Doctors often have a sixth sense that the patient in front of them is in trouble. From my rush of alertness, I knew that carbonated pop definitely wasn’t responsible.

lan’s abdominal pain had begun less than two hours previously. After 10-15 minutes it had become bad enough to phone 111, which had sent him to the out-of-hours centre.

“We wondered if it was the fizzy drinks,” his wife said. “He had two cans, one straight after the other.”

It’s a human trait to try to make sense of unusual events in terms of the everyday and familiar. Alan was restless, periodically shifting in the chair. And though he was trying to concentrate on talking to me, he appeared preoccupied. Some doctors describe a lurch in the gut; others talk of the hairs on their neck rising. For me it’s a rush of alertness, as though everything else is suddenly irrelevant. There’s no way of teaching this as it’s something acquired only through experience: the sixth sense that the patient in front of you is in trouble. Carbonated pop definitely wasn’t responsible.

All Alan’s observations were plumb normal. He got on the couch without movement exacerbating his pain, and abdominal examination revealed only mild tenderness in the left upper quadrant – nothing to write home about. A past screening scan effectively ruled out a ruptured swelling (aneurysm) in the main artery, the aorta. A urine test was clear, making a kidney stone unlikely. He was on various medications to prevent a heart attack following stents for angina several years before. The aspirin could have provoked a stomach ulcer that had now perforated. But I would have expected a history of indigestion and more examination findings. Plus he was on another drug to protect against just such a side effect.

I was still trying to …read more

Source:: New Statesman


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