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A memorable patient: A Lapland lavage

BMJ 1998; 316 doi: (Published 14 February 1998) Cite this as: BMJ 1998;316:h
  1. Pekka Niemelä
  1. Oulu, Finland

    Twelve years ago I had my northern exposure in the remotest Finnish Lapland. In the summertime I saw the owls screaming, the bears and the wolves dreaming of the reindeers, millions of mosquitos, and the midnight sun. The winter showed me the Northern Lights flaming on the vast screen in the sky and the thermometers with their mercury frozen at the bottom.

    Two hundred kilometres north of the Arctic Circle, trapped in the village with its population of 2500, I worked as a GP in my little health centre with one colleague. It was late afternoon when an elderly man came in to have his paracentesis to remove the ascites caused by a carcinoid tumour. I did my routines, but suddenly noticed his ascites had an odd colour. Grey and ultimately black material ran freely in the suction tube from his abdomen. I knew where I was. Politely I repeated the paracentesis and the suction with the new equipment, this time finding normally coloured ascites.

    No peritonitis developed despite my coloncentesis, and a week later he came back relieved and wondering what I had done to cure his constipation.

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