Before I go…

Posted on July 10, 2009. Filed under: Journal from behind the desk... |

It’s been a bit of a mad recently.  I’ve been running a bit late all week, normally if you have a 10.30 appointment with me, you get seen at 10.29! But not this week, and as I have mentioned before, if you are ever running late, you always end up with no quick and simple patients. The later I run, the more complicated the next patients problem is! 

Too pretty to rescue?

(Sods law).  Luckily I am accepting, rather than stressed and luckily so are my patients… 

(Incidentally has anyone heard a patient say: “I know you are running late so I’ll just be quick!” and then actually be quick!)


I had a very pleasant lady come to see me while I was running late and she had a nice simple infection, was intelligent enough that she understood simple instructions and was in and out my room within 5 minutes…or at least she would have been.  She was out of the door, when she turned round and said in a pleasing and buoyant voice:

“My husband died a month after you saw him!” 

She wasn’t cross with me thankfully, and so we extended our consultation to have a little chat…well I couldn’t exactly say: “Really, bye then, must get on!”

She expected me to remember my consultation from over a year ago, which I obviously couldn’t, but I followed the conversation and she told me how he’d died peacefully next to her in his sleep after he’d been discharged home to die.  I asked how she was coping, and after a little further chatting she happily went off as buoyant as she was before.

She was definitely not cross with me. So I assumed I had recognised he was critically ill and referred him to the hospital. Sod the fact I’m running late, I need to look at this guy’s notes…

It made my heart sink a little bit. 

A heart sink! Fab!!

I had not recognised his terminal illness and sent him in, but in fact given him some antibiotics and sent him home, with a plan to review him in 2 days.

So here is the last month in his life:

1/12 before he died…

Seen by Max E Nurse: 4 day history of cough, fever, off food and sore throat. Diagnosed with Pharyngitis and a chest infection, given antibiotics and to return in 2 days for review.

2 days later seen by Dr (I was on a study day…”Recognising imminent death for beginners” or something).  Brief doctors notes reading. “Better. Continue treatment”.

The next week he was not better and in fact worse and another doctor sent him into hospital as a Pneumonia…

A few weeks later he was sent home to die with a diagnosis of lung cancer with brain secondaries!

Lessons learnt – well not a lot really, but it keeps your feet firmly on the ground!

Neils feet were firmly on the ground…”I was here before Michael Jackson”…perhaps that’s were they’ve taken his body… tangent thought processes sorry…


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Lung cancer can be very devious. When I was a student, I cared for a patient who had “pneumonia” for a month or two. He walked into the hospital, and less than a week later he died from lung cancer.

One of my first times to say… Cancer sucks… too bad it isn’t the last time I’ll say it….

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