Thursday, June 21, 2018

Mother knows best

I had the privilege of reading her recent notes in the time it took her to come through the door. I could see that she had seen another doctor three days earlier with a fungal rash. She was eighteen years old.

Mum was in tow. She pulled the extra chair in the room to make a third angle so I got the hint. This was going to be a three-way conversation.

" You don't mind if I sit in, do you?" She asks, rheotorically.

"That's up to Allie" (Let's call her Allie), I look directly at my patient. She looked very timid but she was legally an adult so I asked "Would you like your mum to wait outside for a minute?"

I have found that to be a much better way of phrasing the question as it appears to alleviate the responsibility from the patient. Any shrug, hesitance or vague response is taken as a Yes.

"Oh no she doesn't mind, do you Allie?" Without much choice, Allie obliges her.

The problem was that the rash was still present after three days of using this cream.

"I can see that the other doctor asked you to use this cream for two weeks and then come back for a review"

"Well she was just worried that it would become very serious like mine did" Mum said. "I had exactly the same rash and I ended up in intensive care and this is exactly how it started"

 Getting a bit concerned that we might be missing something serious, I went over the details again.

"How did your rash start?" I ask Allie.

"It started as a small rash under my right bust over a week ago but it spread and became itchy"

"That's exactly what happened to me! I just woke up and my face was swollen. The doctor gave me something but it didn't work just like hers. He gave me some hay fever tablets but I ended up in intensive care and nearly died"

Allie looks a bit nervous now. Mum goes on to give full details of her experience with a severe allergic reaction.

"I think what you had was a different kind of rash" I say to mum. I turned to Allie. "Since you started using the cream, do you think it is still getting worse?"

"It's less itchy but still red." She said.

"It's very itchy and spreading to her face like mine did." Her mum said.

I take a look at her face but cannot find any rash. "Did you say it spread to your face?" I ask Allie.

"My face was swollen, I had to get an ambulance and they gave me some injections and I ended up in the intensive care unit"....Mum.

"Not really, no." Allie says.

I proceed to examine the rash and explain to her that it was clearly a sweat rash. It needed to be kept cool and aerated and allowed time to heal with the cream given. I quickly address Mum's rash history, highlighting the difference between her rash, caused by a severe allergic reaction, and Allie's rash, usually associated with fungal infection.

"Fungal infection? Oh yes! It runs in our family. She must have inherited it from my sister."

They are thankful as they leave. Mum promising to call an ambulance if it got worse and ask her other sister to get checked out.

I despair.

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