Ben was one of those delightful patients who put up with much but never complained. He had his first heart attack in 1975, but his real claim to fame was in 1985 when he appeared in a cardiology textbook. Seated at a Guy's Hospital lipid clinic, aged 63, he faced the camera to show his xanthelasma and his blood pressure being measured, while continuing to smoke his cigarette.
As time went by, he and I enjoyed that subtle transition, for which general practice still remains the richer, from doctor-patient to professional friendship. Last winter, I was tidying the office before we moved to a new health centre, and I came across the textbook. I managed to persuade Ben to pose for my mobile telephone camera, as he waited for his bus home from the surgery, holding the book open at the appropriate page. With his permission, and the new technology, the pictures were emailed to the author, now a professor of cardiology.
At 84, however, Ben found life getting tougher; he developed heart failure. After emerging from a 10 day inpatient stay minus warfarin and with a better dose of digoxin, he was due to come to me a week later for review. In the event, I was called directly to the car park: after a good breakfast, Ben had got in the car with his wife and son, but shortly into the journey he had complained of central chest pain and lost consciousness. When I saw him it was clear that his intermittent peaceful respiration would soon cease.
“I don't think we are going to do anything are we?” I asked his wife and son. We knew each other, and they agreed calmly just to wait.
Within five minutes, a peaceful end came, but what to do next? I got into his car, and we all drove to the undertaker. We agreed there was much in this which would have appealed to Ben's sense of humour. His son and I laid him out before I returned, only 20 minutes late, for the rest of the surgery.
His death rekindled for me the sense of privilege that comes with continuity of care. I am not sure that this is measurable or worthy of “points” on a so called quality scale, or for how much longer we in general practice may enjoy it.