.jpg)
Patients rarely tell doctors the truth.
Not the whole truth anyway.
Over forty plus years in medicine, I learned that people conceal affairs, addictions, violence, shame, criminality and fear — sometimes behind charm, sometimes behind respectability, sometimes behind blood.
Doctors become experts in what is missing.
The hesitation before an answer.
The husband who speaks for his wife.
The bruise explained too quickly.
The child who blurts out what adults are trying desperately to hide.
Belfast, November 1983 and I was working at a GP practice in a downtown area. I’d just turned thirty-four. I’d finished postgraduate training and was planning my next move. I did a house call to a red-brick terrace in a strong paramilitary area. Cold stairwell. Damp wallpaper. Intimidating murals glaring from nearby gable walls. I trudged up a narrow staircase to the ‘good room’ at the front of the house. There, a ten-year-old boy sat up in bed. “He’s been poorly all day, doctor. Off his food, burning up and restless,” his mother told me. “I couldn’t risk taking him to the clinic.”
I told her I understood. She left the room, and I examined him, clumsily dropping the thermometer. As I bent down, the boy called out. “Don’t look under the bed. That’s where Da keeps his guns.”
I looked, and, sure enough, that was where Da kept his guns.
There was worse to come.
On my final day, a request for a sick cert was laced with menace. Around five o’clock, I called what I hoped was my last patient.
He was a small, bulky man with a high forehead and bulbous nose. His sullen face was scarred by acne, and his greasy hair was slicked back in a ducktail. He was in a pin-striped double-breasted suit and a white open-neck shirt. He smelled of cheap aftershave. He spoke first, in a distinct Belfast accent.
‘Howsaboutye?’
I checked the name (Dxxx Mzzz), age (forty), and address (near the city centre). ‘What can I do for you, Mr Mzzz?’
‘Nathin’ much,’ he said. ‘Just sign me certificate.’
I was puzzled because he looked healthy. Ugly, yes, but not unhealthy. And I’d seen him chatting and laughing in the waiting room. His face stuck out. When I called him, he walked without difficulty.
I asked about the certificate. ‘What’s it for?’
‘It’s a sickness certificate,’ he said. ‘I’m sick. Just sign the certificate and I’m outa yer way.’
I asked him in what way he was sick.
‘In every way. Can’t walk with the pain. Can’t …’
I cut him short. “You walked in here without help,” I said. “I don’t see any walking aids. Am I missing something?”’
He was stunned. He stared at me, as if he couldn’t believe what he’d just heard. I looked through his file. There was nothing recorded to suggest he was unfit. I glanced across and Mzzz’s expression hardened. Disbelief was replaced with menace. That’s when I grasped what was going on. He was under the care of a Dr Q. But Dr Q had taken his own life weeks earlier. He’d left a note saying he could no longer live with extremist threats.
Mzzz completely lost it. He screamed at me to sign his certificate, “if ye know what’s good for ye”.’
I hated everything about the man. The bully-boy posturing, the threat of violence, the lying. I should’ve left it at that. I shouldn’t have given him any more time. But I did.
‘Why do you need this certificate?’
‘Till keep me outa court. I’m up on five murder charges.’
I’d heard enough. “See yourself out,” I said. “I’ll write to the courts confirming you’re fit for trial.”’
After he stormed out, I found a letter from the Northern Ireland Forensic Psychiatry Service. It stated, “Dxxx Mzzz is the most dangerous psychopath we’ve dealt with since civil unrest began here.”’
I read that twice. I was leaving the city that evening. In ninety minutes, to be precise. Ninety minutes worrying about what I’d done. Just as I was wrapping up the telephone rang. ‘Is that Dr Carson?’
‘Yes.’
‘I’m Dxxx Mzzz’s solicitor.’
‘And?’
‘He needs that certificate. If I don’t lodge that certificate by Monday he’ll have to stand trial. He’ll go down for a long time.’
‘And?’
‘Sign the fucking certificate.’
I hung up, collected my coat and cheque and made my way to my car. An hour later, I drove across the border to the south of Ireland. I thought about that encounter for years.
Not because I was brave. I wasn’t. I drove out of Belfast, genuinely frightened.
But medicine kept placing me in rooms where human beings revealed what they were capable of.
Sometimes the clues were obvious. Sometimes they sat quietly in plain sight.
A glance beneath a bed. A framed photograph turned face down. The smell of stale cooking oil, damp clothes and neglect. Used syringes on the floor.
Children silent beyond their years.
Doctors notice these things because we have to.
My writing came from necessity. After hospital and family medicine in Australia, I returned to Ireland and set up a practice. I wrote to newspapers and magazines, offering to be a health correspondent. All I’d written to that point were prescriptions that chemists had difficulty reading. One publication, Woman’s Way, wrote back: ‘We can do a weekly column if you’re any good.’ I wrote about heart disease, breathing difficulties, allergies – anything that filled a page and paid a fee.
I eventually moved from journalism into fiction. My first medical thriller, Scalpel, became an Irish bestseller and opened unexpected doors into television development.
Around the same time, I developed leukaemia.
In 2003, I started anti-cancer therapy.
“You might live four more years.” Enter Rituximab, newly approved for specific cancers. And here I am, in 2026, still in remission and very well.
A chance encounter with a colleague during COVID challenged my idle notions of retirement. We swapped stories: “I remember a patient with… this woman told me… it was the little boy who warned me… I thought it was all in her head.” On and on we chatted, and by the end, I knew I had another novel.
Write about what you know: is the usual advice for writers. Doctors see drama in hospitals and family practice. We hear stories that leave us reeling. We’re sometimes exposed to extremes of human behaviour – such as my tale above. A GP colleague told how he stood for an hour in the middle of a field trying to ‘talk down’ a mentally disturbed man who had a loaded shotgun pointed at his chest. And the GP’s sole protection was his doctor’s bag.
In my long medical career, hospital and general practice, I’ve seen and heard a lot. The full spectrum of human behaviour, good and awful. Vile and saintly.
Concealed pregnancies, children put up for adoption, hidden addiction, domestic violence, financial ruin, suicide – “an autopsy may show the cause of death, but will never reveal the thoughts coursing through a troubled mind.” That, I heard at an inquest.
Hospitals and surgeries are strange theatres of trust - where we surrender control. We undress. We confess. We allow strangers to examine us, sedate us, cut us open and decide whether we live or die. Trust is implicit; abuse of trust is abhorrent.
That trust makes medicine fertile territory for thrillers — because betrayal in such places feels uniquely terrifying.
Now, in my 76th year, I’m using fiction to explore the dark side of medicine.
My next novel, Fatal Practice, deals with breach of trust in a medical setting. It follows one doctor’s struggle to understand what he uncovers in a rural GP practice.
I started with simple questions:
What if the prescribing patterns suggest something more sinister than incompetence?
What if missing files are being hidden deliberately?
What if a doctor realises deaths in a rural practice are not natural causes?
In the nineties, publishers were said to be looking for someone to do for medicine what John Grisham had done for law. I never became that writer. But the territory remains rich, dark and largely unexplored.
Fatal Practice by Paul Carson (Whitefox Publishing)
Paul Carson is a retired GP and bestselling novelist. His latest medical thriller, Fatal Practice, is published by Whitefox. Follow his writing and reflections on medicine at: Paul Carson website (www.paulcarson.ie)
No comments:
Post a Comment