A Christmas Break Professor Chris Winearls (1972 Keble College), Consultant Nephrologist in the Oxford Kidney Unit, 1988 to 2016 A long time ago, I was the duty renal consultant for the Christmas period. The SpR rang to seek authorisation for a patient, who normally dialysed in one of our satellite facilities, to be admitted to the Oxford Renal Ward to allow him to be dialysed in the main central Oxford Dialysis Unit. He had end stage renal failure caused by neglected bladder outflow obstruction caused by carcinoma of the prostate. Now he had severe pain which had worsened since a fall in his bathroom. He could not get into a hospital car and there were no ambulances over Christmas to transport him in a wheelchair to and from his local dialysis unit. He came over and we parked him in a bed. The original pain, he told me, had developed about a month before and he had an X-ray at his local hospital. He had not been told the result. I phoned the DGH – the X-ray had apparently not been reported and was nowhere to be found. We requested another. It showed a metastasis in the neck of the femur. Our orthopaedic colleagues agreed to pin it prophylactically. They asked us to send the X-ray over to their hospital. It never arrived so they
could not proceed. I asked for another X-ray. The request was refused on the grounds of unnecessary exposure to radiation. We were told that the first (or should I say second X-ray) would have to be found before he could be seen and operated upon. I knew it was hopeless to expect a search in any of a dozen places between the renal ward in the Churchill and the other hospital site, over Christmas, to be possible or fruitful. I had a mini-tantrum in the doctor’s office and decided to try again to resolve matters the next day. I went in on Christmas Eve to find his bed empty and the juniors beaming. “He has had his operation.” They said, “he was transferred for surgery last night.” “Hooray”, but,” How,” I asked, “was the impasse resolved?” “He slipped and fell next to his bed and fractured his neck of femur so we got another X-ray and the orthopods were happy to proceed.” He returned to our ward, where I wished him a happy Christmas, but before I could apologise, he thanked me for all we had done for him and said how wonderful all the doctors and nurses were etc. I went home after finishing the ward round and treated myself to an extra slice of lemon in the ginless tonic.
Digital-First Primary Care? Dr Chris Mason (1977 Worcester College), Consultant Histopathologist, Exeter
Oxford Medicine | Autumn/Winter 2021 21
