Suffering for one’s art appears to be a fairly well recognised phenomenon in ‘creative’ circles. But I would argue that suffering for one’s art is a fairly prominant feature of medical practice. I have just spent the best part of my evening crying as I feel really guilty about a young girl whose family are at present receiving her diagnosis of leukaemia. I sent her home from A&E last week, after she had presented with large lymph nodes in her neck and a possible but unclear history of fevers at home. I asked about weight loss, energy levels, foreign travel, immunisations…everything to cover the wide differential diagnosis. I examined her thoroughly, checking for nodes elsewhere and feeling her tummy for an enlarged spleen or liver. We sent blood tests, including a blood film, which showed a borderline platelet count of 128 and reactive lymphocytes. These findings would be compatible with a viral infection, so I sent her home with instructions to the parents to return immediately should she become more unwell. I also wanted her to be seen at the rapid review clinic in a week’s time, and the blood tests repeated. That is where things fell apart. The clinic was cancelled for the next two weeks so I couldn’t offer them an appointment. It didn’t seem urgent enough that I should phone the consultant at home, so I asked them to return to a&e for the blood test and requested an urgent outpatient appointment. I then forgot to alter the plan I had written in the notes. Fortunately, they actually turned up this afternoon, and the blood tests were done. They also got seen by the consultant, who happened to be on hand, but who then told me off for not ringing a consultant at the time. Today’s blood film showed blast cells.


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