“I’ll let you see this lady. She’s pretty much a ... I’ll let you decide what she’s like” – and with that the doctor is gone, leaving me to see his 9am patient. It quickly becomes clear that she’s a lot of work. I’ve been in hospital, I’m better now, they’ve changed my medications, no I don’t need a script, I’m 87 you know, I’m meant to see a specialist what’s his name, no I already have a referral, and an appointment, look at these hands, no can’t you see that one’s weaker, I’m left-handed you know and I write with a special pen, oh, what am I here for? My leg’s red.
So I look at her leg. She’s had an ulcer for about a week but it’s going well, I’m just worried that the redness is cellulitis. She’s quite happy to scratch at it with her long yellow fingernails, but I ask if it’s painful all the same. Look at me! she exclaims, pointing to her (tear-free) eyes. But is it sore there, on the red bit? Oh, no, just the ulcer. The doctor agrees that it’s probably red from scratching and she should use a cream, but wants me to prescribe antibiotics just in case.
What is she allergic to? Oh, lots of things, I have a whole list but I left it at home, I can hardly take any medications, how could I remember what happens, it’s years ago, I’m 87 you know. I look up her recent prescriptions – they are many and varied, so we take a chance with Cephalexin.
She needs an ankle-brachial index done. I ask if she’s ever had her blood pressure taken on her leg? No. Ultrasound of her leg veins? No. Doppler, that sound familiar? No, none of that. I look up her notes. She’s had three colour dopplers on her left leg, but now we need to check her right. The nurse gives me a warning look when I request it, “she probably won’t let me!” But we have to try. As the nurse slips the sphygmo cuff around her ankle and begins to pump it up, my patient begins to howl. This old lady must hate me by now.
I have been despairing over this lady for almost an hour, and I must be getting a little terse. She doesn’t really like doctors and nobody likes medical students, so she must be eager to be rid of me.
But as I stand to usher her out the door she smiles and says, “when that nurse was pumping up that cuff on my leg I could feel my boobs getting bigger!” I suggest that maybe she should wear pressure stockings just for that reason, and she breaks into a hacking laugh and pats me on the arm before toddling out the door.
That 30 seconds was the best part of the consultation.
I'm glad she saved it for last.