Matters of Historical Importance, Part - 8

Let me first apologize to all the Women of this planet for writing with such generalization about women being unreliable with history of illnesses in my previous post 'Matters of Historical Importance, Part - 7'!

This happened last might, perhaps to teach me a lesson. A lesson that men can be equally confusing if not worse.

Due to a Continued Medical Education program conducted by the Kochi IMA today, I had to attend to the ER as well as the ICCU last night. Though it wasn't very busy, the night was pretty bad for me. Main reason was I lost my temper and actually admonished a patient which I don't do when I am sane. I wanted to catch some sleep so that I won't be caught napping during a day-long CME today; so went to sleep by 12:40 AM. And soon there were those usual fevers and earaches pouring. By 1:15 AM, I was able to settle down and thought I will finally be able to catch a few winks.

But by 1:50 AM, I was woken up by the nurse saying there was a case of pain abdomen. I am translating our our actual conversation in Malayalam to English. I am afraid some effect of the whole story will be lost in translation, but I still shall try. Thus goes the story...

When I walked into the ER, I saw a young man sitting on the cot and his mother chatting to him. Seeing me, the lady moved aside and the young man actually stood up. It could have been a mark of respect. But I was not amused because I always expect the patient to be lying down in the Emergency Room. You don't expect silly cough and cold cases in the ER at 1:50 AM.

I asked the young man, "Do you expect me to examine your tummy while you're standing?". He immediately rested on the bed. After asking his name and age [He was in fact 19 years old], I proceeded with "His-story"...

Me: So what is the problem?

He: I have pain in the tummy...

Me: Where?

He: Here... Pointed to the lowest part of the tummy, and then he told as an after thought, "I had pain here also" pointing to the upper part of the abdomen.

Me: Since when did this begin?

He: Since quite some time...

Me: Does quite some time mean about 2 - 3 years?

He: No, no... it is only since SOME time...

Me: Can you tell me how long is this period between 'Some time' and 'Quite some time'?

He: It is about 4 hours. But I had pain in the morning also...

As I was getting exasperated, his mother stepped in to help... "He had pain at around 9:00 Pm and we showed him at a local clinic and that Doctor gave these tablets" and she pulled out some medicines. I took note of these medicines as the usually prescribed drugs for Acidity and Flatulence.

Me: Do you have any pain now?

He was smiling widely now: Not very significant pain now, but some pain here... This time he was pointing to the left lower abdomen!

I had lost my bearings by now and almost yelled at him, "What do you expect me to do? You can't tell me where you have pain. On 3 occasions you've shown 3 different sites. You can't even spell out when it started and how long it lasts. All generalizations and no answer. And the best thing is at this point of time, you don't even know if you have pain. What medicine will I prescribe if I don't know what is your complaint?"

Then his mother pulled out a pink card. This was a Discharge Summary issued from our own Hospital in the month of April 2009. That had recorded his complaints as pain abdomen and he had undergone blood, urine and motion tests and even an Ultrasound Scan. All the tests were reported as normal. And the Doctor had discharged this boy after 2 days of hospitalization with a Diagnosis of "Nonspecific Pain Abdomen"

And at the bottom of the card, it was written in the remarks column: Confusing history and unreliable patient. Treatment: Placebo!