‘Knew his father and mother before they were married.’ Howard Marks gave a short laugh. ‘Can’t believe Oliver is grown up, to be honest.’
‘It must be a bit difficult, talking to him about some things,’ Helen volunteered, keeping her voice casual, and when he met her eyes she knew that she was right.
‘He’s a brilliant doctor,’ the man said quickly, ‘but I remember him as a kid. How can I talk to him about—about—’ He broke off and Helen gave a nod.
‘About something really personal,’ she finished gently, and Howard sighed.
‘Stupid, isn’t it, really? An old fool like me.’
‘If something is worrying you, you should talk about it. Is that why you asked to see me, Mr Marks? Because I’m a stranger?’
He gave her a keen look. ‘You’re not stupid, are you?’
‘I hope not.’ Helen smiled. ‘And I do understand that it’s easier to talk to a stranger about some things.’
‘I thought that. That’s why I asked to see you.’ He broke off and gave a long sigh. ‘And now I’m here I don’t know how to say it. You’ll think I’m completely ridiculous.’
Helen shook her head. ‘I won’t think that. If the problem is serious enough to bring you here then it’s serious enough for me to take it seriously.’
He glanced towards the door as if he was contemplating running through it. ‘Your next patient is probably waiting.’
‘Then they can wait a bit longer,’ Helen said calmly. ‘Please, trust me, Mr Marks. Tell me what’s worrying you and we’ll try and find a solution together.’
‘I’m sixty-six,’ he wheezed. ‘Been married for forty-two years and we’ve always had a good—well, we’ve always enjoyed—’
‘Sex?’ Helen’s voice was calm. ‘Has it become a problem, Mr Marks?’
He slumped in his chair and ran a hand over his face. ‘I can’t believe I’m discussing it with you. You’re younger than my daughter.’
‘But I’m also a professional who cares about your health,’ Helen reminded him, ‘and sexuality is part of health. If it’s any consolation, plenty of patients have discussed exactly the same issue with me. It’s very common, particularly in patients who are suffering from respiratory conditions like you.’
He looked at her. ‘You’ve talked to other patients about this?’
‘Absolutely. In London there are specialist nurses who deal with this area.’
He gave an embarrassed smile. ‘When you get to my age you assume that people think you don’t have sex any more.’
‘Sex is an important part of a relationship,’ Helen said quietly. ‘Do you want to tell me exactly what the problem is?’
He rubbed a hand over his face. ‘Well, I just run out of energy. And I suppose I’m frightened because I get breathless.’
‘Do you leave your oxygen on when you make love?’
He frowned and shook his head. ‘No, of course not.’
‘It would probably help if you did. Do you ever go for walks?’
‘Sometimes, but I always use my puffer before exercise and that seems to do the trick.’
Helen nodded. ‘Treat making love as you would any other exercise,’ she advised. ‘Have a puff of your bronchodilator before and keep the oxygen on. Have a rest before you make love and it might be wise to avoid alcohol because that can actually inhibit sexual arousal.’
‘What about the fact that I get breathless? It scares the wife.’
‘Shortness of breath while you’re making love is entirely normal,’ Helen said simply. ‘As long as you are feeling OK you shouldn’t worry about it.’
‘The wife thinks I’m going to drop dead.’
‘Then you can assure her that sudden death during intercourse is extremely uncommon.’ Helen reached for her diary and a piece of paper. ‘There’s a really good leaflet that outlines some sexual positions which help you conserve energy. I used to have a few in the place where I worked last but if you call this number they can send you a copy. In the meantime, this is what I suggest.’