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Walking the Dog by Tim Atkinson

I have named my pain and called it ‘dog’ —Friedrich Nietszche, The Gay Science

I’ve got a cold. A stinking, rotten, sneeze-laden, shiver-inducing cold. I’m livid. Really, really angry. I mean—a bloody cold, for Christ’s sake! As if I’ve not suffered enough! As if I’ve not already hit the illness jackpot. A cold. A miserable, measly, melancholic cold. That’s really sticking in the jackboot.

It’s not really a surprise, I suppose. My immune system is nearly non-existent after years of anti-cancer chemotherapy. Mild anti-cancer chemo, mind you—I don’t actually have cancer, after all. I have a cold. A rotten, stinking, sniffling cold. I also have psoriatic arthritis which is an almighty pain in the neck... as well as in the hands and feet and knees and hips and elbows, wrists and ankles. Hence the methotrexate. (That’s the anti-cancer chemo.) Hence something else called Humera which is a biological infusion also specially designed to go to war with my immune system. Because—and far be it from me to boast here—my immune system is good. Very good. Too damn good. Or bad. My anti-bodies are very anti body—anti my body and in the absence of anything better to do (like fight off a real disease) they attack me instead. They attack the healthy bits of me, specifically my joints and the synovial fluid that surrounds them. Which somehow makes the pain it causes feel much worse. Because as someone called Sophocles said some considerable time ago—

Recognising that your suffering has been caused by no one else magnifies the pain.

Yes, this self-destructive serpent slowly devouring itself on an endless round of self-inflicted misery is entirely of my own making. My body doesn’t seem to get that this isn’t the way things are meant to be. So I have named my pain and called it… not dog, but Ouroboros. But Ouroboros, of course, (the original self-consuming serpent of Egyptian—and then Greek—mythology) creates as it destroys and its self-devouring circle represents infinity. Well I can vouch for that as well. Because this particular pathological creature certainly creates something, and something cyclical, enduring and never-ending: it creates an infinity of pain, an endless cycle of repeated aches and agues and other irritations. All of which is why, when something as simple as a cold decides to come along, I’m seized by a cosmic rage, a giant anger out of all proportion to the coughs and sneezing: a deep and bitter resentment. A cold! As if I’ve not got enough on my plate. Or rather, in my bloodstream.

The odd thing about medicine is that unless something does show up in your bloodstream, clear and unequivocal, no amount of pain, no list of symptoms, none of the obvious signs of illness seem to make much difference to the medical profession. Perhaps that’s why women get such short shrift when they complain of things like period pain. Perhaps that’s why conditions like fibromyalgia take so long to be treated. It doesn’t seem to matter whether someone has to crawl on their hands and knees and headbutt the door of the doctor’s surgery in order to gain entrance to the holy-of-holies; no matter that the patient faints or bleeds or writhes on the floor in agony. The priest-cum-shaman will still have to draw the entrails of a chicken, examine your stools or—now we’re in the twenty-first century—extract a phial of blood to sacrifice on the altar of the laboratory in order to be able to deliver whatever cryptic diagnosis happens to correspond to the results. But let’s not get ahead of ourselves here. That’s all in the future. First, you have to take the test and then you have to wait for the results… and wait patiently, training yourself (the word patient actually derives from the Old French pacient, meaning ‘to endure without complaint’) to be the patient you’re about to become. It seems absurd that you can’t book an appointment to get your results as you leave the surgery after having had your blood tests. But you can’t. “You can’t book appointments in advance,” the receptionist tells me. “You have to ring on the day; lines open at eight-thirty. And please, avoid ringing on a Monday.”

“But…” I stammer. Am I missing something here? How am I supposed to know on what day to ring for an appointment?

The receptionist seems to sense my confusion. She takes pity on me. Eventually. “Results usually take about a week,” she tells me. “Although they can sometimes take up to ten days. Working days, that is.”

“So I’ve got to guess when the results might be in and phone at eight-thirty on the day in question (not Monday!) and keep my fingers crossed both that I’ve guessed correctly and that there’s an appointment free?”

“That’s right,” she tells me cheerfully before looking down at her computer and typing something which probably says words to the effect that this trainee-patient lacks patience (patience—also form the Latin patientia which means suffering, something I’m going to be doing plenty of in waiting rooms from now on) and therefore needs to be taught a lesson. In being patient. A patient patient. She was only doing me a favour, I realise years later, writing this. Because if there’s one thing a patient needs to have to be a patient in the overworked, overstretched and under-funded NHS it’s… patience.

