A bunch of folk just like me, but sweeter, fill in a smattering of glucose columns whenever they can, missing a few days while getting on with their lives. They never bingo all eight sugar boxes on the one day, because they are normal, fallible human beings. They diarise to please their diabetic educator, who secretly knows that the patient eventually learns to write fiction and will merely go through the motions. Which brings us straight back to bowel charts.
Examining the motions is acceptable only in very isolated social groups: mainly microbiologists or dung beetles. Even then, it’s only ever someone else’s sh**. Describing your own waste products in any more than vague terms is, as I say, diabolical.
I have a middle-aged patient—let’s call her Julie: the name and gender have been changed to protect his identity. Actually, his real name is Julian. Julian is a hypochondriac with a comprehensive approach to health—all known diseases are divided into those he has had already and those still to come. Although he is essentially a good person, Julian owns a bowel chart. Unsatisfied with the date and time column, he devotes two thirds of his page to description. And, unlike my diabetics, this white space is never left unsullied.
“Food terms should only ever describe contents upon entry, not exit.”
I could almost handle reading hard, soft, hard. But egg-white mucus is pushing the relationship. Perhaps I should take this seriously (I put it down to too much pavlova), but I reckon food terms should only ever describe contents upon entry, not exit. The words custard and chocolate, Julian, have no place in the faecal lexicon.
Julian is an earnest, sincere man. Like many hypochondriacs, he is chronically lonely, having never married—the bowel chart wouldn’t have helped. I feel reluctant to deny him his anxiety pressure-release, yet my chart-reading role is psychological torture. An ethical dilemma. That’s when I thought of my medical student.
‘Julie,’ I said recently (that’s not her real name). ‘Julie, I’d like to know more about the next patient’s bowel habits. Take as long as you need and call me in when you’re finished. Completely finished.’
The Bristol stool chart pictorially displays a spectrum of seven stools, much like the seven wonders of the world. The pyramids are at the top (ouch), progressing to the splendid Colossus and ending with mud dripping off the Hanging Gardens of Babylon.
I paced guiltily outside the room, knowing Julie didn’t require a Bristol chart to apply meaning to Julian’s excreta any more than a psychic needs tea leaves. Julian the Elder emerged first, beaming, virtually whistling the Hallelujah chorus (coincidentally, the last of Handel’s 52 movements).
I cringed as Julie followed him, but she looked surprisingly serene. ‘He reminded me of my grandfather,’ she observed. ‘Nice enough.’
‘And his bowels?’
‘Normal,’ she snapped quickly. We never spoke of it again.