Suppose they bring me a hernia

Mikhail Bulgakov From A Country Doctor’s Notebook Forty-eight days ago I qualified ‘with distinction’; but distinction is one thing and hernia is another. Once I watched a professor operating on a strangulated hernia. He did it, while I sat in the amphitheatre. Suppose they bring me a hernia? Worse, they brought a dreadfully injured young Read More …

The first urologists

Lithotomy – and hence, the lithotomy position. Commentary French composer Martin Marais (1656-28) wrote this dramatic, narrated piece about the experience of a high-risk, no-anaesthetic, operation for bladder stone. Samuel Pepys had a bladder stone removed when he was 25 in 1658, repeatedly mentioned in his diaries, including in his very first lines written on Read More …

“No one wants advice – only corroboration”

At 7pm on a Tuesday evening, the medical registrar calls you asking for ‘advice only’. He has admitted a 62 year old builder through casualty with a two day history of vomiting. He has a background of ischaemic heart disease, atrial fibrillation for which he is taking digoxin and warfarin, and peptic ulcer disease. His Read More …

From the transplant clinic to the dialysis unit (and back again?)

  On the monthly ward round of your satellite dialysis unit you come across a new patient: a man in his mid-50s, originally from Cyprus, who has recently been discharged from the renal ward and transferred to your unit in the last week. From his discharge paper work and chatting to the patient you learn Read More …

A referral from the haematology ward

You are asked to see a 68 year old woman on the haematology ward of a teaching hospital.  From the notes you learn that she has multiple myeloma with IgG lambda paraprotein.  Serum creatinine at the time of diagnosis was 155μmol/l and there was 13g/24h of proteinuria.  Initial treatment was with bortezomib (Velcade), doxorubicin and Read More …