Being Aware

Ministerial Meandering

Being aware

I will own up to enjoying detective stories on the television. I like to see how

many of the clues I think I’ve picked up actually are used as clues in the plot, and

how many are irrelevant to the crime. I like to deduce attributes of the killer by the

pattern of injury on the body for example, and this probably explains my interest in

forensic pathology.

As a surgeon, I liked to start collecting clues as to the diagnosis of my patient

before I’d even introduced myself to them – perhaps by discreet watching from the

end of the bed while they slept.

What was the respiratory rate? Were the nostrils flaring with inspiration? –

suggestive of airway obstruction. What was the colour of the face, lips, hands, and

nails? Were the nails misshapen in any way that might give a clue to a dietary

deficiency or chronic obstructive airway disease?

And on the first handshake – note the colour of the palm and whether there was

any suggestion of Dupuytren’s contracture, which is more often felt than seen in

the early stages, and can be a clue to liver disease or repeated manual trauma, as in

those who use road drills.

Bedside sleuthing is fun and often useful, but the knack of being aware in everyday

situations can be extraordinarily helpful. Some visually impaired people don’t use

a white cane out of embarrassment or stubbornness, but they can often be spotted –

watching with their ears, and an intense, wide-eyed stare in the direction of travel.

Trying to second guess if a person is left or right-handed by the way they eat their

food, or the position of their wristwatch, can be useful if you think they may be

threatening, and you want to know which fist is likely to lead.

People’s gait is also fascinating; I remember as a medical student many years ago

(just before The Flood), sitting in a neurology clinic with the consultant, and being

asked to assess the gait of his patients as they walked in and sat down. Telling the

difference between the gait of Parkinson’s Disease and a stroke wasn’t usually too

difficult, but between a stroke and severe arthritis of the hip was more challenging.

The clue was the way they held the upper limb; the stroke patient had the arm on

the same side as the affected leg flexed at the elbow, and the wrist also flexed and

the hand clawed. In the arthritic, the upper limb was either at the side or holding a

cane.

The pattern of breathing in the obtunded patient could presage either an impending

epileptic fit, or a cardiac arrest – or simply airway obstruction in a drunk. Or was

he slowly dying in front of your eyes from a slow bleed into his head injury that he

received from his nose-dive into the curb, while you dismissed him as another for

the drunk tank? Check his pupils before you send him away. And his blood sugar;

diabetic coma of both hypo and hyper-glycaemia can cause unconsciousness; one

can be reversed in seconds with a syringe of 50% glucose – the other’s breath

smells of acetone (nail varnish remover) and will take a lot more of your time to

correct.

This has turned into a bit of a medical mish-mash, but was started only to try and

make us all more aware of the things that go on around us in everyday life that

often pass us by. The reason I wanted to share that with you this week is that as I

sat down to write, I was feeling rather more woolly-brained than usual, and thus

less aware than I like to think I am as a rule.

What you don’t need in your vicar is a ‘blind guide’, you need one who is sharp

and aware – so I will indulge in a brisk walk with Gracie and a stimulating cup of

tea, in an attempt to sharpen my wits to deal with the intellectual challenges you

toss in my direction from time to time – for which, by the way, I thank you.

Philip+