Why after 5 years (or 6 in my case!) of medical school and eons in hospital/GP medicine do we still not learn to look beyond the obvious?
The number of strange presenting complaints we encounter every day in our practice surely must have given us the insight to look beyond the tunnel vision we have. It's something I've certainly learnt from the following experience.
It all started in May 2005 after I came back from a camping trip with my partner and his cousin. Within a day of returning, I started developing a very itchy urticarial rash all over my body. I am an atopic person so just assumed I had come in contact with some bizarre nettle found in the depths of beyond in Cornwall! I proceeded to take a cocktail of antihistamines, topical creams etc, but things didn't get better. In fact they got worse. I wasn't sleeping at night because of the itching and started to miss work because the rash was so severe.
It got to July and I was planning a holiday abroad. I was adamant that I would enjoy my time in the US so went to my local GP who agreed. He thought it was an urticarial rash and told me to change my washing powder, go organic and generally try to find what was I reacting to. I convinced him to give me a course of steroids while I was abroad, which worked a treat, but as soon as I got back from the US, the rash reappeared.
Well, by then I was starting to lose my wits and made a barrage of phone calls. I spoke to my father (a paediatrician) who got really worried and ordered me to do a string of blood tests, half of which I didn't even know existed! My registrar and another dermatology registrar suggested various things, treatments, referrals but no specific diagnosis. At that time we were all betting on chronic urticaria. I went to see my GP again who also ordered blood tests and said if they came back abnormal, he would consider referring me to an immunologist.
Then the breakthrough came. It was a late evening in September and I had invited some friends round for dinner, all of whom were potential GPs. The conversation was cutting edge and consisted of my rash intermingled with a few slurps of wine!
As I finally turned in for bed, I went upstairs to change the bed sheets and as I moved the mattress, I noticed them. Those disgusting tiny black things. They were everywhere, all over the wooden slats and frame of the bed. I was traumatised and petrified and proceeded to put bleach on everything. Pest control came over the next day (lovely chap) who sprayed the whole room with pesticide:
‘It's the 'ole bed bugs darling. Natsy little beggars … Probably came from the bed that wasn't treated at the warehouse …’
What? Looks like the eggs of the bugs had been dormant in my lovely bed over the winter and had then hatched over the summer. So much for the reputable company that I shall not be mentioning, but wish I could!
Jed was his name. He looked at my rash and said, ‘Oh, looks like they've been at you as well — surprised they didn't bite your partner.’ And there it was. The diagnosis I had been waiting for months came so matter of-fact from a man who had never seen the dregs of a boring medical textbook. Within 24 hours my rash subsided and vanished.
Two weeks on, I'm still sleeping in the spare room. The bed has been given the all clear but fear has already planted its seed!
I've learnt a lot from this experience … frustration, despair and finally peace … something that all our patients experience when we don't look beyond the bigger picture. Maybe we just need to open our minds a bit more and think of the unusual.
- © British Journal of General Practice, 2005.
