middle-aged woman walked in, and her eyes widened as she saw both Laurie and Marc sitting there.
‘Hello, Judy,’ Laurie said with a smile. ‘I hope you don’t mind me sitting in on your appointment with Dr Bailey?’
‘Is this all to do with your GP training thing?’ Judy asked.
‘Yes.’ Laurie smiled. ‘If anything, Dr Bailey’s senior to me—he’s been a GP for longer than I have.’
‘That’s fine. I don’t mind you sitting in.’
‘Thank you. Just pretend I’m not here,’ Laurie said.
Judy looked at Marc. ‘So you’re not another locum, then?’
‘No, I’m here permanently.’
‘Right.’ She blew out a breath. ‘That last locum was terrible—he spoke to you as if you were a toddler.’
Laurie didn’t say a word—the practice manager already knew how everyone felt about that particular locum, staff and patients alike—but she wanted to see how Marc dealt with the situation.
‘I’m sorry you had that kind of experience with him. But I’d like to assure you that that’s not the way I do things, Mrs Reynolds,’ Marc said. ‘How can I help?’
‘I’m probably wasting your time and I’m making a fuss over nothing, but I’m just—’ She sighed. ‘Well, I’m tired all the time. That locum sent me for blood tests, but I never heard anything back.’
Marc looked at the notes on the screen. ‘I can see he checked you out for an underactive thyroid. Can I ask how your periods are?’
‘A bit on the heavy side,’ she admitted.
‘That can make you a bit anaemic, which in turn can make you feel tired,’ Marc said.
She grimaced. ‘I’m almost looking forward to the menopause so I don’t have to put up with them any more.’
‘You don’t have to put up with heavy periods now, either. It might be another five years before you’re menopausal, but periods can often be a problem in the lead-up to menopause. I can give you something to make them a bit more manageable.’
Laurie liked the way he’d got straight to the point without any fuss or embarrassment.
Marc looked at the screen. ‘Your blood results tell me your thyroid is working properly, but given that your periods are a bit heavy I’d like to take some blood and check your iron levels, if that’s OK?’
Judy nodded.
‘In the meantime, you might find it worth taking a supplement with B vitamins and zinc. That often helps with energy levels. Have you been under any extra stress lately?’ he asked as he took the blood sample.
Judy shrugged. ‘No more than any other mum who’s got kids with exams coming up in a few weeks and they have to be nagged into revising.’
‘Are you waking up at all in the night?’
‘Not that I remember. I sleep like the dead.’ She gave him a rueful look. ‘Though my husband’s been complaining about my snoring, and the kids say we do synchronised snoring.’
He returned her smile. ‘And I bet they told you where it’d embarrass you most.’
‘In the post office, where everyone could hear them.’ She rolled her eyes. ‘Yes.’
‘It could be that you have sleep apnoea.’
‘What’s that?’ Judy asked.
‘It’s where the soft tissues in your throat relax when you’re asleep and block your airway for a few seconds, which brings your body out of deep sleep. It’s so short you won’t remember waking up. Even though you might think you’ve had a good night’s sleep, you’re not actually getting enough deep sleep to restore your energy levels.’
Laurie liked the way he’d explained it: concisely, and in layman’s terms, while putting Judy at her ease. Marc was definitely going to be an asset to the team.
Judy looked worried. ‘Do many people get it?’
‘It’s pretty common. About one in every fifty women of your age get it,’ he said. ‘But I need to ask you a few more questions to narrow things down a bit more, if you don’t mind?’
Marc’s manner was as nice as his voice, Laurie was pleased to discover, and he got a lot of information from Judy while keeping his questions relaxed and sounding concerned rather than aggressive.
‘Do you have hay fever or anything like that?’ he asked finally.
‘Well, I often get a bit of a sniffle this time of year.’ Judy flapped a dismissive hand. ‘But it’s nothing I’d bother a doctor with.’
‘Any symptom’s always worth checking out. That’s what I’m here for,’ he reassured her. ‘I’d like you to have some tests, because from what you’ve told me I think you might well have sleep apnoea. I’ll need to get in touch with the local sleep clinic, but what’ll happen is that they’ll give you a monitor to wear overnight to measure the oxygen in your blood and your breath, plus your heart rate, and then they’ll analyse the data. It’ll take me a couple of days to arrange, if that’s OK? I’ll get Phyllis to ring you as soon as I have some news.’
‘Thank you.’ Judy looked surprised. ‘I’d never even heard of sleep apnoea before.’
‘It might not be that,’ he reassured her, ‘but I think it’s a possibility and it’s worth checking out. If nothing else, we can cross it off the list of potential causes of your tiredness. You can do some things to help yourself in the meantime. I’m pleased you don’t smoke or drink heavily, as that tends to make sleep apnoea worse, but losing weight would help you. So would sleeping on your side rather than your back.’
‘How do I do that?’ she asked.
‘The easiest way is to put a tennis ball in a sock and pin it to the back of your nightie, so it’s not comfortable for you to lie on your back.’
‘Oh, very sexy,’ she said with a grimace. ‘My husband’s going to wet himself laughing.’
‘You said he’s snoring, too. If it disturbs you,’ Marc said, ‘then you can do the same thing to his pyjamas. And tell him it’s on your doctor’s advice.’ Mark smiled.
‘I’ll do that.’ She smiled.
‘Now—your periods. It says here you’re not on the Pill.’
‘No. John had the snip after our son was born.’
‘OK. Have you had any problem with taking any tablets with progesterone in the past?’
‘No.’
‘Good. It’s oestrogen that’s making your periods heavy, and the progesterone will help balance that out a bit. You take the
