A new experiment for this blog. In 7 short daily episodes follow the thoughts and feelings of Dr Patrick Elliot and his patient Elizabeth Valtrey. Patrick has made a mistake; Elizabeth’s bowel cancer went undetected, despite an obvious clue, and is now inoperable.
The scenario is entirely fictional, but it allows an exploration of the reflections and evolving rationale behind a doctor’s decision to be transparent, or to let error go unremarked. We will hear conversations between doctor and patient, patient and husband, doctor and partner, patient and specialist nurse, doctor and conscience, and finally doctor and patient once again. This format owes much to that literary cubist, William Faulkner, who described the death of Addie Bundren through 15 characters.
A new episode will appear at midday for the next 7 days.
Welcome to ‘The Miss.’
Dr Patrick Elliot flipped through the notes on his next clinic patient – Elizabeth Valtrey, recent colonoscopy done to investigate rectal bleeding, large polyp found, biopsies taken. He keyed in her details on the results system – Biopsy: Adenocarcinoma. Had she had a scan yet? Yes; the endoscopist was suspicious enough about possible cancer to have requested one straight away. CT scan result: tumour spreading from wall of the large bowel to adjacent structures. A spot on the liver, query metastasis. Oh.
He called Elizabeth in. She was 64 years old. She took her seat. Patrick used his years of experience to address the diagnosis, mixing clarity with kindness, hope with realism. This was incurable disease.
Toward the end Elizabeth surprised him; “Actually doctor, I think I saw you last year… my GP referred me with tummy pain. You recommended a camera test into the stomach… but it was fine.”
Patrick leafed back through the notes. A sweat had risen on his skin. He found his clinic note, and the corresponding letter. ‘Dyspepsia, no red flag/suspicious features. Plan: Bloods, endoscopy, if normal –> discharge.’ Now he looked back to the result screen. The bloods. Haemoglobin 10.1 g/dl. She was anaemic 9 months ago! She should have been referred for a colonoscopy then. The tumour would have been found, smaller, operable.
He had overlooked the result.
“What is it, doctor?”
“I err… I was just looking at some old results…”
“Nothing. Nothing Mrs Valtrey. Right… we need to make some arrangements for you. Your case will need to be discussed in something called a multi-disciplinary meeting…” and he laid out the near future for her. As she left he reflected that he might not see her again. Her care would now be taken on by surgeons and oncologists.
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