The Doctor Will See You Now [Non-Fiction]

Chapter 116: Acute Medidcine

An 80-year-old man comes in with, according to the family, 'a bit of poor appetite'. He hasn't got much in the way of past history. An active and independent man who does his own shopping and is often out and about.

When he comes in, he's super confused, screaming, flinging his arms about. He refuses to eat -- but that wasn't the biggest issue. He's also got a high fever at 39 degrees celcius. Combined with the confusion, the most life-threatening concern is meningitis.

We discuss a lumbar puncture (LP; where we take a small sample of the cerebrospinal fluid via a tiny needle in the lower back to help grow bacteria and see what organism we're dealing with, if any) with his family. We don't need their permission, but it is good etiquette to keep families in the loop, particularly with invasive procedures.

The family refuses the LP. They actually have no right to refuse, but they could very well sue us if we performed it 'against their wishes'.

The family tells us it's 'not necessary' (I'm sorry, who is the doctor here?), that he 'doesn't have a fever' (I guess our thermometer is broken, then), that he 'should probably be discharged now, actually' (then why the feck did you bring him in?!), and that 'a relative who lives in mainland China says he shouldn't get the LP' (oh, I'm sorry, again, who is the doctor here?).

I rolled my eyes so hard I saw the back of my brain. The family is flipping out, yelling in front of the whole ward, accusing us of not allowing him to eat because we've tied his hands (he only got tied on arrival to the ward two hours ago because he was flinging his arms everywhere and we didn't want him to hurt himself or the nurses) and we have no idea what we're doing. Obviously they're beyond talking sense. I worry they actually have an ulterior motive, to deliberately bring an old man in but refuse all interventions so he will die -- plus or minus suing us in the process for failing to save him or something ridiculous. Naturally, if he dies of meningitis, they'll sue us as well because it's obviously our fault the family freaks out and refuses the LP. /s

It makes our job helluva lot more difficult. I can start antibiotics anyway, but I don't know what I'm treating, nor will I have any idea at all whether the antibiotic will work. Antibiotic dosage and duration are different for different infections and if he gets a fever later on, I won't know if it's because the antibiotic is working but taking its time or if I'm actually treating something else entirely.

My senior has a long talk with them. The man has what looks like a urine infection according to the urine dip, but we can't guarantee no meningitis if we don't LP. We start antibiotics. We can only hope it's a urine infection and nothing else, otherwise his family will kill this guy.