I didn’t realise the impact of my actions. Well, it wasn’t quite my actions, more my thoughts, followed by a question and the actions of others.
I was called to see a patient; he had a temperature of 38.9, was listless and not his usual self; a little disorientated, he couldn’t pinpoint the cause of his malaise and examining him there was nothing obvious – no symptoms of chestiness, no urinary discomfort; his abdomen was soft, the was no pain; I looked in all the usual places and all I could find was a high temperature and what I call rheumy eyes.
A couple of years ago when there was the last major flu outbreak and the virus was rampaging round the corridors of Mallard Ward, I seemed to have worked-out a fairly reliable diagnostic system – essentially, high temperature and nothing else obvious to find other than rheumy, that is slightly swollen and blood-shot eyes, followed by rapid flu-test and voila; diagnosis.
I thought to myself, ‘Perhaps this is flu…’
I then made the mistake, of thinking out loud;
A swab was obtained from the emergency department, a sample taken, then returned.
The poor nurse who ran from my ward to the emergency room was berated for his lack of gown, face-mask and gloves, ‘How could you come here with that, without taking precautions!’
The sample took a while to process; he came back. We called for the result; ‘Where was the nurse’s face mask? What are you guys playing at?’
I became concerned; had I contributed to the spread of infection? I apologised to the patient, his wife and the nurse; the poor support worker who had just been in to take the m a cup of tea had also been exposed. Where would this end?
I left the room, and returned, checking again on my patient, still without mask.
His wife sat beside the bed, Sudoku opened at the very difficult page, bemused.
The sample was negative.
It was funny how people panicked at the consideration of flu. As if you cannot say the ‘F’ word without taking all the precautions.
The thing about medicine is that we are often in the dark, struggling to determine what is the cause of what; we work on the basis of hypotheses, diagnostic sieves and risk stratification, usually starting with the worst possible scenario and working backwards; chest pain > heart attack; only afterwards do we think about indigestion. Most people are content with this approach. Sure, experience tends to make you more confident and able to arrive at the heartburn more quickly, but everyone can be caught-out and over confidence is the inevitable step before a fall.
Before we had near-patient tests the flu thing was shambolic; as with me, merely suggesting the possibility would drive a patient into isolation until the result was returned from an off-site lab; this could take days.
When there is a concept that is readily accessible such as ‘flu’, it sometimes over-rides all other considerations, such as in the case of my patient, the sensible approach… he may have had flu, and if so, he probably had flu before the idea came to me and consequently isolation doesn’t and cannot be instantaneous.
This is not to belittle the importance of the infection; when you write ‘influenza’ on a death certificate it brings things into focus.
How readily we jump down these escape-routes, these shortcuts in thinking many of which bypass the person and all caring, compassionate and rational thought, as if, the notion of a crisis is more attractive than the mundane reality of virus. Ill-defined and unexciting. And these kill too, only not with the same drama.
The next time someone says, ‘query flu,’ I’d suggest we all, like everything else in life, pause for a few moments, gather our thoughts and proceed sensibly.