Last weekend, I talked to a patient about her father, and a father about his daughter. They are one and the same. We’ve walked only a short path together, but I’ve watched her blossom because of him, and him because of her. She’s not ready for him to die, because she doesn’t think there will ever be a time that she is okay.

I didn’t tell him, though I wanted to, that when he died, she would be okay. I didn’t tell him, but I knew that his love for her would be what would make it okay. I didn’t tell him I knew it would be okay because in another world, I am the daughter with the dying but not yet dead dad.

The similarities of our stories are not lost on me.

Remembering a colleague who worked with me in general practice. We were older doctors.

We had said goodbye when he was leaving the clinic to work elsewhere. In a quiet moment we were sitting in the tearoom talking, as he would move away in a week’s time.

We reminisced about working in medicine and in general practice, as we had known each other professionally for about 30 years.

I asked him about his plans for the future and he told me where he would work and what he would do, and he talked about his family.

Then he told me how, when the time came, he wanted his death to be.

We talked about how the future may not be known to us in advance. He looked at me and for a moment we sat in silence.

As things turned out, it was the last time we met.

A few years later he took his own life. Exactly as he had predicted.

My patient is 18. Depressed, shy, withdrawn, and with a very low self-esteem. She has suicidal thoughts and can’t see a future for herself.

I’ve managed twice to get her to agree to admission, and on both occasions she’s discharged herself on day two because they’ve insisted on weighing her. She’s so shy she won’t talk to anyone. She’s had bad experiences in the past in ED, and tells them just what they want to hear to send her home and “see your GP”.

I can see her spiralling down. I’m seeing her several times a week, just to keep her alive. It’s suffocating.

A new patient came to see me today, looking for a female GP to help with menopause. Somewhere in that first consultation she told me she has bipolar I, diagnosed 20 years ago. Almost nobody knows. Her husband, her psychiatrist, her previous GP. And now me, a complete stranger until today.

There is something quite extraordinary about that kind of trust.

We started a small dose of oestrogen, cautiously, because even something that may help her menopausal symptoms carries the risk of tipping her into mania. Two weeks later she feels so much better, and now we carefully add progesterone.

I sometimes wonder if people realise what GPs carry. These deeply private stories, fears and secrets, entrusted to us, often one after another, back to back. Then the door opens and we call the next person in. Nobody outside knows what has just happened in that room.

That trust is a privilege. But also such a strange, quiet weight to carry.

After the KFP nearly broke me, I found out I was pregnant during my OSCE prep. So determined to do my very best for my family, I put my heart and soul into preparing for the exam.

The day before the exam I started bleeding. I attended the exam with my mind completely focused on fear: fear of losing my baby. During the exam I continued to bleed, and it finally ended in a miscarriage.

Passing the OSCE was bittersweet, and I will never forget that day.

I fell pregnant the year after I fellowed, excited for the “next” stage of life. I did everything right. I prepped my body, my mind. And finally, I fell pregnant.

I worked through the first-trimester nausea and fatigue, until one fateful day at 10am, a patient asked if I needed help cleaning up the blood.

What blood? I asked, perplexed. She pointed carefully to the floor, where there was a small puddle. I told her I had it, and sent her on her way. I blinked at it several times, details blurring in my vision.

Blood. On my floor? At my feet?
Oh. There’s also blood on my leg. How did that get there?
Oh.
Oh no.
No.
No!

I rushed to the bathroom, and yes, it had come from me.
My baby.

I froze on the toilet. I had six consulting hours left. Fifteen patients. If I went home, I’d have to try to get in with my GP. Get a blood test, or an ultrasound. People had threatened miscarriages all the time. Surely. Surely I’d be ok?

I washed my face. I washed my hands. I took a deep breath.

And I went to my consulting room again.

I bled for the next six hours with increasing intensity. I couldn’t face telling anyone, explaining what was going on, cancelling patients, and risking cancelling again if it didn’t go well.

I just couldn’t. I told myself I’d worked in the hospital on ward call with influenza A. I could handle this.
Women bled all the time.
Pregnancies ended all the time.

I wish I had been kinder to myself, now.