Despite this the health service clearly struggles with the word. The noun is fetishised to an extent that when you’re actually a patient you’d be forgiven for thinking that they’d fan you on arrival and unlace your boots, place some silken slippers on your feet and a glass of something sparkling in your hand before carrying you to your appointment in a sedan chair. Unfortunately, it’s the verb these days that is most in evidence. As I wait, patiently, as patients are expected to, for a very long time, I read a leaflet about something called a ‘Patient’s Charter’ (they struggle with the plural too); there are ‘Patient Surveys’ (quietly waiting to be completed without ever once complaining?) and a handwritten notice ‘To Patiants’ [sic] on the pin board explaining why the WI coffee shop is closing.

I’ve got used to it, now. Years of hospitals and waiting rooms, appointments, tests, results, examinations mean I can adopt a zen calm when waiting, as a patient has to do. Patiently. Or rather, I used to be able to. Then, suddenly, waiting rooms everywhere were filled with distractions. Someone had decided that us patients waiting patiently needed entertaining. There’s a TV now in phlebotomy; local radio is piped throughout the GP’s surgery and there’s a fish tank (my favourite) in X-Ray. They’re all as familiar to me now as my own four walls. But until the to-ing and fro-ing of my arthritis diagnosis I’d been fortunate. In 27 years I’d not really troubled the NHS over much. I was once, some years earlier, diagnosed with glandular fever. I suppose that’s relevant for two reasons: one, it’s another diagnosis; two, it’s about tests. Three (there’s a third reason I’ve only just thought of) it’s about me. Aged about 24 and in my first teaching job I’d gone to the doctor about feeling fatigued. Teaching is pretty tiring; I know we all have six weeks holiday each summer but, believe me, it’s necessary. For a start you can’t simply walk into a classroom and teach: lessons need preparing. There’s a lot of stuff to do. Second, it’s pretty physically demanding. Especially when you’re new to it, as I was.

“I’m so tired all the time,” I told the doctor.

“Go to bed,” she said. And it wasn’t an invitation.

“But it’s more than that,” I whined.

Only when I added a sore throat to my list of symptoms and she got up to feel my glands did she reluctantly agree to send me for a blood test.

“Your glands are a bit swollen,” she said as she started scribbling (pre-PC, and pre-preprinted stickers that could be peeled off and put on sample request forms like the one she was now completing) on a large, brown envelope. “Take this to the hospital,” she said, handing me a pathology request form with a flourish. “And phone back in about a week once the results are in.”

“But... but. What do I do until then?” I asked.

“Get a good night’s sleep,” she said.

A week later, and feeling no better, I phoned the doctor for the results of my blood test. “Yes, yes,” the Locum who took the phone call told me, “the tests have come through and it’s been confirmed.”

“Excuse me? What’s been confirmed?”

“The results of your tests.” His tone of voice implied he might be dealing with a moron. Maybe he was. “You have…” I hear what I think is a stifled laugh but could be static on the line, “… infective mononucleosis. Glandular fever, to you, young man.”

Young man! I must’ve been at least 24 and certainly felt and sounded older. And this Locum doctor didn’t sound as if he was very much my senior. I bristled. I always resented being called ‘young man’. When I was a young man it was so patronising to be called one. It seemed belittling, the kind of thing that Brian Clough would say on Match of the Day to some upstart interviewer—Motty, maybe, even though John Motson was probably the same age as Cloughy, or maybe older. But at least, for me, back then, when I was (relatively) young it made some sense. It might have been belittling, patronising, annoying, irritating but it was strictly speaking—chronologically—an accurate description. No more. The last person to call me ‘young man’ was probably younger than I am. It still happens. I still hear it being said, even though it’s no longer true. I don’t even look young. If anything, I look older than my fifty-four years. But that’s arthritis for you. That’s chronic pain. You can’t help but wear it on your face and it wears your face out, deepening the wrinkles and sagging the bags and generally exaggerating all the usual signs of ageing. But I didn’t know that then. In fact, back then, all I knew was that the doctor who had just diagnosed glandular fever had just asked me when my sick-note expired. I explained that I was phoning from work and that, well, I didn’t have a sick-note and didn’t know it was suspected glandular fever. But somehow, the effort of explaining the similarity between the symptoms of my illness and the symptoms of a hard day’s teaching were just too much at the time.

