Empathy for Dr Grumpy

A patient called our secretary today asking for someone to give her advice. She had a large tumour removed from her bowel almost a year ago, and was taking imatinib (a non-chemotherapy 'anti-cancer' tablet) to reduce the risk of recurrence. She was supposed to be taking it for a year in total, and was due to complete the course in early November.

The message the secretary gave me was that the lady was puking up the imatinib (and her other medications) whenever she took it, so she wanted to know if it was OK to stop the imatinib as she was nearly finished the course anyway.

I called her. I had to speak to her via her lobotomised husband as she was too ill to come to the phone. I eventually managed to get out of him that she had been throwing up for 2 days, not keeping anything down, had crampy abdominal pain and had not opened her bowels for 2 days either. Their only concern was about the imatinib and whether they could just stop it.

Me: 'Have you been to see your doctor about the vomiting and stomach pains?'

Mr Lobotomy: 'Er...no, no, you see, last year she had the exact same symptoms and we were told they were brought on by stress, so you see she just needs to rest in bed for a while and all we want to know is can she stop the imatinib?'

Me: 'You mean she had the same symptoms just before she was diagnosed with a large tumour in her bowel and had to undergo extensive abdominal surgery?'

Mr Lobotomy: 'Er, yes. But she's sure this is all due to stress. We've just moved house, you see. So what about the imatinib, is it OK to stop it?'

Me: 'I think she's already stopped it, hasn't she? Seeing as she's not keeping it down? I don't think that's the main problem here, I'm worried your wife may have a blockage in her bowel, either related to the tumour she had before or possibly from adhesions from her previous surgery. She's probably very dehydrated now too. Are you able to bring her to hospital so we can assess her?'

Mr Lobotomy: 'Oh, er, I don't know about that, she's not very well, she might throw up in the car.'

Me: 'OK, if she's not well enough to come in the car I would advise you to call an ambulance to bring her to A+E and I will see her there.'

Mr Lobotomy: 'Oh, er, um, I don't think she'd like that very much....'

Eventually I managed to get the patient on the phone. She sounded very unwell. I explained that she might have bowel obstruction, which was potentially very serious, and that she should come into hospital. She said she couldn't come today, she needed to rest in bed. She might come tomorrow, and could she have my phone number in case she decided to come tomorrow?

The end result was that they agreed to a home visit from their GP, so at least a doctor would examine her today. Mr Lobotomy assured me he would contact the GP surgery to ask for a home visit. I felt sure that his wife would veto that as soon as he put the phone down to me, so I told him I would call the surgery as well to make sure they had details of her medical history.

I called the surgery. I spoke to the receptionist, explaining who I am, and asked if I could speak to the duty doctor regarding the patient (her own GP was no longer with the practice) and to request a home visit.

Receptionist: 'I'll just put you on hold and ask Dr Smith if he can speak to you.'

Me: 'OK.'

After holding for several minutes....

Receptionist: 'I've spoken to Dr Smith, he's busy at the moment I'm afraid.'

Me: 'Well can he please call me back as soon as he's free? It's rather urgent.'

Receptionist: 'Oh, I don't know about that....hang on...'

Several more minutes of holding...

Receptionist: 'What symptoms is the patient experiencing?'

Me: 'Pardon?'

Receptionist: 'Dr Smith asked me to find out from you what symptoms the patient has.'

Me: 'He wants you to take a history for him?!'

Receptionist: 'Yes. What symptoms has the patient been experiencing?'

Dull thud as my head hits the desk.

I gave the history to the receptionist. Eventually a GP (not Dr Smith) called me back (asking to speak to a completely garbled version of my name - I'd even spelled it for her), I told him the details, and he's gone to see the patient at home.

I need a stiff drink now.