Friday, October 10, 2008

Grace under pressure.

Around a year ago Grace started to complain of tummy pain. This was before she came to Ambridge. After a few weeks she was unwell enough to need a hospital visit, and there they found a pelvic mass, around the size of a mid term pregnancy. Only trouble was that Grace was pushing seventy years of age and was long past her menopause.

In pretty short order she was told she had ovarian carcinoma. Then that she had inoperable ovarian carcinoma. Then that she had inoperable ovarian carcinoma that was not responding to chemotherapy. At some point in that process she ended up relocating to Ambridge and joined Dr Neighbour’s list.

She has in Dr Neighbour an excellent GP. She also has the input of the best available local Oncologists and Mc Millan Nurses. She also has the Ambridge District Nurse A team on her case. She has little or no pain and has no fears for the future, taking each day on it’s merits, but she has no illusions that this will be her final illness. Lately she has been a bit queasy, and has begun to feel what we English like to euphemistically call “a bit bunged up”. The usual array of laxatives isn’t helping much and neither this past week has repeated enemata from the aforementioned A team.

And so it fell to me as duty doc, a day or two ago, to call on her mid afternoon, to see if we should be trying harder to get things moving. The duty had been a bit busy, so no time for the usual lunch on the hoof for your humble narrator. I needed to examine her abdomen, so she gamely struggled upstairs to get on the bed (one simply does not submit to examinations of that sort on the settee) despite the evident effort it was costing her. I was keen to rule out intestinal obstruction, and as I leant over her “bump” to apply the stethoscope, to my eternal shame, it was my tum and not hers that did the rumbling.

In the end the exam did not reveal immediate concerns and we agreed there was no need for an urgent admission, though a quick Xray of her abdomen might be a good idea to rule out a sub-acute obstruction (believe it or not a fairly precise surgical definition that would have signs evident on said Xray). As a result I arranged for her to go for the pictures that afternoon, and in the event they were clear and we have pulled back from the purgatives and enemata and reassured her that a little feeling of fullness can be expected simply as a consequence of the mass in her tummy, but that so long as it causes no pain and no nasty vomiting she need not fear it.

In the end as happy an outcome as we could have hoped for in the circumstances, and Grace was effusive in her thanks for me not wanting to admit her. And in the midst of all this, as I was arranging for her to pop in for the films to be taken she politely wondered if she might offer me a cup of tea and a sandwich.


Elaine said...

Well, you did drop a gentle hint!

Doctor Jest said...

I didn't actually say anything on the subject, honest. Disappointingly I had to hare off to another patient and so had to decline her kind offer.