The universe is cruel. I saw MTOPs and pregnancies that day, children, and heavy bleeding.
I soaked through pads.
I felt the cramps.
I got my bHCG done in a brief lunch window.
I got the results. It was declining.

I told my workmates on my way out. They understood why I was probably not going to be in tomorrow.

I called my GP’s clinic on the way home.
She called me right away. Got me an ultrasound that afternoon, somehow.

“There is no heartbeat,” I heard. “I’m so sorry.”
I knew. But I’d held on to hope. So it crushed me all over again.

I had a week off. And when I came back, patients asked me how my “holiday” was.

I didn’t tell them I could still smell my blood in the room.
I didn’t tell them I could still see my blood, remnants of my child, on my floor.
I didn’t tell them I felt broken. Failed. Betrayed by my body.

Only one person I snapped at, which truly is a testament to a strength I didn’t know I had.
“It must be nice to just decide to take a week off. I booked that appointment weeks ago!” he spluttered.
“I’m sorry my miscarriage came at an inconvenient time for you,” I seethed.

He apologised. I was numb.

You never know what’s going on in anyone’s life. Women are incredible. And we need more compassion for ourselves.

Whenever I diagnose cancer, I see a litany of ghosts in the room. Some of them are still on this mortal plane, but the echo of their memory, their spiritual form at the crossroads of life, appears before me.

The ghost of my brother in his 30s.
The ghost of my father in his 40s.
The ghost of my mother in her 40s.
The ghost of both my grandfathers.

The ghost of the first cancer I diagnosed as a GP.
The ghost of my first patient who died from cancer, five years on from her diagnosis, one I made because something was off about her reflux and I just couldn’t shake it.

It’s so close to home, as you would have gathered.

I live at peace with these ghosts. They haunt me only with the beauty of compassion and lessons learnt. Empathy and condolences, shared experience to a degree, and above all a reminder that to age is an honour. What a privilege it is.

I work in a private billing practice, but I bulk bill anyone with a cancer. I can’t bring myself to charge them. Or perhaps my otherworldly collective conscience reminds me to have compassion and patience above pay.

I wish it were simple, to see all these ghosts in the room. It is heavy, to see them all in the room, adding another to their midst. A new ghost.

But there will not be a séance or a sage-ing any time soon.

Before my day begins, I look through my list of patients. Some mornings, I pause for a moment before I open the door. I take a breath. I reflect on what the day may hold. I prepare myself — mentally and emotionally — for the conversations ahead.

These are the days when my most unwell patients are coming to see me. The ones living with irreversible, life-limiting illness. People navigating grief, fear, uncertainty, and loss. On those days, I know there may be little I can offer to change the course of their illness. My role is simply to be present — to listen, to bear witness, and, for a little while, help carry the burden they have been forced to shoulder. Some days I wonder whether I am enough.

Like so many doctors, there are days when I feel emotionally drained, questioning whether I have enough left to give while carrying the weight of keeping my patients safe, well, and sometimes, alive. It can feel like a heavy load for one person to carry.

Yet somehow, you find the strength. You borrow it from your patients, whose resilience humbles you every day. You draw it from colleagues who quietly understand the weight you carry because they carry it too. You find it in your family and friends, who remind you who you are beyond medicine.

And then there are the moments that restore you. The adolescent you’ve cared for since childhood who overcomes unimaginable challenges and steps confidently into adulthood. The patient who walks into your room beaming because, for the first time in years, they feel well again. The small victories. The quiet triumphs. The reminders that change is possible.

This is the yin and yang of general practice.

Despair and joy.

Loss and new beginnings.

Heartbreak and hope.

It is a profession that asks us to carry both, often within the same morning.

I cannot imagine doing anything else.

That small moment I take before my day begins — that single breath — is more than a pause. It is a reminder of why I do this work. It grounds me before I step in and somehow, it gives me the strength to begin again.

A patient’s grieving daughter once said to me, concerned, “You’re very young to have seen so much death”. Her sympathy was unexpected. Her own mother had just passed. Sometimes it pays to be reminded what an abnormal job we have. Most don’t witness pain and suffering as a normal part of their day. Some days it’s harder to see the light than others.