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Listening man—an oxymoron
  1. Colm O'Mahony
  1. Countess of Chester Hospital NHS Trust, Chester CH2 1UL, UK

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    “Will you listen to my chest?” “What, it's 3 am!” “I know, but it's sore and I feel I'm catching my breath.” (So, no chance of sex then!) “Alright, alright, I'll get the stethoscope.” After clearing several layers of dust off it (the stethoscope that is, not the chest) and listening for the second time, I was still uneasy that all was not well. There was a difference between right and left lung. However, the clouding effect of yet another alcoholic Christmas night out blurred my ability to work out which lung was not quite right, or left . . . . . . I opted for masterly inactivity and reassured my wife that “everything sounded fine, dear.” I did fully intend to listen again in the morning (don't look at me like that, I did).

    Three days later . . . . . . “You just won't listen when I've got a pain will you? I'm going to the GP. There is definitely something wrong.” “Hold on, hold on, let me check again” (how could I have forgotten!). Now there was clearly a problem, absent movement, absent breath sounds, and a percussion note that Phil Collins would have been proud of. I even did the coin test,* as this was my wife and not a patient. On reflection, scrambling round for small change did little to inspire confidence in my increasingly sceptical, breathless wife. Lastly, where had the trachea gone! Tracheal deviation be damned, this was more like a detour. “I'll just phone Casualty and tell them I'll be in shortly with you.” “Not before I've had a shower and washed my hair—it can't be that bad or you wouldn't have waited three days to listen to me . . . . . .?” “Let me turn on the water for you.”

    In A&E, Staff ask “where have you been until now?” “It's a long story . . . . . .” Chest x ray showed complete right lung collapse with mediastinal shift.

    Gradually, it all started to become clear. Maybe the cause of that chronic intermittent right sided chest pain often around period time, since the prolonged traumatic twin delivery six years previously, was finally becoming clear. Endometriosis of the lung—catamenial pneumothorax—that is, collapsed lung pertaining to menstruation, virtually always right sided. Minute spontaneous collapses monthly over the next four months confirmed the diagnosis.

    The cardiothoracic surgeon firmly commented that “if you were a normal patient, I would do it endoscopically, but you are a consultant's wife, so anything that can go wrong will. I will therefore just have to go and do it the old fashioned way—that is, open up the chest, strip off the pleura, a touch of a sander to rough up the surfaces and you'll be permanently adhered.” I couldn't have agreed more. Evidenced based medicine is no substitute for common sense, experience, and sound intuition!

    Nothing like a chest drain to dampen the Christmas spirit. Then again, even though “it only hurts when I laugh,” there wasn't much to laugh about that Christmas.

    Christmas shopping, however, still had to be done. I was determined to disprove the old adage: send a man to a supermarket for butter, milk, and eggs and he comes home with wine, jeans, and a tree! I therefore went forth diligently with an extensive list and, in my opinion, did magnificently. Failing only in the understandable misinterpretation of one item. The list said—buy at least £15 worth of crackers. It did cross my mind as being a somewhat unusual purchase, as I piled up the packets of Jacob's Cream Crackers, Ritz, Carr's Water Biscuits, etc. My successful expedition was greeted with thinly veiled sarcasm “Well, that's just grand! They're going to look really lovely on the Christmas tree! You men, you just won't listen.”

    Now where have I heard that before?


    • * Coin test: Place coin on the back, tap it with another coin and listen at the front. Normal lung—you hear a dull thud. Pneumothorax—especially if pressure is increased, you hear high pitched tinkling sound, time to panic!