I greeted Chris and Emily Parsons at the door to my surgery shortly before 0900. Given that it was a Sunday, my receptionist was absent and the waiting room deserted. It had been raining steadily since before dawn and my two visitors quickly closed up their umbrellas and deposited them in the stand by the door.

"Morning, Mart," Parsons said, stripping off his MacIntosh, shaking off the water, and then laying it carefully over the back of one of my chairs. He was dressed casually in a shirt, pullover and trousers, and wore glasses rather than the contacts he sometimes favored.

As he and Emily stood side-by-side, I was reminded that she was a head shorter than her husband. Like him, she was somewhat on the plump side, though hardly obese, and unlike Parsons, had a full head of curly reddish-brown hair. I couldn't help but think that they looked like they belonged together, something few people probably would say about Louisa and me.

"Any lingering problems last night?" I asked.

"No," Parsons replied. "Slept like a baby."

Our baby had been up twice during the night, and I hoped Parsons had slept better than I had. I looked at Emily for confirmation. "No problems," she said, with a forced smile that didn't quite hide her worry.

"Good," I said, and saw Emily frown. She undoubtedly was hoping I would say something reassuring. However, until I'd completed my examination I wasn't prepared to give her false hope.

Instead, I grabbed a fresh card for patient notes. "Should I have you register with the practice first?" I asked, my eyes at least attempting a smile. "I wouldn't want to be accused of not following proper procedures."

"You'll be okay." Parsons' eyes nervously twinkled back at me. "I'll put in a good word for you with the head of the PCT."

I was relieved that Parsons seemed back to his normal self. Nonetheless, last night's events couldn't be ignored. It was time to get started. The exam could take some time and there wasn't much for Emily to do in my waiting room. Normally, she could visit with Louisa, but as she'd been sleeping when I'd come downstairs, I suggested Emily try the coffee shop down the street and sent Parsons through to my consulting room.

"How are Louisa and the baby?" he asked, once he'd seated himself in front of my desk.

"They're fine." This wasn't the time for small talk. I picked up my pen. "Shall we get started?"

"Sure."

Given that I didn't have his GP's notes, for the next ten minutes I methodically went over his medical history, starting with childhood illnesses and working my way to the present. If Parsons was annoyed with my thoroughness, he tolerated it well and answered my questions without complaint.

"Last night you mentioned a history of hypertension," I said. "How long?"

"Ten years. It started after my mum and dad died in the same year."

I glanced up in surprise. "Hmm." I probably should have said that I was sorry, but I hadn't known his parents nor that they'd died. And I couldn't help but think that my own blood pressure would likely have gone down with news of my parents' deaths.

"What medications are you currently taking for it?"

Parsons easily rattled off the names and dosage amounts and assured me that the hypertension was under control. There were benefits to having a physician as a patient.

I glanced back down at my notes. "You said your cholesterol was elevated."

"I'm on Lipitor. My medicine cabinet looks like a damn pharmacy."

"Last night you started to tell me about a prior episode of neurological deficit. Aphasia, hemiparesis, paresthesia," I reminded him.

"Right." Parsons cleared his throat. "As I was saying last night, about a fortnight ago I was home watching the telly; Emily and Dan were at school. All of a sudden, my vision got blurry and the right side of my body went numb. It was as if I couldn't even think straight."

Parsons had detailed his symptoms more as a patient than a physician – not exactly a precise medical description, I noted in passing. "What did your GP say?"

"I didn't go see her."

I'd come to expect most of my patients to act like imbeciles, but not Chris Parsons. He of all people should know better.

"You're an idiot," I said sharply. "You had a significant neurological incident and, instead of consulting your GP straight away, you sat around for a fortnight until you had another attack. Just brilliant."

"Come on, Mart. I wasn't even sure it was serious."

"Oh, that's ripe. Did you think your symptoms were normal?"

He gave me a weak smile, which I didn't return. "No wonder your patients complain about you."

"Only the stupid ones." I said, shaking my head. "Describe the numbness."

"At first it felt like my arm and leg had fallen asleep. But when I tried to move them, I couldn't. I thought I might be having a CVA."

"And yet you didn't think to consult a physician."

"I am a physician and I did consult you. Besides, the symptoms resolved almost immediately."

"Right." I drew out the word to emphasize my displeasure with the way he'd handled the situation.

"Dammit, Mart, I'm here now, aren't I?"

Although berating Parsons might make me feel better, it wouldn't help me address his symptoms. I forced myself to keep my irritation at least somewhat in check. "How long did the prior episode last?"

"Five minutes at most."

"And did you recover fully?"

"Yes. By the time Emily got home, it was as if nothing had happened."

But something clearly had happened and two such incidents in such a short time were ominous. I continued on, forcing him to relate details of each symptom. Only when I was convinced there was nothing left to learn by further questioning, I looked up from my notes.

"When's the last time you had a complete medical examination?"

"Couple of years ago."

My eyes narrowed. "How many is 'a couple'?"

Parsons gave me a sheepish look. "Three, maybe four."

"Oh, for God's sake." I shook my head in disgust as I stood up from the chair and walked over to the bank of cabinets against the wall. How could Parsons be so cavalier about this? I could only hope his stupidity and delay hadn't adversely affected his health.

In my prior life as a surgeon, I would simply have done what the referring GP had requested – an exam to confirm or rule out a vascular etiology. That, of course, presupposed that Parsons had already been seen by a GP to evaluate other potential causes of his symptoms. That hadn't happened here and now, as a GP myself, I felt obligated to do the full exam.

"All right," I said. "Since you haven't seen your GP for . . ." I pointedly cleared my throat, "some time, I'll start with a complete medical including a neuro exam, and then do a vascular workup. Any problems with that?"

Parsons grimaced. "Would you change your mind if I did?"

"Nope."

"Didn't think so. Then no problems here," he said.

I handed him a paper gown and nodded toward the exam couch. "Everything off but your pants."

Medical Glossary

Aphasia – impairment of language ability; trouble speaking normally

Etiology – cause of disease or illness

Hemiparesis – paralysis on one side of the body

Paresthesia - sensation of tingling, pricking, or numbness of a person's skin. Often referred to colloquially as "pins and needles" or of a limb "falling asleep."