Post 8 Nurse Janet's Ethical Dilemma

Janet smiled to herself as she ran across the concourse at Euston Station to catch the train north.  She felt relaxed and happy; proud of her recent achievement.  She had completed her nurse training at St Thomas’ Hospital, passing the final examination with honours.  She was now on her way to take up a post as a staff nurse at Manchester Royal Infirmary.  She had enjoyed her three years in London but Manchester was home and in her new job she planned to spend more time with her parents and rekindle old friendships recently neglected.

She was pleased to find a quiet carriage on the train and took a seat opposite a distinguished looking gentleman and his rather dowdy, dumpy wife.  Not being a regular churchgoer, she couldn’t be certain about his exact status but he wore a purple shirt and a clerical collar. A large silver cross on a heavy silver chain hung from his neck onto his portly chest.  She presumed he was  a bishop.  She said a polite ‘Good Morning’, received a similar greeting in reply, then settled down to read her book.

Occasionally she glanced across at her travelling companions.  The Bishop was engrossed in the Times crossword but there was something vaguely familiar about his wife.  Janet was certain that she had seen her face before.  But where?

She returned to her book but glanced up periodically to take a further look at the woman sitting opposite, fortunately without attracting the attention of the bishop.

 Then it struck her; she hadn’t seen this particular face before but she had seen a picture of a very similar face in one of her nursing textbooks. It was in the chapter on thyroid problems.  If the thyroid gland was overactive the patient was slim, anxious and excitable with wide staring eyes. The picture in the nursing manual was of a patient with the opposite condition; that in which the thyroid was underactive; a disease called myxoedema.  

  In her mind, she recalled the features of the disease.  It occurred predominantly in middle aged women and they tended to put on weight.  She looked again at the bishop’s wife and observed that she fitted that description.  What else did she recall of the condition?  Having recently revised for her final exam, she knew that patients tended to lose their hair and that their skin was dry and flaky. Surreptitiously she again glanced across and, now feeling excited, she saw that this woman also had these features.

Janet also knew that patients with myxoedema often had a large goitre or possibly a scar on the neck from a previous thyroid operation.  Damn, the bishop’s wife was wearing a scarf hiding her neck but, of course, patients with this condition always felt the cold and it certainly wasn’t cold in the carriage.  She wondered if somehow she could get the Bishop’s wife to speak. These patients always had a deep husky voice.  She decided to play detective. She opened the packet of sweets she was carrying, had one herself, then offered them to the lady opposite hoping to hear her voice as she acknowledged the gift and offered her thanks. Irritatingly though, the bishop replied on his wife’s behalf.

“That’s very kind of you,” he said, “but my wife doesn’t eat sweets.” He patted his own generously proportioned abdomen as if to suggest that his wife was fat enough already.

Despite this setback, Janet remained certain of her diagnosis. She wondered if she dare mention it to the bishop but her courage failed her.

 The train rattled on through the midlands, stopping at Rugby and then at Stoke on Trent and still Janet felt unable to raise the subject that was now worrying her. Surely the bishop would want to know that his wife was ill and needed treatment; particularly as it would only require a few tablets to put her right. But Janet reminded herself that it was none of her business and once more tried to settle into her book.

But her conscience niggled  and instead of reading her novel, she thought again about myxoedema - now remembering that patients with an underactive thyroid gland were at risk of coronary artery disease and heart attacks. Surely, knowing that, it became her responsibility to express her concern.

 The train stopped at Crewe, then raced on through the pleasant green Cheshire countryside but despite Janet’s increasing anxiety, her confidence still failed her.

The final stop at Stockport’s Edgeley station came and went and Janet knew they would arrive at Manchester’s Piccadilly station in precisely five minutes time. It was now or never.

“Excuse me,” she said to the bishop, in a hesitant voice that was barely audible.

“Yes, my dear, can I help you,” the bishop replied in a sonorous voice that Janet could imagine resonating around a grand church or cathedral.

“Look, I know that I’m speaking out of turn, and perhaps I shouldn’t mention it, but I am a nurse. I’ve just qualified, and I’m worried about your wife. I’m sure she has an underactive thyroid gland.”

 “Yes, my dear. You’re quite right,” the bishop replied, glancing fondly at his wife.  “Before her operation, her thyroid gland was overactive; she was full of nervous energy. She chattered incessantly.
It was like living in the middle of a hurricane.  I couldn’t get a moments peace and my life was very difficult.  I prefer her this way.”                                                   
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Would you have handled Janet’s situation differently – and if so how?

Comments welcomed.

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Thought for the day

'It was, perhaps, one of those cases in which advice is good or bad only as the event unfolds.'                                                                                                                                                         Jane Austen 1775 - 1817

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                                                          Extract from a doctor’s letter: The skin was moist and dry!