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I don’t know what the opposite of an epiphany is, but I think I’ve just had one. And all it took was a hernia.
I’d seen the patient a month before with a few weeks’ history of mild, left-sided abdominal ache, worse with movement but becoming more constant. No other symptoms, though he felt the area was swollen at times and so reckoned he had a hernia.
But I couldn’t demonstrate any swelling and he was pointing to his left iliac fossa, miles away from inguinal or umbilical hernia territory. So I told him it was muscular and arranged a therapeutic ultrasound only because of the look of utter disbelief on his face.
Which is exactly the expression I have now. Because I’m looking at the ultrasound report and it states, ‘Left-sided spigelian hernia, high risk of strangulation. Suggest referral.’
What? A what?? A left-sided high risk what??? A quick bit of Googling later and I discover that, yes, a spigelian hernia is a Thing – a Thing my patient actually gave a classic history of, in fact, and a Thing, yes, with a high risk of strangulation.
But I have never even heard of a spigelian hernia. How can this be? How did I miss that lecture/chapter/article? Why has everyone been keeping this secret from me? What have I been missing, literally? The only consolation is the absence of any note of a recent A&E attendance, plus the fact that he does appear to be in the waiting room now, rather than in ITU.
This does nothing to ease my endarkenment. Let’s face it, after 35 years in medicine, I reckoned that I knew, or at least had heard of, everything. It turns out I don’t and I haven’t. This freaks me out to the extent that I know I’m suddenly going to be diagnosing a lot of possible spigelian hernias, even in patients who come in with a sore throat. Also there’s the uncomfortable implication that I’m going to have to start listening to what patients are telling me, and I’m not sure I can change the habits of a professional lifetime.
I sigh, deflated. Poised to call him in, I quickly read the scan report again. Because there’s more. Something about an ‘abdominal aortic aneurysm’. Now, what the hell’s that when it’s at home?
Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield