“My suspicion is that Mrs Pepper is inflicting this ulcer on herself”, the words out of my boss’s mouth.

We were in the sister’s office, in dermatology outpatients, discussing the morning’s patients. There on the table in front of us was a photo of a huge ugly-looking ulcer on a woman’s right lower leg, almost encircling it from her knee to ankle.

“I reckon she is using some thing like caustic to keep it open”.

I was the house doctor on a skin firm (a team of doctors under a consultant) at Guy’s Hospital. The idea anyone could do this to themselves was a shock to me.

“We’ll bring her in, clean it up and ask the surgeons to graft it. Bell, can you organise this for me please?”

“Yes sir, There will be a bed available next Tuesday. Is that okay?”.

Dr Wells nodded. In the three months I had been on his ward, the diagnosis of minor self- mutilation had been made a couple of times. I thought it was ridiculous and didn’t believe it. ‘Who would ever do something like this to themselves?’ and ‘what on earth for?’ I couldn’t accept anyone doing this. Maybe an over zealous episode of spot or scab picking but deliberate gouging of normal skin.

Well, I was to learn something in the next few weeks. I was to see it with my own eyes. Mrs Pepper was admitted and her wound cleaned up. She seemed very keen on the whole idea.

“Oh, thank you doctor. At long last I will have the opportunity to be normal. I will be able to get back to my old routine. I will no longer be a burden on my family”.

The graft was a complete success. The uptake was one hundred percent, unusual in an ulcer this size. Everybody was delighted including Mrs Pepper. She was enthusiastic with her thanks. It was decided to keep in a couple more days.

Her husband and children were all over the moon with praise, joy and gratitude.

“God doc”, her husband said. “This is fantastic. This ulcer has been around for more than five years. Our whole life has revolved around Mum and her ulcer. At long last we will be able to get on with life again. I’ve had to take so much time off work to look after her and the kids. It has been so trying. She has spent most of the time with her leg up and has been having daily dressings. I’ve become a slave to this ulcer. I’ve come to the end of my tether. I’ve been close to leaving her so many times but I’ve stayed because of the kids. Last month I thought I would leave anyway. Then came the admission letter.”

“Well, I hope it all works out for you”, I replied. I was beginning to get a queer sort of feeling. Something was not straight here. I couldn’t put my finger on it but…

“Well dear, we will let you go the day after tomorrow”, Dr Wells told her. “You will be off into a brand new world without your ulcer. You will be able to get back into life again”. I caught a flash of feeling go across her face. What was that? It didn’t look happy. “I won’t see you again on the ward but we will see you in a week in outpatients.”

The next morning I received an urgent call to get down to the ward pronto. An urgent call on a skin ward. This is a first, I thought.

“Come with me”, the ward sister grabbed my arm and led me off to the women’s toilets. She put a finger to her mouth and indicated that I should walk on my tip toes – be very quiet was the message. She led me to one of the cubicles and indicated for me to stand on a toilet and look over into the next one.

OMG! I couldn’t believe my eyes. Mrs Pepper had her bad leg resting on her other knee. The dressing was lying on the floor. She had something in one of her hands and was slowly and deliberately scrubbing at the graft. She was wincing in pain as she did it.

Astounded, I stood there just staring at this performance. My boss was right. This lady was into self inflicted mutilation. I crept out of the toilets feeling disturbed. I rang my boss.

“You were right sir. She’s scrubbing her graft off in the toilet”. He asked me to confront her. I suggested that he do it. By the time he arrived she was back on her bed . She had replaced the dressing.

“Oh! Dr Wells, something awful has happened, my ulcer feels sore and painful. Something isn’t right”.

She denied she’d done it, even when the sister and I told her we’d seen her do it. Whatever next! She was discharged and given an appointment for out patients and with the psychiatrists.

What was she going back to? A husband who was looking forward to a new life. What would he do? Why did she do it?  

Old commentary

“Isn’t this hard to believe? It was for me and now it isn’t. Later Dr Wells told me, “This is a lot commoner than most of us might like to imagine. I often suspect this sort of thing is going on but can’t prove it.

I sat with him scratching the back of the right side of my head (inflicting a very minor wound to my scalp) trying to understand why anyone would do such a thing, This area on the back off my head years later became my picking stress spot. I couldn’t stop it. It was sort of automatic. One day I asked a medical mate to cut it out. That fixed it but there is still a small thickening there.

“I’ll tell you what”, Dr Wells continued. “You are in for many more surprises”.

“Like what”? I enquired.

“Well, you are having a hard enough job believing what you have just seen with your own eyes. You may have to start believing what you suspect without proof. You may come to realise that a lot of ill health is sort of self-inflicted or maintained and not only in the way that this woman is doing it. You’ll see.

“Oh come on sir. You’re teasing me.”

“Well, I can’t prove it but I am sure some ‘illnesses serve various functions for people that they have lost sight of. Let’s say you’re angry with someone and you don’t deal with it. You suppress this anger and forget it. The things that made you angry persist. Well, just maybe, you end up damaging yourself. In effect, you turn the anger in on yourself. I am sure a lot of symptoms have this kind of thing behind them”.

“Sounds a bit far fetched to me”. I didn’t say that I thought he was off his rocker. I forgot all about this conversation until about eight years later. Now I am convinced he is right and I can’t prove it.

    2019

Who knows what was going on behind closed doors in this family. We humans can get up to some nasty stuff with each other. The dam builds and the life force ends up distorted. Its distorted form ends up destroying the joy and wonder of the love that was once there. To what extent is ill-health or even illness a consequence? To what extent are we not listening to the whispers, shouts and screams as the life force tries to get through.

I have some advice for we men and you women.

Not too many years ago a husband and wife team were consulting me together. He kept calling her mum and referring to her for answers to my questions to him, mum this and mum that. I remember thinking I wish he’d stop calling her mum.

A little while later he came in for a minor accident. While stitching him up her started to talk about his impotence. I had a powerful impulse to tell him what I was thinking but thought better of it and suggested he come back another day, so we could look into his impotence.

What I wanted to say to him was this. You refer to your wife as mum. You are not supposed to fuck your mother. You refer to her all the time for answers to questions directed at you. As a child you are not supposed to fuck your mother either. You need to grow up. Probably a good idea I kept my mouth shut.

My advice to men – don’t call your wife mum.

My advice to women – tell your man to stop calling you mum, even if you kind of like it – know you have him under your thumb.