Going potty

Asking the right questions may help avoid being seen as a loco locum

“Mrs Parsons,” I called into the crowded rural waiting room full of discharging paediatric noses and of coal miners yawning after the night shift. An older woman heaved herself into a standing position with effort — teetered as if she were not sure whether she could fully rise — then wobbled towards me on her two canes, giving the appearance of a stiff four-legged creature. Finally, the surprisingly cheery woman was seated and began pulling up her trouser leg to reveal a recalcitrant ulcer. For 3 months, she had been travelling the 80 km to attend her biweekly dressings.

“Blasted thing,” she said as if frowning at the wound might shrink it.

I expected that both her grandkids and her grown-up children were used to being told what to do and speedily obeying.

Eager to show that, though I was yet another one in a string of locum general practitioners, I was thorough and caring, I set out to establish how the wound had occurred.

“Doh, I’ve told the other one,” she tut-tutted. “It was a simple fall.”

“Ah, but what were you doing when you fell?” I persisted, seeking to make a suitable entry about the “mechanical” nature of the event or otherwise.

I enjoyed locum work and enjoyed the thought of providing timely and thorough care for rural and remote patients. Zebras had often crossed my mind in the past, but I had learned to ignore them and graze in the pasture of “common things occur commonly”. Nevertheless, it could have been a transient ischaemic attack or an as yet undiagnosed arrhythmia, or …

Mrs Parsons settled herself back and sighed, glaring once more at the leg.

“I was going to the potty when I fell,” she said.

“Oh, perhaps a nocturnal cardiac event,” I thought, growing more interested, “perhaps an occupational therapist referral would be prudent.”

I waited.

“It was dark and I was on my way out to the potty.”

“Outside?” I asked horrified, images of old thunderboxes crossing my mind.

“Yes, outside. Way out the back of the garden I was.”

“Definitely an occupational therapist needed,” I thought.

“Do you have a path out there — is it well enough lit for you?”

“It’s fine,” she said, “I go out early every morning, while it’s still dark.”

“Nocturia,” I entered in the file.

“More than once at night?” I asked, beginning to form a picture.

“Course not, love,” she said, looking at me peculiarly.

Not to be put off, I quizzed diligently about lower genitourinary symptoms and medications.

Peering out the door as if she hoped the nurse might rescue her for the leg dressing, Mrs Parsons proclaimed, “the potty knocked me over — it happens sometimes in the dark.”

Worse! Worse than I had imagined.

Not just the problem of a poor farming widow with a disability, with a thunderbox a mile from the house, but now the true kernel of things was being uncovered: she was delusional.

I allowed a little pride at uncovering what others had clearly missed.

“Tell me about the potty knocking you over,” I said kindly, leaning forward for rapport.

“Well, it just comes up behind you when you’re least expecting and, boom, headbutts into you. She’s that excited to see you, and with me bringing the nice parcel for it, no wonder!”

This wasn’t going to be a short consult. And she seemed too sensible.

An inkling struck me before I began a lengthy psychiatric history …

“What is a potty?” I asked, as if I was asking “what is a stethoscope?”

“A baby cow, you daft thing!” she exclaimed chuckling. “Whatever did you think I was talking about? I was going out to feed the potty calf!”

“A toilet,” I said sheepishly.

“You thought I was being chased down the yard by me toilet?” she said, erupting into laughter.

Henceforth, I have learned that in the country a baby cow is known as a potty calf and a baby sheep as a potty lamb.

Mrs Parsons was not potty, although it remains to be seen whether she can be convinced of the same about me.