Friday, 28 August 2009

"Come on and leave me breathless"

The first patient of the day was a middle aged man who said that he was asthmatic and that he felt short of breath.
He also told me that he was on his honeymoon in our little town ,- (clearly needs a psych referral then!!)-,and that he had accidentally left all of his medicines at home...naturally,he didn't know what medicines he took apart from the salbutamol inhaler...mainly I think because mine was on my desk.

He presented a sorry sight.His hair had clearly last been cut using a pudding bowl about 2 years ago-and that was about the same time it had last been washed as well;he was wearing the obligatory white England football shirt down the front of which was fetchingly displayed his breakfast coffee and porridge.
He was also,ineffectually using one turned out he had arthritis in his right knee...
And he was wearing sandals with white socks.

(I idly wondered why his wife would let him go out in public dressed like that...surely one of the key advantages of actually surrendering your freedom and entering a lifetime of financial servitude,-ie,getting married-, is that you will have someone to make sure that you look and behave like a normal human being when you go outside the house?)

After a full and thorough examination I decided that whilst his chest felt subjectively tight ,that objectively,his shortness of breath had as much to do with the changeable weather as anything else...we had just had a run of a hot dry day;then a hot wet day;then a cold dry day;followed by another very muggy hot and humid day.
Indeed his sats were 97% on room air and he was blowing 520 on the peak flow-meter which was 80% of his expected best effort...well...according to my Archimedes anyway.

So I decided to give him back-to-back ventolin 5 mg nebulisers;followed by an ipratropium 5mg nebuliser.
And lo...he felt all happy and cured!!

As he was about to leave he asked if I would like to see a photo of his new wife...explaining that he met her when she had been sent by the local council to be his carer.

In fairness he said that he had been able to be weaned off of all the many exotic psychiatric drugs that he had been on...*sigh*...the power of love!!

He pulled out his Benefits-funded iPhone and scrolled up her photo.

I looked at it...took off my specs and cleaned them...looked at the photo again...
...and referred him to the ophthalmic surgeons for an urgent appointment .

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