It was late spring and yet Susan arrived dressed in a heavy overcoat, which she kept on throughout the whole of our consultation. Her surgeon had written to me from a hospital in Blackpool. ‘I should be grateful if you could see this pleasant young woman, who has suffered from severe constipation for the last 14 years. I have carried out a colonoscopy, an MRI scan and a battery of blood tests and cannot find any obvious medical cause. She has been treated with senna, bisacodyl and movicol but she remains severely constipated. She is on the list for total colectomy (removal of her colon), but before going ahead, I should be grateful if you could throw any psychological insight into her condition.’
My heart sank as I gazed at Susan, huddled in her overcoat, looking down, unable to look at me, but I took a medical history and made some tentative enquiries about what might have led up to her illness. She responded in brief sentences. It was hard work. She was clearly very uncomfortable and I could not help her, but she returned the following week and we experienced another tortuous session. On the third week, I could not think of what to say. It was a pleasant day. Warblers were singing in the trees outside and I settled into a reverie watching the birds and letting my mind slip into plans for a trek along the West Highland Way. Time passed. Susan said nothing and neither did I. At 50 minutes, I announced. ‘It’s time to go now, Susan.’ She got up abruptly, pulled her coat around her and almost ran out of the room.
I felt awful. Why hadn’t I said anything? What was I going to write to her surgeon? Surely, she would never come back. But she did. The next appointment was very different. She strode into the room, took her coat off, sat down, leaned forward and glared at me. ‘Do you know how far it is from Blackpool to Sheffield?’ I shook my head. ‘It’s eighty miles! I have to get a train to Preston, change for Manchester, change again to get on the Sheffield train. And do you realise how far it is from the Sheffield station to the Northern General Hospital?’
‘About three miles’, I muttered.
‘Yes’, she retorted. ‘It took me three hours to get here last week and you didn’t say a bloody thing! I’ve been so angry, I’ve had diarrhoea all week!!!
I was amazed. This was the young woman who had had such resistant constipation for so long that her surgeon was going to remove her colon. Yet, getting really angry with me had reversed all that and given her diarrhoea.
We started to talk – really talk. She told me how ashamed she had felt when the man she was going to marry had rejected her, how she had gone back home, where her brother controlled everything she did, how she took a job in the local library and never went out. For years, she had felt locked in, trapped, and like her bowels, unable to move.
Over the next few weeks, she told me more and her bowels settled down and worked normally. Her surgeon took her off his list.
A year later, she came to see me again. She was a different person. She had lost weight, had her hair cut, was wearing make up and stylish clothes. It was like she was ten years younger. She smiled. ‘I left the job in the library and moved to Salford and took up a job in television, and,’ she added, waving her hand in front of my face, ‘I’m engaged to be married’.
And her constipation? That was all behind her!