Unk – the use of deliberate placebos

Lionel Nicholls never married. He had grown up in Woolgoolga. He lived in a one room fibro shack next to his nephew Jack’s house, close by the beach. He had been a fisherman for much of his life, although he would have almost certainly have worked in the local timber industry intermittently, as well as on the Woolgoolga Jetty during times of peak demand. He was functionally illiterate.

His sole venture into the wider world was apparently his military service during the Second World War with the Australian Army. The story I remember best was his regular description of hair-raising trips through the mountains of Syria in a frigid winter, driving large trucks along perilous roads.

Unk’s fishing boat had been destroyed in the big cyclone of 1937. The same storm washed about 100 metres of Woolgoolga Jetty into the sea. Quite possibly he was still struggling to make a living when war broke out in 1939, so joining up would have been a logical enough step.

I don’t know whether the army managed to tame Unk, as he was affectionately known to all and sundry, but no one else seemed to have. He was singularly undomesticated. He kept cats and regularly seemed to have new litters of kittens. In later years it fell to his nephew  to gather most of them up and despatch them in the traditional rural manner. There was no vet in town in those days. Unsurprisingly his home was rather chaotic, and yet exuded a homely character.

When I came to town in 1981, he had been a long term patient of my predecessor, receiving daily Fortral injections for reasons that I never clearly elicited. At first I wasn’t game to challenge that practice as a young solo GP trying to make his way in a small country town. However, as the months went by I became increasingly uncomfortable giving a daily opiate injection to an old man who still managed to live in his own home, however humble, on his own terms and had no need or wish to go to hospital.

It took a little while to summon the courage to substitute his Fortral with something more benign. I had already worked out for myself that there was no rational discussion to be had on the matter with my grumpy old patient. I tried some vitamins, reasoning to myself that they might even help him, B1 and B12 came to the fore. I didn’t alter the daily routine, he still presented to the surgery every morning around 8.00 am, waiting with the swelling numbers of patients for the doors to be opened at 8.30 am (In those early days I didn’t have appointments, it was “first in, best dressed”. Fairly soon I started afternoon appointments, but left the mornings as they had always been for the good folk of Woolgoolga.)

Six days a week, Unk would be on my front doorstep around 8.00 am (For the first six months in my own general practice we lived out the back. The arrival of child number two and the desire for some sort of respite on weekends saw us find offsite accommodation in the latter part of 1981.)

Sundays were different, I went to him. I would take whichever of our children were capable of walking to give their mother a break. They were shy at first, but quickly learnt that someone had suggested to him that little children liked lollies. He took delight in handing over small bags to them, whilst the cats hopped on and off the bed, or exited via the window. I could see that it became one of the highlights of his week, so carried on as before. Interestingly, he never seemed to notice any difference when I injected him with thiamine occasionally, mostly normal saline, so I was at least able to avoid opiates. He was clearly dependent on the injection process, rather than the contents thereof. I think he was a lonely old man, quite reclusive, incapable of normal social interaction, and in need of some reason to have regular human contact. This we were able to provide for several years until the inevitable happened. He stroked out, and fortunately did not survive his trip to hospital, exiting this world having lived it generally on his terms. For me it was an important early lesson into the many and varied ways of humanity.

Of course, it would be impossible to practise in this fashion nowadays – such things would not be sanctioned in the current millennium.

Assoc Professor John Kramer