For doctors, what exist first and foremost are their medical categories and classifications. These have real existence, like immutable Platonic forms. The actual human being sat in the chair, with his or her symptoms, is granted existence only in so far as he touches these Ideal Forms. Anything else is 'nothing to worry about', probably psycho-somatic, illusory in some way, not quite there. This was true of my stomach symptoms, which caused puzzlement to break out like a rash on many a doctor’s forehead. Gurglings to the left of the stomach, no sensations in the stomach, light headedness after eating? These descriptions did not resemble, or only imperfectly resembled, the Platonic Forms set out in medical textbooks and were therefore shadows cast by the hypochondriac imagination. Hence the other strategy the doctors employ, completely disingenuous, couched in the glove of concern, which is to ask you, the patient, what you think it might be. What do you think it is? But what this means of course is not "guide me towards a diagnosis" but only "Let me put your mind at rest regarding the imaginary illness you're worrying about", “let me assure you it’s not stomach cancer” and so on. The doctor thereby turns the whole thing into a question about your mental health, his role redefined as the person who allays our fears rather than treats our symptoms.
One doctor, particularly smug and patronising, replied to my desperate story with "I'm not sure what you expect me to do; these are not symptoms of anything serious, barely symptoms at all I would say” and stared at me vacantly. He was a locum of some kind I think. I should have noted his name. All the bad doctors actually. A list of names. I'd like to hunt him down. I could access my medical records, get his name from there. No motive that Officialdom would recognise. Twenty years, after all, have elapsed. It was a summer's morning. A brief appointment. One of hundreds. Nothing remarkable. A young man with vaguely defined stomach problems, consistent with IBS, it might say. Possible psychological aetiology. I'd catch up with him, now living in Jericho, a house near the canal. He wouldn’t remember me of course. I’d say I'm from the council. We're inspecting moorings in Jericho. He’d tell me the boat's been there since he moved in. He's never used it. “Irrelevant” I’d reply, “completely beside the point”. We’d walk down to the water's edge. I'd tell him a ledger's been kept of his deeds. What? He’d say, confused, “What deeds? The deeds for the mooring?” “Wrong sense of ‘deeds’”, I’d reply, smiling. The other sort of deeds, deeds that he thought unrecorded, unregistered, and therefore erased, obliviated, inexistent. Your error, I’d say to him, was to meet someone's pain with blank contempt, pretend puzzlement, cold condescension. To fail to treat someone's experience as meaningful. This, I will explain to him, is casual sadism. The casual sadism of institutional power. Refusing to see a human being sat in front of you. Looking straight through someone and refusing to recognise them. Anyway, I’m inspecting the hull of your vessel for leaks, I’d say. I’d pick up a large stone from the river bed. I’d crack his head with it. He’d fall into the water. No, he’d fall into the boat. I’d set it free. A small narrow boat, a wooden skiff, floating down the canal, to where it meets the Thames. The body of a doctor laid out like Holbein’s dead Christ. Someone would see it from the bank, thinking he’d fallen asleep, but then see the slow ooze of blood and start shouting.
It pleases me to revisit this image, replay this story, as I do now and then. I have a number of them, little fictions, rubbles of memory. Very few end in death of course. We have, within us, flows of pleasure, flows of enjoyment, which need objects to fulfil themselves, to quench themselves, even if these objects are imaginary. This story of the avenged patient is one such imaginary object, around and through which enjoyment flows and gurgles. Of course, sometimes the imagination isn’t enough.