Last week I was asked to see an old lady in an OPH. The problem was a stiff and painful wrist. "Could it be gout?" offered the care assistant. "Nobody's reported a fall, and she says she hasn't hurt herself" she went on. On examination there was indeed no apparent swelling, but the wrist would not permit even the slightest movement without a yelp of pain from the patient. Reluctantly I advised the home to take her up to A and E where she could be X rayed. I hate doing this, because an upheaval like this can have a highly deleterious effect on a very old, very frail person; sometimes even kill them. But as I said to the carer, "just because there's no history of injury, doesn't mean there wasn't one" I noted, not the first time, that it is rather cruel of God's grand design that, while mental faculties fade with age, the appreciation of pain does not.
Today I rang the home concerning another patient and enquired about the former one.
"You were right, doctor. She did have a fracture" There was a slight note of awe and admiration in her voice.
"Good God, you mean I actually got something right? I suppose it's bound to happen every now and then, just on the law of averages"
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