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Cool, calm, and collected?
  1. Rob Miller
  1. Balham, London SW12 8JP, UK

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    The trip to the steam railway was meant to be the highlight of the bank holiday weekend. My son Jamie (then aged 4) shares his father's fascination with steam trains. His lack of interest and pale colour made me realise he wasn't well. That evening, having returned home, it was clear that he was sleepy and did not want to eat his tea; he dramatically vomited the milk I had persuaded him to drink.

    His complaint of a headache added to my worry. I did not sleep much that night. Several trips to his room to check on him—hot and sweaty, slightly raised respiratory rate, but deeply asleep—did nothing to reassure me.

    The next morning he wouldn't wake up and was very hot. The little paediatrics I remembered (only a fraction of the tiny bit I ever knew, despite 6 months as an SHO) underwent rapid review.

    Trying to be calm, I examined Jamie—

    No rash

    No lymphadenopathy

    No organomegaly.

    Mouth—tonsils looked okay (through his clenched teeth)

    So far, so good!

    Neck . . . . . . . . . . . . VERY stiff, oh,—!

    His neck was still stiff 10 minutes later when I checked again.

    A telephone call to the GP's surgery, “Could you bring him around?”

    “Well, no. He is drowsy.”

    “What do you think is wrong with him?”

    Trying not to seem too stressed . . . . . . . . ... “Well . . . . . . . . .he's got a stiff neck . . . . . ..”

    “Okay, we will be right round.”

    Moments later, or so it seemed, the doorbell rang and the GP was on the doorstep. As I came downstairs to open the door, I could hear him speaking to a medical student who accompanied him.

    “This sounds like meningitis, the diagnosis isn't much in doubt—the father is a consultant physician—but we'll just check for ourselves.”

    Jamie lay sprawled on the bed. The GP's examination was thorough.

    “So, no rash, huh hmmm—juicy nodes in the neck” (Where the hell have they come from? I thought.)

    By pushing open Jamie's mouth the purulent exudate on his tonsils was clearly visible.

    The rate of evaporation of my confidence in my own clinical skills was matched only by the alarming increase in my own discomfort and embarrassment. I suddenly wished a hole would open beneath my feet, as while Jamie's abdomen was being examined he suddenly opened his eyes, propped himself up on his elbows, and said, “That's not the way you palpate a spleen, Daddy doesn't do it like that!”

    Now, who was it who said, “never work with children and animals?”*


    • * W C Fields.