A surprising diagnosis

The elderly woman was already frail when she came to me complaining of a cough and weight loss. Alarm bells rang as I examined her and arranged for blood tests and a chest x ray examination. As I feared, the chest radiograph was suspicious, and referral was advised.

The chest physician concluded that bronchial carcinoma was almost certain and recommended awaiting the outcome of events, rather than subjecting her to an unpleasant bronchoscopy. Rather to my surprise neither she nor her family agreed, and she came back to me insisting on further investigation.

Some time later I rather hesitantly explained the eventual diagnosis of tuberculosis to her and was astonished by her calm response. “I rather thought it might be that, doctor,” she said, “after that trouble I had years ago. Didn't I ever tell you I'd had tuberculosis as a child?” Red faces all round, but a well, elderly patient five years later.

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.