Cautionary tales - Dr Mike Birrell

I WAS a first year resident in a big provincial hospital finding my way slowly through the gamut of presentations in the chaotic emergency department with a lot of theory but short on practical experience.

The cachectic charge sister, with an FEV1 well under 50%, ordered me to see a 54-year- old man with chest pain and thrust his patient card at me. 

She had placed him in the cubicle next to our humble resuscitation area. I walked in and was greeted by a lean fit looking tiler with a generous smile, lying on a trolley with his legs crossed. We levelled the playing field over a quick chat about my kitchen colours and textured tiles.

Moving onto his reason for attendance, he had been troubled with two to three days of intermittent burning chest pain and ran his hand up and down his sternum when describing it. 

On further questioning he felt it was made worse by food and he had no family history of heart disease but was a smoker.