Post 2 Cats and Confusion

              

2 Cats (continued)

Thought for the day

Four legs good,   two legs bad.                             George Orwell  1903-1950

The story so far (continued from the previous post )

Miss Mullins has brought her pregnant cat to the emergency department where the medical staff have diagnosed an obstructed labour. They need some specialist obstetrical advice!

Dr Bill Makin picked up the telephone and asked the switchboard to put him through to St Margaret’s. It was the first time anyone had thought or perhaps dared, to seek advice from the maternity hospital on how to manage a difficult labour in a pregnant cat!  Inevitably everyone in the Casualty Department was keen to hear what was said. Unfortunately they could only hear one end of the conversation. 

“I’m sorry to trouble you twice in one evening David,” Bill said, “but I’m afraid I have another patient here. She’s pregnant for the first time and I need your advice. I’m afraid it’s a bit complex. As you probably know, I’m not an expert in obstetrical matters but I've a sneaking suspicion that this is a multiple pregnancy. The patient is in labour; probably has been for four or five hours now, and she’s started to bleed quite heavily. She’s also in a lot of pain and really doesn’t look at all well. I’m concerned about her and would be grateful if you’d take a look at her for me.”

There was a pause but those ‘ear wigging’ could imagine what was being said at the other end of the line, even though they couldn’t actually hear it.

“No, she’s not one of your patients.”

Another pause.

“I’m afraid she’s had no antenatal care whatsoever. This is the first time anybody has realised that she’s pregnant; she’s been a little secretive about it.”

There was a longer pause. “Yes, I know. Some people blame the schools, others blame the government but personally I think poor parenting has a lot to do with it. There’s no shortage of contraceptive advice available these days, is there? I’ve tried to speak to her but she’s not got a lot to say for herself. I don’t think she’s the most intelligent of patients. Probably the sort that just can’t say ‘no’.”

Another pause, shorter this time.

“No, I haven’t remonstrated with her; I’ll leave that to you. But I think I should warn you, she’s a bit woolly headed. I very much doubt that she’ll listen to reason. Her mother is with her though. She seems quite sensible and may be able to keep an eye on things in the future.”

Another pause.

“Look, David, I’m a chest physician. Anything below the belt is a ‘no go’ area for me. In my speciality, we don’t go delving or diving into deep dark holes. I wouldn’t know where to find the cervix, let alone say whether it was dilated.

Another pause.

“OK and thanks for agreeing to take her. She’s called Kitty by the way. I’m not sure what her surname is. She'll be coming by ambulance and I’ll have her with you within twenty minutes. Thanks David. It’s very good of you.”

Bill smiled as he continued to listen.

“Yes, fair enough. I owe you one. I’ll buy you a drink next time we meet. Good night and thanks again.” Then as an afterthought he added, “Oh and David, perhaps you would let me know how things turn out.”

He turned to face the group who had been listening intently to the telephone conversation. Everyone realised that he had not told his friend that the patient was a cat!

“David says he’s sick and tired of silly young girls who get themselves pregnant and then are so ashamed that they hide themselves away. They think they can cope on their own but then turn up in labour having had no antenatal care at all. When he’s sorted Kitty out, he intends to give her a good telling off.”

Bill turned to the ambulance men.

“Are you sure you’re able to take Kitty to St Margaret’s?  I wouldn’t want you to get into any trouble.”

“Of course we’re sure,” said George. “Nobody at Ambulance Control is going to know anything about it, because it’s not going to be recorded in our log. We’ll have her there in two ticks.”

George picked up Kitty and the basket, his colleague took Miss Mullins by the arm and they started towards the door.

Miss Mullins turned, a grateful smile on her face. “Thank you all so much. You really have been most kind.”

 “It’s been a joint effort,” Bill replied, “and our pleasure. I hope all turns out well.”

Work in the casualty department continued but two hours later Miss Mullins was back. Carrying her basket with great care, she had made the return journey from St Margaret’s, albeit this time on foot. She looked overjoyed, beaming from ear to ear, bursting to tell what had happened.

“I just had to let you see.”

Gently, she placed the basket on a chair, then lifted a corner of the towel. Kitty was now lying contentedly in the basket, tenderly licking three tiny balls of fur that were snuggled up to her belly, their eyes closed. She handed sister a letter.

“This is from the doctor at St Margaret’s. He was just as kind as you were.”

Sister opened the envelope.

‘Dear Casualty Staff,’ it read.

‘You were quite right. This was indeed a multiple pregnancy; triplets in fact. But all has turned out well. As you see, mother and babies are all fine despite the lack of antenatal care. To avoid further problems, I have taken the liberty of giving Kitty’s ‘mother’ some contraceptive advice.

Kind regards,

David.’

                                                         **********************************************************************************                         

 

 

Confusion

Thought for the day

 ‘It’s only those who do nothing that make no mistakes.’

                                                                                   Joseph Conrad 1857- 1924

It had been a long day; an emergency had been added to the day’s operating list and it was  dark when I went back to the office to collect my coat. My secretary had already gone home but she had pinned a message to the lapel of my jacket.

‘Sorry but Dr Bennett rang asking if you would do a D V

Mrs Edith Smith, aged 80  
6 St George’s Rd
Obvious breast cancer but probably too frail for surgery’

The Domiciliary Visiting service is an admirable arrangement that allows General Practitioners to request a hospital consultant to visit a patient at home. In the early days, I always met the GP in the patient’s home and we undertook the consultation together. Later, due to time constraints, I usually visited on my own. It was an excellent way of establishing a relationship with colleagues in General Practice and also helped reduce the number of unnecessary hospital admissions.

