Late presentations “Hard Bastard”

Working in an isolated area with a reputation for hard “bastards” you see things presenting even later than you might imagine. Had this “Bloke” present to ED. (Not barry crump for clarification)

<—–Kiwi literature

 78 male. life long bachelor.

Presented with anorexia, lethargy and feeling “as weak as an Auckland accountant” Some clarification for those outside New Zealand, Auckland is our largest city almost half our population and residents are known less than affectionately as JAFAs  (Just another f#$%ing Aucklander)

So the had been off his food for a while and not eating any solids as was “difficult”. His main complaint was that he got tired when pushing his lawnmower.

 The patient last saw a doctor 25 years ago following a “small” accident with a chainsaw when working in the Forest.

He had stitched himself with twine as was 2 days walk from the bush-end. “It was only about 20 stitches”

He came to get the stitches looked at. Not a bad job according to the ED doc. Was going to be revised to some formal sutures but self discharged after theatre list was bumped to following day. Explained to me that the boys were going hunting and didn’t want to wait another day and miss out.

So this time he had a Biochem panel done which showed this.

 

ECG was as below.

 The following day with some potassium replacement ECG developed to this.

Pt left hospital a week later unfortunately with diagnosis of oesophegeal Ca with mets. Declined any further intervention, but accepted some fortisip for dietary supplementation and review in clinic in a months time as he didn’t have any trips into the bush planned then.

His plan “Ill hunt until I can’t walk, and then the boys can strap me to the back of the Ute(Pick-up truck) and ill shoot from there”

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  1. […] Late presentations “Hard Bastard” – Working in remote areas really does highlight how resilient these patients are at times….This case is the perfect example. […]

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