Fillers A memorable patient

The price of presumption

BMJ 2004; 328 doi: (Published 01 January 2004) Cite this as: BMJ 2004;328:21
  1. Alan Byron, retired locum general practitioner
  1. Ryde, Isle of Wight

    Assembling on the surgical ward for our first ward round, we were like snowmen on parade, with freshly starched white coats and stethoscopes shyly peeping from pockets. I was to clerk a young man, take a full history, and make an examination.

    As I sat at the patient's bed his fear was almost tangible. Being psychiatrically inclined, I inquired of the source of his anxiety. He told me that he had dived into a swimming pool and injured his left knee, which had required treatment. I wasn't quite clear what treatment he had already received and had not the opportunity to read his case notes. He spoke of an operation to his leg, and, because he seemed anxious, I specifically asked him if he had any particular worries (although I had already concluded he had a cancer phobia). Reluctantly, he admitted that he was frightened that he had cancer and that the diagnosis was being kept from him.

    As undergraduates, we were supposed to take a history, examine, and make an assessment. Therapy was certainly not part of our mandate. However, I boldly dismissed his dread and then asked to examine the offending part, certain I could reassure him. As he drew back the blanket I could see the right leg was perfectly normal. The left leg, I noted with dismay, was missing. Clearly an amputation had been performed. I was mortified, embarrassed, and quite inarticulate. It seemed that he had had an osteogenic sarcoma with secondaries. In 1963 chemotherapy had yet to arrive. Concluding the examination, I crept away without further comment.

    I thought of him from time to time, hoping I would never see him again. Towards the end of the surgical attachment, however, we were doing “rounds” on the same ward. There was little apparent empathy with the mute suffering of people patiently enduring the detachment of the “professionals.” I passed a side ward and caught sight of a gaunt and pitiable figure in bed. Our eyes locked in mutual recognition. It was my patient. His pleading burning eyes begged for reassurance—just once again.

    Ashamed, I turned away in despair and hurried on. A week later he was dead.

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