Fillers A memorable patient

The headache and the rabbi

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7360.376 (Published 17 August 2002) Cite this as: BMJ 2002;325:376
  1. Peter Arnold, general practitioner

    “The sudden onset of severe headache, in someone who doesn't usually get headaches, especially a young person….”—the professor's words, as best as I recall.

    A woman in her mid-30s accompanied her mother to my surgery one afternoon. The appointment was for the mother, who asked if, instead, I could attend to the daughter, who had a severe headache and didn't normally get headaches.

    She said that the headache had started suddenly that morning. Asked what she was doing at the time, she said that she was at the children's school's speech day. Which school? “You know, the one on the hill.”

    This reply made me suspicious, as there were four schools on the hill behind our surgery. I pressed her further: “You know, the one my children go to.”

    I tried another tack: “Who was giving the speech?”

    “Rabbi Fraser.”

    Prime Minister Malcolm Fraser had many attributes, but being rabbinical was not one of them. Settled on the diagnosis, I meticulously examined her nervous system but found nothing else. I telephoned my usual neurosurgeon, who lived nearby and was, fortunately, not working that afternoon. He was at my rooms within half an hour, took the patient's history, conducted a more thorough examination but with the same result, and took me to another room to discuss his thoughts before telling the patient and her mother.

    “I'm always upset when GPs don't get patients with subarachnoid haemorrhages to us early enough,” he said, “but that's what she has, even though there's nothing to confirm the diagnosis. I suppose we shouldn't wait, which is what GPs usually do, but just get her into hospital as soon as possible.”

    The next day, I helped him with the removal of a deep seated arteriovenous malformation that had been leaking. The patient's recovery was uncomplicated.

    I was therefore surprised when she returned a few weeks later: “I want to see you again, because I've got that same headache.” This time, the computed tomogram showed an abscess at the site of the excised vascular anomaly. At a repeat performance of the operation, we removed a 7-8 mm diameter ball of bacteroides pus. She has had no trouble since.

    When I meet her now, 20 years later, at the local shopping centre she always gives me a hug anda kiss and tells any surprised bystander, “He saved my life.” I suppose I did, and, for a general practitioner in a fairly pedestrian suburban practice, this was indeed a memorable experience.

    Acknowledgments

    We welcome articles of 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. If possible the article should be supplied on a disk. 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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