Harriet’s hats

Loaded down with four volumes of medical records, I struggled into the clinic room to see the next patient. Beaming from under a bowler hat covered with silver glitter, a plump, dishevelled woman greets me enthusiastically: “Hello, I’m Harriet! Are you my new neurosurgeon?” There is clear fluid dripping from the tip of her nose, and throughout the consultation she continues to wipe the recurrent drops of leaking cerebrospinal fluid (CSF). I listen in increasing despair as she stoically recounts 12 years of neurosurgical management, a litany of operations like a Michelin tour of the central nervous system. Flummoxed, I tell her I will have to seek advice. Afterwards I learn that she has delivered chocolates to all the staff she knows: the receptionist, the typist, the nurse unit manager, the physio and the surgeon who did her last operation.

At the next visit, I too am on the recipient list for chocolates. Harriet is wearing a hat of purple artificial velvet with appliqué trains. Still CSF drips from her nose. She wipes the drops with white tissues and drops the crumpled blooms to join the growing pile in her lap. I send her away with a bundle of coloured forms for further tests and scans.

Returning months later with her test results, Harriet is clutching her bus ticket and a broken sandal in one hand, and the ever present pile of tissues in the other. Yet more exotic headgear covers her scarred scalp. Is it possible she never wears the same hat twice? I suggest that we do yet another operation, and ask her if she thinks it’s worth the risk and bother. She wipes away a drop: “Definitely doctor. This dripping is awful!”

The operation is painful and leaves her with a bruised, purple face and swollen eyes, but still she smiles. Her concern and consideration for the staff make it difficult to tell who is looking after who. She is reduced to a rainbow knitted cap as she potters about the ward cheering and encouraging everyone.

At the post-op visit she is wearing a large floppy hat decorated with a plastic flower and a painted clown’s face. The clown’s smile is echoed underneath by Harriet’s grin as she reports that she no longer drips! I share her delight and tick the form to indicate discharge from clinic.

Moments later I hear a commotion at reception. Harriet is almost in tears. In spite of everything she has been through, this is the first time I have seen her upset. “But I always have another appointment”, she wails. The receptionist catches my eye and shrugs helplessly.

There are 1000 patients on the waiting list and outpatients is booked out for weeks. But for half her adult life, Harriet’s existence has been punctuated by visits to neurosurgery. I give in and overbook her for clinic in 6 months.

Next time I see Harriet, she is up on the ward, wearing a Santa hat and enormous red and green earrings. The faces of the ward-weary staff light up when they see her, as she hands out chocolates and jokes. She now comes to an appointment twice a year. We tell her she is doing well, and she reminds us that, in the end, medicine is about making people’s lives happier, and that doesn’t always take a fancy operation.