“So, what seems to be the problem Mr Hughes?” Harry asked genially, trying to hold back his yawn. He was so tired. First Monday back into an early morning routine after a holiday was always difficult, especially for doctors during the Christmas period. The number of sickness bugs in every community seemed to triple between the 27th and the 2nd but no patient wanted to hear it was food-poisoning from undercooking or poorly storing their festive leftovers. Also, nobody wanted to hear it ‘will pass in a few days – drink plenty of fluids and if you’re not any better in a few days or you suddenly get worse, call NHS 24 immediately.’ They were convinced it was something life-threatening and wanted drugs and admittance to hospital straight away. It was hard, especially when dealing with an anxious parent, to talk them into believing they/their child wasn’t bad enough to go to hospital let alone admit that the hospitals probably wouldn’t take them anyway because sickness bugs could too easily spread and cause an epidemic.
“Well it’s a mite uh… embarrassing Dr Styles,” Mr Hughes squirmed, giving Harry a big clue as to what was coming. Late fifties, slightly overweight, poor diet, lack of exercise, uncomfortable shifting, no obvious symptoms… he’d put his salary on it being haemorrhoids. He hoped it wasn’t haemorrhoids because he was quite looking forward to his lunch of leftover turkey and stuffing sandwiches and well… some procedures… like rectal exams… were rather off-putting.
“I can assure you there’s nothing you can say that will phase me,” he replied, with as gracious smile as he could muster.
“Well…” Hughes cleared his throat again, “it’s just… every time I’ve been to the toilet recently there’s been a bit of blood."
Harry groaned inwardly and gave the box of gloves and lubricant on the counter a dark look, as though their mere presence tempted fate.
“I see,” he said, leaning forward, “how much blood would you say there was? A few drops smeared on the toilet paper? Enough to turn the water pink? Or more?”
“Enough to turn the water dark pink,” Hughes admitted, blushing and tugging on the sleeves of his jumper nervously. There was something tragic about watching a burly middle-aged farmer squirm like a bag of worms knowing he was likely about to get probed in a place no straight guy wants to get probed.
Harry nodded at him and made a note about the pink water, “Is it dark or bright red?”
“Bright red.”
“Any pain?”
“A bit – often a prickling feeling when I go… like the sensation you get if you graze yourself. Other than that, I don’t feel anything except a slight itch.”
“I see,” said Harry, making another note, “have you been constipated recently?”
Hughes shifted again and looked away, clearly embarrassed as he scratched the back of his neck, “Yeah, a bit, I admit Doc. With the run up to Christmas you tend to forego the good diet guidelines for more festive treats. May, that’s my wife, loves to bake up a storm and she’s gone all out this year with our Grandchildren visiting. I guess I haven’t been having as much fibre as I ought to.”
“Happens to us all,” Harry smiled, “it’s the plight of the festive season. Have you had any other symptoms? Headaches? Nausea? Back pain? Dizziness? Fatigue?”
“No sir,” Hughes shook his head, “nothing like that.”
“Well that’s a good sign,” said Harry, putting down his pen and looking Hughes in the eye. “So far, your symptoms suggest haemorrhoids or an anal fissure caused by your recent constipation – both of which are fairly easy to treat. A simple physical exam will be able to confirm either way.”
