I had a case at the clinic yesterday which is now troubling me.
Basically this man presented at the casualty with a fractured neck of femur following a history of trivial injury. He came at 10pm, THREE WEEKS after the fall. Later on I was informed that he had been walking with crutches for the past 6 months prior to that after allegedly hearing a crack from the joint.
Now, I was the one who saw him at the A&E. He was brought in by his daughter who claims to be a GP in one of the East Coast states. Since the patient is now pain-free, I offered to allow him home and gave him a date at the clinic.
So, he came and was informed that the lesion on his bone looked suspicious. Sans daughter, he refused everything and was discharged.
Imagine my surprise when another daughter who is apparently a nurse, came to the clinic and requested to be seen by my specialist, about 3 months later. Maybe 'surprise' isn't the word I would use. Amused? Puzzled? Perplexed?
In ward, we proceeded to work him up for more sinister causes. He continued to be uncooperative, only hesitantly agreeing for invasive procedures after being coaxed by his daughters.
Anyway, the CT scan showed multiple metastases but the primary hasn't been identified yet. I spoke to the children, who brought a family friend who openly displayed his DR (I mean, couldn't he just introduced himsef?) without the father present. I explained that he is now unsuitable for any surgical intervention on his femur and the more important issue now is to find out the cause.
Though I silently thought, with the advanced stage that he is, is it even worth finding out where it came from?
I spoke to the pakcik and he looked in relatively good spirits. Before he left, he said something that left me pondering. He said, "Doctor, I hope that we could leave the past behind us. I am now open to all your treatment choices and will give my full cooperation"
His statement continues to play in my mind and I wonder what brought that on.
and I wonder if it is now too late?
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