What Mind does not Know….

Polar Bear on Crutch Consulting With Doctor
Image by Laughing Squid via Flickr

It was an incident some 12 years back. I entered into the surgical ward in our hospital only to find a boy’s right lower limb in traction.I thought the child perhaps is suffering from some orthopedic condition.
It is learnt that my senior surgeon has applied the traction to the boy.History taking revealed that the boy had fever at least for one week followed by limping gait.He was unable to stand erect and had to bent at the right hip.This was due to pain in the right lower abdomen.Incidentally the treating surgeon also came in and told me about it.So I asked our attendant to release the traction and made the boy stand.There was a distinct bend at right hip as the boy was having pain.The limb can not be made straight even passively.There was a diagnosis in my mind.The boy was asked to to lay down and I palpated the painful site in the lower abdomen. My diagnosis was found to be correct as similar cases had been seen by me some time back.One hard lump was felt in the right lower abdomen nearer to the inguinal region.That was a case of psoas abscess.
So this is a sort of spot the diagnosis for the doctor if he had seen it earlier .The mind knows it.If not,the doctor is sure to be in darkness .Of course, now-a-days it has been made easy by ultrasonogram.At that time ultrasound was not available in those places.Had it been to-day I would have ordered for an ultrasonogram.My senior colleague was skeptical about the diagnosis.The treatment was to drain the abscess either under general or local anaesthesia.Once pus comes out the patient is bound to get a lot of relief.
We took him to the operation theater to drain it.The knife was with me.First, I palpated the most painful and prominent part of the lump.I aspirated the lump and scanty pus was out in the syringe.But my colleague did not appreciated that.Still I went ahead to make an incision on that part by knife.Then I took another instrument called sinus forceps to make a path to the lump from outside.Pus was not found .Again it was a victory time for my senior colleague . He tried to persuade me to abandon the procedure.But I did not move.I knew that the path of exploration was not right.I tried again and could reach the lump.A gush of pus came out under pressure to much the relief of the patient and of course,myself.
At that time only, my senior could appreciate that.So in medical science there are some diseases which are to be spot diagnosed .Now a days it is much easier.Diagnosis is to be confirmed by ultrasound and an ultrasound guided needle will invariably yield pus.But we lack the clinical confidence to-day.

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