Archive for October 5th, 2006

Herd of zebras

Patients would make liars of us all. All patients lie, or in fact everyone lies, as House MD would say. I’m sure they’re lovely people and I’m not even sure they intend it. But they’re liars all the same. Intent on making fools of poor unsuspecting junior docs like me.

Today, for instance. Kiwi guy called Bruce (no aussie jokes please) who i admitted the night before when I was on call. Sent up by his GP to be sure he didn’t have a clot in his lung.

Quick note for the non-medical on clots in the lung. They’re rare, in comparison to say chest infections. Though more common than say, having three kidneys or a third nipple. In general they occur in a select proportion of people. And when they do occur (rarely and in a select group of people) then they’re often fatal. This GP, when he hears the sound of galloping hooves outside obviously thinks it’s a heard of zebras. Common things are common. If someone is short of breath then 9 times out of 10 they’ll have a chest infection or asthma or something. If they’re dead then they probably had a clot in their lung.

Bruce (strooth Sheila! Couldn’t resist aussie joke) is drinking a cup of tea, sitting in a chair fully dressed, smiling at me. Bruce doesn’t have a clot in his lung. He is however an odd one out. The only patient I’ve seen tonight who doesn’t smoke.

Bruce has a chest infection, one he’s nearly over one to be honest. He knows it, his wife (who for some reason persists in telling me daily how much weight she’s lost. She had plenty to lose to start with to be honest, so no-one’s calling out search and rescue) know it, the nursing staff know it. His GP thinks he has a clot in the lung. (Protracted sigh).

Anyway, he gets admitted cause they admit everything here it seems, so I have to do the same. He stays in a cosy bed and is wonderfully well (comparatively well) all night and I see him again in the morning. Ready to drop-kick him out of the hospital. And then there’s that dreaded moment. When your boss comes in to take the history again with you in the room. And then all of a sudden there’s a different Bruce before me. One who’s had worsening shortness of breath for 10 years, who was brought up on a diet of asbestos and tobacco. Who has just returned from an 18 hr non-stop flight from dear-knows where to have treatment for some rare blood disorder that causes his blood to clot if he stays still for more than 30 seconds, which is funny, cause it’s the same disorder is mother, father, two brothers, auntie in samoa and family pet suffer from. And of course he’s mighty worried it might be a clot in his lung, cause he’s had 17 before and young uppity doctors never listen to what he says, yaddah, yaddah, yaddah.

I don’t get a telling off from my boss (Otto the Hungarian), cause he’s been there himself. And anyway he didn’t listen to the history I gave him the first time and further more he was a dentist for four years before he jacked it in to do medicine cause it would get him out of hungary…

I sit and fume at the nurses station. Not at Bruce, nor even Otto the dentist/doctor, or in fact dentor as I might call him from now on. I fume at myself. Whether or not Bruce (strooth Sheila) had a clot in his lung or not, it was hardly the point, it was that I had to be right. And more importantly than that, I had to be seen to be right. And all of a sudden I have that rising sense of shame mixed with anger, as they quarrel inside my head. As, somehow, I try to find an excuse, a justification, someone else to blame for the fact I may be wrong. Followed by the fear… that I may be wrong. And all of a sudden this isn’t a blog about medicine at all, it’s a blog about what’s fundamentally wrong inside me. And I’ve been staring at this last paragraph for a half-hour now.

Bruce (strooth Sheila) on the other hand, got needles stuck in unfortunate places, difficult calculations done needlessly on alveolar/arterial oxygenation gradients and then a CT scan of his chest which revealed nothing but a peanut he swallowed in 1972, and oh yes, a chest infection.


October 2006