Filler A patient who changed my practice

One’s own medicine

BMJ 2008; 336 doi: (Published 26 June 2008) Cite this as: BMJ 2008;336:1494
  1. David Crampsey, specialist registrar in otolaryngology, West of Scotland Rotation, North Glasgow University Hospitals
  1. david.crampsey{at}

    The operation itself was uneventful. I went to theatre at 10 am and was home at 5 pm, having had a tonsillectomy. The day unit sister promised to telephone me on the following two mornings. When she did I proudly told her that I was fine.

    As an ENT registrar, I would blithely tell tonsillectomy patients on the postoperative ward round that they should “eat and drink normally.” Gone are the days of taking only jelly and ice cream.

    Early on the third postoperative day, I decided to follow my own advice. On went the toaster, and presently I took a bite out of a crisp slice of toast. Within seconds, the unmistakable taste of fresh blood filled my mouth. Peering into my throat in the bathroom mirror, I saw an active tonsil bleed. One hour later, and I was still bleeding. I considered what to do. My local hospital was also the unit where I worked. Suddenly, the calm and relative detachment of the day surgery unit was a distant memory—I was in danger of becoming a real patient on a real ward with real doctors and nurses, all of whom were my colleagues. I was scared.

    I packed a bag with clean clothes from the wardrobe and folded them neatly. I selected some books, my laptop, and a DVD. I checked my email and looked at the on-call rota to see under whose care I would be admitted. In fact, I did everything possible to put off the inevitable. Finally, I telephoned two friends, one an ENT consultant and the other a GP. I left messages. They arrived some five hours later (during which time I had managed to convince myself there was no need for my immediate admission) clutching silver nitrate cautery sticks and wooden tongue depressors. The surgeon and the GP both peered into my mouth. “You have a clot,” I was told.

    The next day the pain started. Diclofenac and co-codamol were struggling to cope. I had been given a topical anaesthetic mouthwash in my bag of discharge drugs. I had ignored this as a homoeopathic remedy that would play no part on my analgesic ladder. It became my salvation.

    So how has my practice changed? My guidance to patients now runs along the line of, “You will feel like you have two massive mouth ulcers. Eat and drink what you like, but avoid anything which could irritate a mouth ulcer.” Anything with citric acid, including most carbonated drinks, fresh fruit juices, and jams and preserves. I now look very sympathetically on those admitted with post-tonsillectomy pain, and perhaps tread a little lighter on the bipolar diathermy pedal. I strongly recommend two weeks off work.

    I haven’t had any more tonsillitis. I think I might just leave my deviated nasal septum where it is though.

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