Mr Healthy
Mr Healthy was referred by his local community clinic. He is lean, well kept, with an old, but clean and neat, bright red two-piece suit, and leather shoes. His hair is close cut, grey at the temples, and he has a toothpick protruding from the corner of his mouth, which he occasionally wiggles in a casual sort of way. He is the epitome of "dapper".
I first notice him as he is walked into resus to have an ECG taken. He is in his late 60s but strolls in with a casual ease, no signs of creaking joints or the fatigue of chronic disease. The clinic letter states he was referred for an incidental finding of bradycardia (slow heart rate), his pulse was about 35 beats per minute.
I examine the ECG. It is sinus bradycardia - a normal but slow heart rate, and I cannot see any other serious signs of a heart problem. In the meantime he has been attached to a monitor, and blood pressure, oxygen saturations, heart and breathing rate are all up on the screen. They are entirely normal.
We exchange smiles as I approach the bed. He has been relieved of his suit, but though he is now dressed in the drab, blue, anonymous hospital gown, he defies the attempts to make him look like another sick patient. Nonchalantly chewing his toothpick, he looks at me with patient interest, clearly wondering what this was all about.
"Why did you go to the clinic today?" I ask.
"To get the results of my blood tests."
"Why did you need blood tests?"
"I just wanted to see if I was healthy."
I pause.
"You didn't feel unwell? Sick, feverish, vomiting, pain in the chest?"
"Nope. I just wanted to get a check up".
I need another pause. So far my experience here has taught be to be very circumspect about which bits of the patient history to take at face value, and which need a lot more digging to get to the bottom of the issue at hand.
l look at the monitor, he is still running at about 37 bpm. He is clearly totally well with it.
"No chest pain, shortness of breath, dizzyness...?"
"Nothing" pronounced: "Naa-theeng" with a very matter-of-fact smile.
Examination reveals good strong pulses, no heart murmurs, no other signs of serious pathology. There are some scattered crackles in the left lung, but a chest x-ray is unremarkeable, and he admits to being a life-long smoker.
The "wellness" check up bloods done at the clinic 5 days before are barn-door normal.
After a couple of hours of remaining totally well and stable, he is moved from resus to a majors (less acute) bay, with the plan to be reviewed by the consultant in the morning. This would decided on whether in/outpatient cardiology review should happen.
The next morning the boss arrives, and our large group of night / day shift doctors pay a visit to Mr Healthy. I present the story so far with my conclusion that this was a warning on the dangers of healthy people going to doctors; once we find something amiss, we're going to start digging.
There is good natured banter between the consultant and patient, and the boss spends a couple of minutes trying to elicit the same hidden problem that I had failed to. Surely there was some symptom, some issue that Mr Healthy was hiding from us?
No, he was an active sportsman in his youth, stays active and is well.
Finally the boss relents, but wants to check the heart is capable of working well when needed.
"My friend, can you do a sit up for me?" the patient obliges, and needing little encouragement, he goes on to perform a further 10 sit ups in the bed with enthusiasm, all the while his tooth pick casually waggles from the corner of his mouth. We are all now grinning, including Mr Healthy who is delighted to demonstrate his fitness. I quietly hope that this improvised "exercise tolerance test" does not lead to a sudden cardiac problem, as it seems a shame to have got this far unharmed.
On completion of his workout, Mr Healthy's pulse has increased appropriately, but is still regular, strong and he has not even broken a sweat.
"You see?" he smiles.
An hour later as I am driving from the hospital I spot a red suited man striding energetically along the pavement into the township. I give him a wave, and as he smiles, his toothpick waves back.
I first notice him as he is walked into resus to have an ECG taken. He is in his late 60s but strolls in with a casual ease, no signs of creaking joints or the fatigue of chronic disease. The clinic letter states he was referred for an incidental finding of bradycardia (slow heart rate), his pulse was about 35 beats per minute.
I examine the ECG. It is sinus bradycardia - a normal but slow heart rate, and I cannot see any other serious signs of a heart problem. In the meantime he has been attached to a monitor, and blood pressure, oxygen saturations, heart and breathing rate are all up on the screen. They are entirely normal.
We exchange smiles as I approach the bed. He has been relieved of his suit, but though he is now dressed in the drab, blue, anonymous hospital gown, he defies the attempts to make him look like another sick patient. Nonchalantly chewing his toothpick, he looks at me with patient interest, clearly wondering what this was all about.
"Why did you go to the clinic today?" I ask.
"To get the results of my blood tests."
"Why did you need blood tests?"
"I just wanted to see if I was healthy."
I pause.
"You didn't feel unwell? Sick, feverish, vomiting, pain in the chest?"
"Nope. I just wanted to get a check up".
I need another pause. So far my experience here has taught be to be very circumspect about which bits of the patient history to take at face value, and which need a lot more digging to get to the bottom of the issue at hand.
l look at the monitor, he is still running at about 37 bpm. He is clearly totally well with it.
"No chest pain, shortness of breath, dizzyness...?"
"Nothing" pronounced: "Naa-theeng" with a very matter-of-fact smile.
Examination reveals good strong pulses, no heart murmurs, no other signs of serious pathology. There are some scattered crackles in the left lung, but a chest x-ray is unremarkeable, and he admits to being a life-long smoker.
The "wellness" check up bloods done at the clinic 5 days before are barn-door normal.
After a couple of hours of remaining totally well and stable, he is moved from resus to a majors (less acute) bay, with the plan to be reviewed by the consultant in the morning. This would decided on whether in/outpatient cardiology review should happen.
The next morning the boss arrives, and our large group of night / day shift doctors pay a visit to Mr Healthy. I present the story so far with my conclusion that this was a warning on the dangers of healthy people going to doctors; once we find something amiss, we're going to start digging.
There is good natured banter between the consultant and patient, and the boss spends a couple of minutes trying to elicit the same hidden problem that I had failed to. Surely there was some symptom, some issue that Mr Healthy was hiding from us?
No, he was an active sportsman in his youth, stays active and is well.
Finally the boss relents, but wants to check the heart is capable of working well when needed.
"My friend, can you do a sit up for me?" the patient obliges, and needing little encouragement, he goes on to perform a further 10 sit ups in the bed with enthusiasm, all the while his tooth pick casually waggles from the corner of his mouth. We are all now grinning, including Mr Healthy who is delighted to demonstrate his fitness. I quietly hope that this improvised "exercise tolerance test" does not lead to a sudden cardiac problem, as it seems a shame to have got this far unharmed.
On completion of his workout, Mr Healthy's pulse has increased appropriately, but is still regular, strong and he has not even broken a sweat.
"You see?" he smiles.
An hour later as I am driving from the hospital I spot a red suited man striding energetically along the pavement into the township. I give him a wave, and as he smiles, his toothpick waves back.
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