Tuesday 6 March 2012

Give me enough KY jelly and I will give you a diagnosis


Dear Dr Gestalt

Psychiatric Registrar

St Howling-at-the-Moon Hospital


Thank you for referring Mr Watamaniak to me at the Minor Injuries Unit today.

I note that he has a profound mental illness and frequently exhibits threatening behavior and was accompanied by four nurses,and with the recommendation that he only been seen by a male member of staff.

That was me.

I see that you "examined" him this morning because he was complaining of :-

1.intermittent stabbing abdominal pains for 4 months which worsened over the past week

2.dark blood in his stool for 4 months

3.fresh blood on the toilet tissue for 1 month

4.vomiting after every meal for 4 months

5. and constipation for 6 months...

...since you changed his medication...

...just after he was admitted...

...and that would be the medication that causes constipation in long term use...

...or so I am reliably informed by the British National Formulary...

...you remember what that is Doctor...

...the 'drug bible' that we all to use to prescribe medicine...?

...and that you were worried about all the symptoms because you thought he might have an acute appendicitis...

I note also that he has seen his own General Practitioner yesterday at his surgery;and that the GP also saw him on Wednesday of last week;and on Tuesday of the week before that.

He also had a battery of blood tests done by his GP yesterday including my all-time favourite shotgun panel of a U&E + FBC + amylase + LFT...and also a CRP...I'm assuming that was done to try and win some in-house medical scrabble contest?

BTW...they were all normal... ...and just so you know... ...the results were all on the LabReporting system we all share...

I note also that the GP could find nothing wrong with him.

I note finally that no one on your staff...no single doctor or nurse has ever examined his stools to check for melena at worst, and fresh blood, at best.

...further...no single doctor or nurse has ever examined his stool or toilet paper to check for fresh blood...

...except one of the nurses with him today who said that the patient showed him a tissue with what looked like a 'few pinpricks ' of bright red 'fresh' blood on it this morning...

...further...no single doctor or nurse has ever apparently seen the patient vomit...certainly none of the four nurses with him today,-all of whom help care for him full time-,has ever seen him vomit.

They all also report that he has a healthy appetite...and has had no weight loss,-explained or unexplained-, over the past few months

Because I am a diligent nurse with large fingers and a low boredom threshold,I examined him thoroughly...

...including performing a rectal examination to check for hemorrhoids or fresh bleeding...

...apart from losing my appetite I found no sign of either...

...BTW...I was unable to elicit any pain of any sort during the examination...


The only thing I did discover during the physical examination...

...in fact quite early on in the examination...

...in fact pretty much as soon as I asked him to take his (five) shirts off...

...was his appendectomy scar...

...just where you might find it,if you look for it...

...in the right lower quadrant...

...which admittedly was about 0.7m south of his head...

...where you normally work...

*sigh*

So I have returned him to your care with a prescription for a laxative.


Kind regards

Lucien de Beer


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