To the Hon Casualty Consultant
Thank you for accepting this 71 year old male patient who has a number of acute but cross-discipline medical problems , most of which require intervention;however apart from a referral to psychiatry,I am not sure where to start.
He has just returned this morning from a two month holiday in Thailand;in fact he drove directly from Heathrow to our Minor Injury Unit.
His presenting complaint is acute urinary retention;he has not passed urine for 37 hours.I have inserted an indwelling catheter and gradually emptied his bladder of 3 litres of turbid and offensive smelling urine.
I have sent a sample to the lab for MC&S.
Fortunately the catheterization didn't hurt me.
He reports that he has had five bladder infections in the two months for which he received over-the-counter medicines,possibly antibiotics.
It would appear as if a new UTI has partly precipitated this retention episode.
He also has genital warts which he apparently didn't have prior to his trip;and also has what appears to be a chancre.
He reports,-quite proudly,even gleefully-, that he had sex with over 80 different prostitutes in the two months.
He is also jaundiced and has a large , and painfully palpable liver.He says that he drank a litre of whiskey a day for the two months, in addition to his 'normal' beer intake.
His liver is so large that I expect he had to pay excess baggage when he flew back.
And he thought his jaundice was sunburn.
My main concern however is that he also has a central chest pain with some new ECG changes.He reports that he has taken a Viagra a day for the holiday period.
I have told him that there is nothing that can be done for his greasy grey ponytail apart from cutting it off and giving it a decent Christian burial.
Kind regards
Lucien
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