Every now and then, I have a perfect consultation. It gives me a warm glow inside. I’m sure that any doctor reading this knows what I am talking about. The diagnosis is spot on, you can fix the problem there and then, patient leaves the room happy and satisfied. These consultations don’t come along very often, but when they do, they are worth sharing.
Daillies, my long-suffering interpreter, was off work today, so I was consulting solo, mainly seeing patients who spoke reasonable English. A well-dressed lady came into the room with a pretty little girl in tow. Literally. She was being dragged in by her mother. After a feeble protest, she reluctantly climbed onto her mother’s lap and stared at me.
I like to think I am good with kids. I alter my posture, get down on their level, speak to them directly in a soft voice, smile and give no indication that I am about to jab a needle into them. This little girl hid her face behind her hand. “If I can’t see you, you can’t see me.”
Her mother’s opening gambit was, “My daughter, she stinks.” I flipped through the child’s medical records and there were a few recent consultations about headache, runny nose, a cold. “Generally, or just in one place?” I asked. Her mother said the daughter’s breath smelled.
Mild halitosis is common in children who have blocked noses and breathe through their mouths. There is a particular breath smell associated with glandular fever that doctors who deal with adolescents can spot a mile off. This little girl smelled a lot worse than that. This was getting into forgotten tampon territory.
I showed mum how to trap her daughter’s arms with one arm, and pull back on her forehead with the other arm, so I could take a peek inside her nostrils. The left was clear, but there was a lot of snot in the right. We don’t have any tissues in the clinic, so I had to get some toilet paper out of the staff lavatory, and I got her to give a big blow. The odour was more overpowering now, so I was obviously on the right track.
I put my finger on the point of her nose and pushed it up and back, to get a clearer view with my head torch. Using a pair of curved artery forceps, I grabbed hold of a greyish looking mass and gently pulled. Out came a disgusting piece of what-might-once-have-been-cloth, about the size of a cherry. The putrid, rotting stench was from anaerobic infection caused by the “foreign body”.
The mother gasped, “What in the Lord’s name is that?”
“Just something she probably put up inside her nose and then couldn’t retrieve it,” I replied.
In my experience, it is always worthwhile having another look, just to make sure that there isn’t another foreign body present. The nostril was clear. Job done. Pat the child on the head and say what a brave little girl she had been, do a “high five” with her, and next patient, please.
“What, no medicine, doctor?” asked her mother.
ME: “No need, I’ve solved the problem.”
MUM: “But she has been coughing. She needs cough medicine.”
ME: “The stuff in her nostril was causing her to produce a lot of mucus in her nose, which trickled down the back of her throat, causing her to cough. It is gone now, and the cough will improve by itself.”
MUM: “What about paracetamol?”
ME: “No need for that, either. It is good that I have fixed the problem without her needing to take medication.”
Mother was not beaten yet in her quest for medication. She told me that now it was her turn to see me. “I’ve had this problem for the past year…”
I took her history, examined her, but could not find anything wrong and admitted diagnostic defeat. Even she smiled when I said, “I wish I could cure all my patients so quickly and easily by pulling out the problem.”