An Interesting Rash

And no, not interesting in the funny-because-it’s-in-a-funny-place but more because it was a bit… inexplicable.

So a few months ago when I was on my acute medicine rotation as part of my ED training, I came across a bizarre presentation. This young-ish (so I admit, I can’t remember his age!) about 40-something year old, came in with a bizarre rash that had been ongoing and worsening for the past 3 days. He noticed a non-blanching pinpoint rash that started on his hands and forearms, and (not that he noticed initially) his lower legs, and then also started sprouting on his chest. It was very petechial looking, yet his platelet counts were within normal limits, and he had no prior bleeding or clotting disorders, and his PT/APTT etc were all normal. Denied any history of drug usage, and was on only one medication, something innocuous like omeprazole, and the rash was not painful or itchy or cause any unpleasant symptoms (Other than the fact that it was there!) There was nothing significant in his history, no contact from any allergens, no history of any atopy or allergy. I sought my consultant’s opinion, she was equally puzzled. It was all quite bizarre, and we were all ready to send him home after much hemming and hawing, with a prescription for a basic antihistamine. I wrote it out and got the nurses to give him a pack to go home with. 15 minutes later, the nurse came to me and said bizarre-rash-guy wanted to have a word. I went in and found, to my further astonishment, that his rash had suddenly disappeared. Like completely. Whatever was causing his symptoms over the past 3 days, had now suddenly, without warning and certainly without any helpful insight from me or any of the rest of the staff, completely and utterly vanished. I literally searched for it all over his skin, taking possibly more time now than when I first examined him. I recalled how I had apologised when he first came in and I admitted we hadn’t figured out what had caused the rash. And now I apologised again and admitted I couldn’t for the life of me figure out how or why it had disappeared. He must have really thought us to be useless and incompetent. But as I pointed out to him, we did end up solving his problem, albeit without any knowledge of how we managed it.

To this day I have no idea what he had, and later on my consultant and I sometimes found ourselves discussing what it could have been for weeks after this patient had left the ward. Unfortunately we had no photographic evidence, only my notes and our memories.

Hello world!

Greetings! New blogger in da house, what?!

Three days. That’s when I had this sudden bright idea (read ‘overheard my wife and sister-in-law talking about the benefits of blogging’) of starting my very own blog. I do, after all, have some interesting stories to tell.

I am a doctor by profession, and my chosen poison or…errr…specialty is emergency medicine. Yes, all the stories you have heard are true. We not only deal with the mundane cardiac events and road traffic accidents and strokes, but we also deal with the very interesting (and not so mundane!) foreign bodies in weird places that you ‘accidentally fell on to while climbing a ladder in the middle of the night naked and that’s how it ended up in my bum’. Very classy, and we totally fall for it. Not.

I also have an almost-2 year old, and the combination of sleepless nights due to daddy duty, and that of my lesser evil but equally exhausting shift work that I do, leads to quite a collection of interesting … incidents, shall we say? Some of them I would not breathe a word to anyone, and others, well let’s face it, they do make for great dinner party conversation.

So here I am, sharing my wisdom (or lack thereof). These are my stories, memories, anecdotes, reflections and thoughts – the inner rantings of a 30-something budding (balding?) doctor, trying to be an emergency physician, while also trying to dad.