Iain is usually charming and friendly, and has a good joke to tell about his time managing a pub. But not today.
Using my best consultation skills, I ask Iain to tell me more about his worries and concerns. He has a long list. Apart from his ‘blackouts’ and binge drinking, he reminds me about his painful feet. His teeth hurt a lot. He is sleeping badly and is often irritable. He has little interest in ordinary things, such as watching television or reading. He rarely goes out of his house, partly due to the pain of walking. And he is distressed because he can no longer be bothered to see his children.
He leans forward and says, ‘You see doc, basically the problem for me is I just can’t see any point in getting up in the morning any more’.
He talks about his loss of ability, his painful feet and the complications of his diabetes, both present and to come. He talks about his loss of purpose, how he used to be a successful pub manager and a caring father. But now he has no role, with either work or family. His life is futile, a relentless trudge through pain and disability. All he can see is a slow, inevitable path towards death.
Iain’s problems seem to me to be beyond the reach of medicine, and way beyond the relevance of any possible formal diagnosis.
Iain and I are facing a profound, existential question. What, actually, is the point in his being alive?
I find myself thinking about Sisyphus, condemned by the Gods to spend eternity rolling a huge rock up a mountain, only to see it fall down again as soon as he’s reached the top. And then about Bruce Springsteen’s exhausted night shift worker: