Fillers A memorable patient

The longest weekend

BMJ 2004; 329 doi: (Published 12 August 2004) Cite this as: BMJ 2004;329:400
  1. Nigel E Drury, senior house officer
  1. department of cardiothoracic surgery, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Middlesex

    It was late February, and I was working at a busy seaport hospital that often accepts patients from docking ships. A man in his early 30s was one such arrival, admitted to the infectious diseases unit with suspected chickenpox. In basic English, he complained of a rash over his face, trunk, and thighs, with pain on swallowing preventing him from eating or drinking.

    On examination, he was feverish with generalised lymphadenopathy and widespread crusting papulopustular lesions. He also had painful aphthous ulceration of his oral mucosa and genitalia. A chest radiograph was suggestive of right basal pneumonic changes, and he was given both antiviral and antibiotic treatment.

    Several days passed, and he neither deteriorated nor improved, with a diagnosis proving elusive. After much debate, we suspected that he might be immunocompromised, and on the Thursday afternoon the genitourinary specialist nurse was asked to counsel him and perform an HIV test. The result would be available within 24 hours, and we assumed that he would be told of the result before the weekend.

    It was a bank holiday, and I enjoyed the long weekend away at a theme park near Paris; Pirates of the Caribbean in the snow is a real must-see. Returning refreshed on the Tuesday morning, I was pleased to find the test had proved negative—but unfortunately no one had told the patient. I strode into his room to convey the good news only to find a broken man.

    He had spent those four days in isolation, unable to eat, sleep, or defecate through fear. The thoughts had gone round and round in his head. Were we avoiding breaking the bad news? Were his wife and children infected? Would he lose everything he cherished? Emerging from his room an hour later, I had listened to him trying to make sense of it all: while I had been enjoying myself with friends, he had been suffering alone in a foreign land. Overwhelmed by relief, he could not comprehend why he had been so tortured.

    He was subsequently discharged with a diagnosis of Behçet's syndrome, but I still think of how he was so cruelly let down by circumstance and our lack of foresight. His plight reminds me that clinical practice is not just about deciding which tests to perform, but checking the results and acting on them appropriately, and not presuming that someone else will do it.

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