Further Confessions of a GP

Thank goodness for the humble chest X-ray. X-rays show the air in the lungs as black and the bones as white. Fat, even a thick layer of it, can be seen through if the clever radiographer cranks up the exposure of the film. I was depending on the chest X-ray to show me a reasonable picture of her lungs to help work out what might be going on. The portable chest X-ray was done and the picture soon showed up on the computer monitor. To my relief, the image was reasonably clear and I could see the white fuzzing of infection in the lower part of her right lung that was probably causing her problems. Oddly though, the infection wasn’t the only thing that I could see. There was some sort of electrical device implanted on the left side of her chest wall. I was used to seeing pacemakers on a chest X-ray film. These are implanted under the skin on the chest; the wires from them travel to the heart and give off electrical pulses to help prevent it beating too slowly. This didn’t look like a pacemaker though, because I couldn’t see any wires travelling from the machine to the heart.

I called over one of the other doctors to have a look and soon there was a small collection of us crowding round the monitor trying to work out what the device was. I thought it might be an implantable defibrillator but one of the other doctors pointed out that these have visible wires too. The cardiology registrar, who was also staring in confusion, had heard about a wireless pacemaker being developed in America and wondered if this was a version. As the number of doctors surrounding the monitor grew, the debate on the identity of the mystery device intensified. During a rare moment of quiet, a voice from the back of the crowd piped up, ‘It looks like a Nokia 1101.’

Everyone turned round to look at the baby-faced medical student at the back.

‘Nokia don’t make pacemakers,’ the cardiologist snapped impatiently before returning to his debate with the emergency medicine consultant.

‘No, the Nokia 1101 is a mobile phone. I used to have one and it looks identical.’

There was a moment of silence before the cardiologist continued to shout down the student for even considering that a mobile phone could be implanted inside her chest. I went back to see the patient. With a bit of help from one of the nurses I leaned her forward and pulled apart a large roll of fat on the left side of her back. I pushed my hand in and felt what I was searching for. The Nokia 1101 needed a bit of a tug, but it soon came free and I returned to the collection of doctors around the monitor to show them my catch. The medical student quite rightly enjoyed his moment of triumph while the cardiologist left quietly, shoulders slumped.

The coroner

It was 8:15 on a Wednesday morning and I had just arrived at work. I had barely taken off my coat when the receptionist put a call through to me.

‘Morning, Dr Daniels, it’s the coroner’s office here.’

A wave of anxiety washed over me. The coroner only calls when someone has died and usually when that death is unexpected.

‘Barry Dawkins. Know him? Date of birth 22 April 1963. He was found dead at home last night by his wife.’

The name rang a bell but I really couldn’t picture him. Having been born in the year 1963 made him only just 50. Why had he died? That’s much too young.

My slow NHS computer was taking a lifetime to boot up. I was repeating the name Barry Dawkins over and over in my mind. Why couldn’t I picture him? Who was he? Had I missed something? Of course, with more than 6,000 patients registered at our surgery, one or two tend to fall off their perch every month or so, but normally these are patients who are expected to die and the coroner doesn’t get involved.

The coroner’s office deals with deaths that are violent or unexplained. They often call for a post-mortem and sometimes order an inquest to clarify the details surrounding the death. A coroner’s inquest can be a scary place for doctors. They are not a criminal court and so can’t attribute criminal negligence, but they often still involve a doctor standing up under oath and trying to justify why they did or did not do something with regard to a patient’s care.

When I finally got Barry Dawkins’ notes up, I scrolled through in a slight panic wondering if I might have missed something. He’d been in a few times recently for a review of his blood pressure and diabetes, but that was about it. My biggest fear was that he had presented with symptoms that I had dismissed, which he had then gone on to die from. Could he have had a burst aorta that I’d dismissed as simple back pain, or a bleed on the brain that I’d thought was a migraine? I was mightily relieved to see that no such mistake had been made, but a pang of guilt washed over me as I realised that selfish self-preservation was all I’d been able to think about upon hearing of this man’s untimely death.

The coroner disrupted my thoughts.