This week I am feeling supremely proud of myself because last week I nailed two serious clinical diagnoses, and the most sophisticated tool I had at hand was an X-ray machine.
This first was Ms X, whose cousin brought her in because she'd woken up with a headache and was acting a bit more obtuse than usual (she's apparently not very easy to get on with, even at the best of times). So anyway, Ms X is in her mid-thirties, and she's quite scrawny and looks a bit rough-around-the-edges. She was acting a bit strangely (napping on the waiting bench, and then flinging her arms and head down on my desk to continue her snooze while I was trying to interview her), and her neck was as stiff as a board. In this part of the world, the sum of these three things (skinniness + acting weird + stiff neck) almost always means HIV and some kind of opportunistic central nervous system infection, and generally we'd just pop a needle into their spine to get a diagnosis, but in this case a little voice whispered in my ear 'Wait.' On closer inspection, she had not even the hint of a fever, a slightly elevated blood pressure and when prodded enough she could vaguely explain that the headache had come on quite suddenly. So I called up Civilisation, and spent ten minutes trying to convince the guy on the other end of the possibility that she'd had a sub-arachnoid bleed. Eventually he conceded that maybe they could give her a scan, 'just to make sure', and off she went. Two days later, she wasn't yet back, and I called Civilisation up again. After many switchboard detours, I finally got through to a sister in the neurosurgery ward, who confirmed that Ms X had in fact had a bleed, and was being prepared for an angiogram as we spoke. Woo-hoo, Karen!
And then my second super diagnosis for the week was on Baby Y - born at around 32 weeks gestation (around... hmm.. sevenish months?) at 1500g, she'd vomited everything she'd been fed in her first 24 hours of life, and had failed to make a poo. When we put in a nasogastric tube we drained dark green fluid, and her X-ray looked like this:
Ya ya, I know the diagnosis is really obvious now, but I've practically spoonfed y'all each little puzzle piece. Anyway, I called Civilisation up again and told the pediatric surgeon I thought I might have a case of duodenal atresia*. I was quite unsure of myself though, and said he could send the kid right back if there was nothing wrong with her. 'Don't be stupid, Karen!' he yelled. 'There's obviously something wrong with her! Send her at once!' (This was quite a pleasant change from the attitude of the spinal unit folks).
Anyway, the next day Civilisation called me back (d'you hear that? Civilisation called me!) to tell me that Baby Y had jejenal atresia**, that they had operated, and that she was recovering nicely in ICU. What I'd seen on the X-ray had confused me a bit, looking almost like a double-bubble sign, but not quite (Bongi could probably explain why it isn't one, if you really want to know), and the reg told me that it was in fact a triple-bubble, so that although my diagnosis wasn't spot-on, it was only a couple of centimetres off.I'm trying to maintain some modicum of modesty, but it's quite hard.
*Kind of like a blockage of the small intestine, because a part of it doesn't grow.
**The same, just a bit further down.