Catalogues of ailments

Several lifetimes ago when I was a recently married family doctor in a group practice on the west side of the city of Adelaide, South Australia, I remember coming into the house one day from the consulting rooms that opened on the street in front of our home, and telling Wendy about a patient I had just seen. This was a very interesting woman, a retired lawyer who had spent her professional life as a parliamentary draughtsman. She was single, and every annual holiday she traveled to a new destination, spending her annual leave soaking up the 'atmosphere' - the culture and ways of life - of the people in the city or country she chose as her destination. At first she had traveled to each of the main cities in Australia, then to New Zealand, and after that, as air travel became less costly while she became more well to do, she had visited Singapore, Hong Kong, India, Fiji, Honolulu, and several cities on the west coast of North America, San Francisco, Vancouver and Los Angeles (she made these longer expeditions by sea). She told me a little about these annual expeditions; usually she stayed put in the same hotel at her destination, using it as a base from which she made day trips, visited the local museums, art galleries, etc, went to live stage performances of plays, ballet, or whatever else was on offer. By the time I met her those travels were a thing of the past, she was old, frail and sick with multiple diseases that often afflict elderly people. She had survived breast cancer and gallbladder surgery, she had varicose veins and a small varicose ulcer, and most recently, not long before she became my patient, she had fallen and broken her wrist. She had a list of her diseases and disorders, arranged in chronological order according to their date of onset, and beside each one, her estimate of severity - the extent to which it inconvenienced her, caused pain, or interfered with her comfort in other ways, the medications or appliances she used for each condition, and whether, in her judgement, the treatment was doing her any good. Altogether she listed almost 20 conditions, all neatly tabulated. She was pleased and proud when I told her I intended to adapt her system for use in my practice; I duly did so, and it was my first serious step along the road that took me from family practice to epidemiology. I've sometimes thought I should go full circle and make a list of the ailments I have now in my 85th year, but it would be a depressing sight to see; so I'll continue my ad hoc approach, telling my excellent family physician what's bothering me the most each time I see her, ask her to deal with that and forget about the other dozen or more other problems on my unwritten list.