Back Again

So, I've been away; there may be clarification as to why in the future; we'll see.

It seems to often be the way that the patients you really like end up with the shitty end of the stick. I saw just such a patient yesterday; we had seen them a few days before, and sent them on their way, reassured with a simple diagnosis of 'constipation'

I dislike 'constipation' as a diagnosis; to my mind it's a symptom, but I guess that's open to debate. We all have our own foibles, or pet hates, or what have you. This is one of mine. I think it's more important the more elderly the patient is, and that's built on a deal of experience, but I recognise that 'in my experience...' are dangerous words in medicine.

Anyway; the patient was at least of pensionable age. I subjected them to an 'end-of-the-bed-ogram', and concluded that they looked pretty good, actually. Sitting in a chair, chatting happily to the MedStudent. Not gowned and trolled by the nurses, which often says something in its own right.

The tale; ah, well, its all in the telling. I'm not sure how sensitive, or specific, my 'gut' is; clinical gestalt is supposed to be pretty good, but one only tends to remember the times when you get it right, or are proved wrong spectacularly. The patients about whom you really worry, but turn out fine, tend to fade from view.

Anyway: this tale, of gradually altered bowel habit, loss of weight, loss of appetite made me anxious. And lying the patient down, removing the bulky pullover gave the lie to the idea that they looked 'ok' when sitting in the chair. The drum-tight belly, empty rectum and slightly hollow, pale eyes tell a tale all of their own.

Throughout all of this, the long wait, the uncomfortable, undignified examination, the merciless poking of the blood tests, this apteitn remained cheerful and upbeat. Grateful. Chipper.

I really like them.

So, it came as no surprise when the belly film confirmed an obstruction, the gas pattern neatly nipped off around the mid descending colon.

Of course, I don't have a diagnosis yet, but the probabilities hang heavy around my neck.