BMJ  2003;327:598 (13 September), doi:10.1136/bmj.327.7415.598

Filler

A mistake that might have been my last

In the years 1943, 1944, and 1945 there occurred late spring sub-epidemics of bubonic plague in the city of Chuanchow, in Fujian province in south China. Hospital admissions were between 88 and 69 each year.

I was called to see a patient in the emergency room of the hospital. She was a young woman, semi-comatose with a high fever and a tender swelling in the left inguinal region. The usual practice was to aspirate a speck of fluid from the bubo to confirm the presence of bipolar staining bacilli of plague.

Unwisely, I did not wait for nursing assistance, but instead steadied the lymph node between two fingers and pushed in the aspirating needle. The patient jumped, and the tip of the needle emerged and grazed one of my fingers. The epithelium was broken, but there were no bleeding points.

I consulted a colleague with expertise in tropical medicine. He anaesthetised my finger and excised a wedge of skin that included the entire graze, leaving the wound open to granulate. I may have taken some sulphathiazole for a few days. The patient died within 24 hours.

I learnt that it is rash to undertake a delicate technical procedure in an ill patient without any assistance.

David Landsborough, retired medical missionary

We welcome articles up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. Please submit the article on http://submit.bmj.com Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for "Endpieces," consisting of quotations of up to 80 words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.


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