‘I do, although it might prove to be a bit vague. I’ve been working at this practice for more than a decade now, and I’m used to patients going through phases, coming in and out. There’s one particular male who I referred for a brain scan last year, as well as a psychiatric consultation. He didn’t attend either. He explained that he’d been traumatised in his youth. Having suffered severe depression, which hadn’t been managed effectively through medication, he was sent for electroconvulsive therapy. Since then, he hasn’t been able to tolerate any sort of treatment relating to his head.’

‘I see,’ Connie said. ‘What was it about his symptoms that made you think of him today?’

‘He’s come to us over three discrete periods in the last five years, on each occasion attending regularly for a few months then disappearing for around six months each time. The symptomology follows a similar pattern each time. He starts off by reporting a general sense of unwellness. Generic stomach pains, aching limbs, headaches, reports of mild fever but nothing that ever shows on a thermometer. No discernible physical presentations when we begin investigations. Urine and stool samples come back clear. Same with bloods. The first time we ordered both an endoscopy and a gastroscopy.’

‘Both clear?’ Connie asked.

‘Both clear. But by then he was presenting with new symptoms that bore no clear link to the original ones. At the end of the first period of presentation, he told me he could no longer feel his heart beating. I put his fingers on his wrist, let him listen through my stethoscope, and he told me I’d completely validated his complaint. He heard and felt nothing. After that I asked him to allow me to refer him to psychiatric services. While he was with me, he agreed. I said he’d get a date through. He didn’t appear to be any threat to himself at that stage, hadn’t self-harmed or threatened suicide, so when the hospital notified me that he hadn’t attended his psych appointment, there was no further action I could take.’

‘And then?’ Connie asked.

‘He didn’t come to the clinic for …’ there was the whisper of turning pages, ‘seven months. The next time he came back he asked to see a different doctor, which was fine. In fact, at that stage he was presenting with a stomach complaint, saying he couldn’t keep food down. It was diagnosed as a virus, advice was given. The notes say he was rational and not expressing any of the previous symptoms that had given rise to the psychiatric referral, so we treated him normally.’

‘Did his symptoms worsen?’