After a few years of working in Emergency Medicine,with any luck,you begin to develop a sense for which patient's are really unwell,beyond tick-boxing a list of obvious signs and symptoms drilled into you at university.
You notice the way they move...sit...speak...their colour...that their clothes are perhaps a little loose for them...that they seem tired...resigned...dispirited.
They often 'present' with an apparently innocuous complaint.
Often you can just look at a patient and know what is wrong with them in broad terms.
The patient on this Sunday morning was 10 years younger than me,but she looked 5 years older.
Her complexion was sallow and waxy.
Her clothes reeked of cigarette smoke and hopelessness.
She was a widow with no close family...she was unemployed,having been the main carer for her husband.
She sat down slowly and carefully,sighing in pain.The left side of her face looked swollen,particularly under her lower jaw.
"Good morning ma'am....what can I do for you today then ?"
Well...I had a biopsy taken from under my tongue 12 days ago...and its still bleeding and its getting more painful...I've been taking 12 kapake tablets a day and its not helping with the pain...
"Who did the biopsy?"
The ENT surgeons at St Vulva's'...
She handed me a sheaf of papers...a letter from the Department of ENT-Oncology attached to a well written 4-page guide to their services.
"Why did you have the biopsy?"
I'm not sure...my dentist sent me there...they did the biopsy 2 days after I saw them and I have another appointment in a weeks time...
"Okay...could I please just have a look?"
Slowly,leaning forward and swallowing slightly in pain,she carefully opened her mouth and lifted up her tongue.There was a small necrotic hole at what I guessed had been the biopsy site.
What do you think is wrong?
"To be honest,I have no idea...but fortunately,I do know someone who will know...could you please excuse me for a minute...I'm just going to phone the ENT surgeon-on-call..."
...who was happy to see my lady on the ward as soon as she could get there.
"Okay ma'am...I've spoken to the ENT surgeon and she will see you right now..."
Now ? Do you think I need to see someone today? Its Sunday...
"I know ma'am...but here's the thing...the biopsy site is still bleeding...and we also need to get the pain under control for you...so I do think you should go today..."
"I'm going to give you some Oramorph for the pain now and Julian will organise hospital transport for you...it shouldn't take too long...and then...as I say,the surgeon will see you as soon as you get to the ward..."
I finished her notes,printed her a copy to take to the ward and then handed the notes and her original letter back to her.
"You're welcome ma'am...nice to meet you...bye bye now..."
She paused as she got to the door of my room...
Can I ask you something please?
"Certainly...although I can't promise that I know the answer...",I smiled.
Well...I didn't want to bother the doctor...he was so busy...and my husband used to take care of everything for us...so...this letter from the Department of Oncology...
Well...could you please tell me...what does 'oncology' mean?
And so I sat her down again and told her.
There is a reason why I keep a large bar of fruit and nut chocolate in my locker.
Its for a day like that.