Fillers A memorable patient

Words unsaid

BMJ 2000; 321 doi: (Published 15 July 2000) Cite this as: BMJ 2000;321:172
  1. Adrian Drake-Lee, consultant ear, nose, and throat surgeon
  1. Birmingham

    In hospital medicine, as in general practice, trust between patient and doctor builds up over the years. Sometimes very little occurs during the consultation apart from reassurance that all is well and yet both the doctor and patient are satisfied at the outcome.

    My particular patient had a carcinoma of her lower lip treated by radiotherapy four years before my appointment in Birmingham 13 years ago. This left the skin very thin and subject to repeated superficial breakdowns. From time to time I would biopsy an area when it had failed to heal for three or more months, and each time she was free from recurrence. Since she was retired, she visited with her husband and I also came to know him as well.

    During one of her admissions for a biopsy, we diagnosed her hypertension in the last year of her life. It may be a coincidence, but when she was treated for her blood pressure, her lip healed up. Their last visit was just before Christmas when she came to tell me that her lip had healed nine months previously. She had struggled from the car park, which is a considerable distance from the hospital, to the clinic on the top of the hospital.

    I asked her why she had come since she was obviously unwell. She was deeply jaundiced at the time and was short of breath owing to ascites secondary to her inoperable metastatic carcinoma. She told me that she had cancelled the previous appointment because she was in hospital undergoing investigation, but she had wanted to come and see and thank me for all the care and attention that I had given her over the years. What remained unsaid was that she knew that she was dying and we both understood that she wanted to say goodbye.

    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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