I looked out at the dark November evening. It was cold and had just started to rain. Finding the address and seeing the patient would delay me by at least an hour and the thought of ‘switching off’ and relaxing over a hot meal and a glass of wine in the warmth and comfort of my own home was appealing. However, a quick look in my diary confirmed that the following day already looked busy. I groaned, muttered a vague obscenity then reluctantly decided to call and see Mrs Smith on my way home.

Mrs Smith’s home proved to be a ‘two up, two down’ terraced house, with the front door opening straight on to the street. The house was in complete darkness.  I knocked but got no  reply. I knocked again, louder this time, but still there was no response. The rain was hammering down even harder.

 I was just turning to leave, frustrated and angry that I'd made a wasted journey, when a figure approached pushing a pram.

“Are you the doctor?” she asked.

I confirmed that I was.

“The key’s just inside the box,” she said. “Just let yourself in.”
 I'd forgotten that frail elderly folk often hung the key to their front door on a string just inside the letterbox, so that family, neighbours or carers were able to gain entrance.

 I slipped my hand through the letterbox, hoping that there wasn’t an aggressive dog loose in the house, located the string with the key attached and let myself in. The door opened directly into the front room. The room was in darkness as was the back room, but light was coming down the stairwell between the two downstairs rooms. Climbing the stairs, I entered a small bedroom. Most of the space was occupied by a large double bed which was hard up against the far wall and lying in the bed was a very elderly couple.  My patient, Mrs Smith, was on the far side of the bed and an elderly gentleman, whom I presumed to be her husband, lay on the near side. Also on the bed was a large ginger tomcat that clearly took exception to my presence. It showed its claws and snarled in an alarming fashion.
“Hello,” I said. “I’m the specialist from the hospital. Dr Bennett asked me to call.”

There was no response.

I tried again. “From the hospital,” I repeated, louder this time. “I’ve come to see you about that lump in your breast.”

Still no response, just two blank faces staring back at me. I tried once more to explain who I was and why I was visiting but even after repeating myself a couple of times, they still didn’t understand. All the while I kept a wary eye on the cat, fearful that it was about to launch itself at me.

 Presuming that both husband and wife were extremely deaf, I used sign language to indicate to Mr Smith that I needed to examine his wife. To do this I had either to kneel on the bed or, alternatively, lift her to the near side of the bed.  Either way, Mr. Smith had to get up and vacate his place.  Regrettably he simply didn’t understand what was required, so gently but firmly I overcame his resistance and assisted him out of the bed and into a chair in the corner. I was pleased to see that he took the belligerent cat with him.

I then tried to take a history from Mrs Smith but failed to get any account of her symptoms despite repeated attempts. Since Dr Bennett had said that the cancer was obvious it seemed that in these circumstances a clinical examination would be more important than the patient's story so I motioned to her to move across to the near side of the bed so that I could examine her. She seemed reluctant to do this so eventually I was forced to kneel on the bed where the old man had been lying. It was the first time, and I hope the last, that I  have to perform a breast examination, kneeling in a bed with my patient!  It was almost impossible  to keep my balance on the soft mattress and there was an alarming tendency for me to topple forward on top of my patient.

I pulled the bedclothes down to her waist, then reached under the sheets to lift up her nightdress. I heard a movement behind me and turned, anxious to check that the cat was still behaving itself. Fortunately it was. The noise though came from Mr Smith who had a hand in the air and appeared to be trying to remonstrate with me. I smiled at him, assured him that I was a consultant and knew what I was doing and returned to my examination.

However, I found no abnormality at all in either breast or in the regional lymph glands. I was surprised.  Dr Bennett was a sound practitioner; it was not like him to make an incorrect diagnosis. Perplexed, I examined again only to confirm that Mrs Smith had two perfectly normal atrophied post menopausal breasts.

Angry that I had made a wasted journey, I covered Mrs Smith with the bedclothes, offered a handshake to Mr Smith, which rather rudely, I thought, he declined and I then left, locking the front door and replacing the key as I did so.

Later that evening, my humour restored after a hot meal and a couple of glasses of wine, I rang Dr Bennett and reported that I could find no abnormality in Mrs Smith’s breasts at all.  I also commented that I felt lucky to get away without being attacked by the aggressive cat.

“I don’t remember there being any animals when I visited,” he said.

“Yes,” I said, “I large ginger tomcat hissing and snarling at me whilst I did the examination.”

“Mrs Smith doesn’t have any cats,” he said. “Where on earth you have been?”

 “Number 6, St George’s Road.”   There was a long pause.
“Ah. That explains it,” Dr Bennett said. “My Mrs Smith
lives in St George’s Street.”

For a few moments I sat totally shell shocked. What on earth had I done? I’d walked into a stranger’s house without a ‘by your leave’ and assaulted an elderly lady in her own bed. No wonder her husband had looked aggrieved! Then, I confess, the funny side of the matter struck me.

 The next day I told the theatre staff what had happened. They thought it was hilarious and made up a dozen potential headlines for the local paper. Some were quite amusing, others somewhat disturbing

“Surgeon in sex attack on local resident.”

“Surgeon struck off by GMC for sex assault.”

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