!” I said. “Er, okay”, he agreed. And after dropping my trousers in a secluded room, he sceptically advised me to seek a second opinion. After an appointment with my general practitioner, I found myself at the lesion clinic of my local London hospital 2 weeks later. It had been 2 weeks of crises and insomnia: I had checked my mole on an hourly basis, flicked through books to find out survival rates, and, during dawn each morning, made a mental checklist of 11th hour conquests—visiting the Pyramids, doing a parachute jump— before I finally croaked. My mole was benign; so benign that the doctor didn’t even bother with a biopsy. He just looked at it, like a mechanic checking a dodgy tyre, and stood up, hands on hips. “Nah, bit of trauma”, he said, ruffle-haired and chewing gum. “You probably just scratched it or something.” He gave me a leaflet and sent me on my way, telling me to stay out of the sun.
T
“
As I shuffled from the clinic, I felt subdued rather than elated. It might have been guilt: how many people in the waiting room, I reflected, had genuine melanomas—and real reason to fear for their health? It was then that I saw my absurd paranoia for what it was: a premature anxiety about death—brought on, I guessed, by my new job. Many believe that a mid-life crisis is the full acceptance of mortality, and consequent regret about past decisions made. To be young, perhaps, is to feel immortal, but awareness of death gets everyone in the end—some, I was discovering, earlier than others. The English poet Philip Larkin (miserable while alive) once likened human awareness of death to a distant mountain on the edge of our vision, growing slightly closer by the day. Through the phantom mole on my thigh, I realised, it was Larkin’s mountain I’d seen. But then I remembered the words of the great American novelist John Updike in a Guardian interview (July 21, 1995). “You can’t help being your age, so your prayer is to put it out of your mind and appreciate the moment. After all, it isn’t a very nice way to respond to the gift of life by being vexed all the time about its ending.” If Updike could muster such joie de vivre at 63, I thought, why am I being so morbid at 24? So come on, I told myself, walking out of the hospital— visit the Pyramids, do the parachute jump, get the most out of life. But as I strolled along the sunlit street, I spotted an obscure shape on the horizon. That’s strange, I thought, entering the darkness of the London Underground, I don’t remember any skyscrapers in this area? What was that thing I’d seen? Was that a mountain? Daniel Davies
THE LANCET • Vol 351 • January 10, 1998