See it, say it, sort it: to tell or not to tell?

Abstract

> ‘Far more crucial than what we know or do not know is what we do not want to know.’ > > (Eric Hoffer, The Passionate State of Mind and Other Aphorisms , 1955) What do we want to know, and what not? This often seems ‘irrational’, even unnegotiable, to others. Three vignettes from different decades portray our conundrums. A crisp, bright autumn morning. It is only my third week in this poor, inner-city practice: almost everyone is still a stranger. The phone rings in the brief handwriting-of-notes interlude between two patients. This is fortunately timed because the receptionist’s voice explodes with urgency and without preamble: ‘Doctor, Mrs O has just rung; she’s really upset. She says there’s something really wrong with her husband, Alf. She wants you to go there now … I really think you should, doctor. They live just fifty yards away, at the other end of this block. You can see your remaining patients when you come back.’ In 1977 such a request is not so unusual: the family-doctor is quite as likely to be called as an ambulance. In my haste I take the remarkably slim Lloyd George envelope of notes of this 64-year-old man and slip them, unperused, into my well-checked medical bag. Speed and now is of the essence; history can wait. Mrs O is waiting at her open front door. She is dabbing at her eyes with a handkerchief and then holding it to her chest, as if for comfort. She is clearly fearful yet coherent. She says: ‘He suddenly sat up and started gasping and then he … Doctor, it’s terrible: you’ll see.’ She leads me into a sparsely furnished yet meticulously cared-for bedroom: this couple may be poor, but they are proud. Alf is lying in a vast pool of blood, emitted from his mouth and now haloing his thorax. The blood has not dried …