A few years later, and I’m in a different part of the country, seeing a different doctor about what on the face of it seem to be a similar set of symptoms: chronic fatigue, muscular aches and pains now accompanied by some serious swelling in my joints. The balls of my feet are tender. My fingers and toes have swollen. I’m finding it hard to get out of bed in the morning. Arthritis has already been mentioned. But back then—as a ‘young man’—I was convinced I couldn’t possibly have arthritis. Because arthritis is for old people, right?


“Arthritis can affect people of any age,” I was told in the I-thought-everyone-knew-this manner doctors must be trained to use at medical school. “You’d be surprised how many children get it.”

“But I thought…” my voice trailed off, imagining old, gnarled hands and crooked backs, men with walking sticks and women hobbling along on painful feet. Feet very much like mine, in fact. Because it was in my feet that I first noticed something, seriously wrong. At the time, however, it was my knee that was the real problem. I—my knee—needed an operation. The cartilage had been damaged doing something really stupid (jumping out of an aeroplane, if you must know) and, in addition, there was something the surgeon called a ‘congenital defect’ he’d noticed during the arthroscopy he’d performed. I never did ask him what that was because, in my final appointment after the surgery and after weeks of post-operative physiotherapy, it was my feet that were really troubling me. My knee was fine. And all the knee surgeon was interested in was my knee. If my knee was ok, it was ‘job done’ for him. He didn’t want to hear about my feet as well. “But they still hurt,” I told him. “When I walk.”

“Get some new shoes,” he told me. “The type with air-cushioned soles,” was his prescription. “They’re as comfortable as slippers.”

I did, and for a while, they were. But gradually things—principally, the shoes—deteriorated. And my feet still hurt. I limped. From the first time my feet hit the floor as I got out of bed to the final kicking off of slippers (real ones) by the bed at night, my feet, my ‘pedel extremities’ (in Fats Waller’s memorable words) ached. Other things began hurting, too. Like my hands. And then my knee—the one the surgeon ‘cured’—started to swell. And so it was back to the doctor. Or rather, back and forth between the doctor (several doctors) and the hospital, where tests of various kinds were undertaken. There were blood tests and scans and something rather alarmingly called a radionuclide examination. Then, after all the tests, there was the wait. Waiting for a letter, waiting for a phone call. Waiting. Because, of course, that’s what patients do. They wait. Patiently. And so I waited. As patiently as I could, as ‘like a patient’ as I could manage, as paceint as possible, while all the time my patientia was increasing.

You know you’re in for some bad news when you phone – as instructed – for your test results and they don’t give them to you straight away, when they tell you instead that you’ll have to see the doctor, when they ask in a kind voice if you’d like them to make an appointment for you. And then, when you do, finally, step into the doctor’s surgery it’s like stepping into the dock: the jury has returned after long deliberations; the foreman is about to stand and deliver the verdict. What happens in the next few minutes will, in one way or another, decide a large measure of your future.

“I’m afraid it’s bad news,” the doctor says as he looks down at the results.

And outside the surgery window, from over the fence, from one of the gardens of one of the small houses huddled around this cramped, urban medical practice, a dog begins to bark, rather loudly. And it doesn’t stop.
Author Tim Atkinson

I've been writing since the age of 12, having been paid what amounted to a month’s pocket money by the Railway Modeller magazine for an article about my train set! Since then I’ve written on a freelance basis for the Yorkshire Post, Times Educational Supplement, and The Irish Times as well as a number of online blogs and magazines. I’ve also published several books. My first novel, Writing Therapy (2008), was longlisted for the Young Minds fiction award the same year. I have written two popular school textbooks in the Hodder Wayland ‘Discover Countries’ series (India, 2010 and The United Kingdom, also published 2010) as well as three ‘A’ Level study guides. My second novel, The Glorious Dead, was published by Unbound in 2018 after a successful crowdfunding campaign.

'A vivid picture of battle-ravaged Ypres... rooted in historic fact.' The Soldier magazine 'An interesting read on an almost forgotten aspect of the First World War' Martin Middlebrook, author of The First Day on the Somme 'A powerful subject tackled with energy and skill.' Ian McMillan, BBC Radio 3 presenter

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