On the trail of an unwitting TB carrier

"MORNING Mr Bourner"

"Morning, Dr Thornton"

"I was hoping we'd bump into each other."

"Forgive my scepticism, but I've never yet met a GP who wanted to bump into patients outside the surgery.

"And also, bumping implies an element of randomness. Whereas you turning up in the waiting room of the Rainbow Valley Alternative Complimentary Healing Farm on the day of my appointment suggests an element of pre-planning."

"OK, I'll come clean."

"If you ever get struck off, doctor, you could be an extra in The Bill."

"Look. Let's cut to the quick. I've had an urgent phone call from Dr Fentamen at Johnny's."

"And?"

"He says that the reason you've had night sweats and coughed up a bit of blood is because you've got tuberculosis."

"I know that..."

"Yes, but you were discharged from hospital two weeks ago with strict instructions to return three times a week to have your drugs under supervision. And you've only been once..."

"So?"

"So Dr Fentamen's very worried."

"He's not capable of emotion. Look in his eyes and he blanks you. There's nothing behind them."

"Well there must be something. He's Editor of the European Journal of Respiratory Physiology."

"Look. I don't like the man and I don't like his drugs. I got indigestion and my urine went red."

"That's the rifampicin. You should have been warned about that..."

"I was. But they didn't tell me my tears would go red too. My girlfriend thinks I'm possessed..."

"Look, anti-tuberculosis drugs are very powerful because they need to be. And you need to take them for at least six months because it's a very difficult disease to eradicate..."

"Why?"

"Well, from what I can remember, the bug that causes it..."

"Bug?"

"Mycobacterium tuberculosis. It has a thick cell wall with a large lipid content, which allows it to survive inside host cells and resist digestion by preventing phagosomelysosome fusion."

"You've lost me there..."

"But the body's immune system keeps fighting, so you end up with a chronic T-cell mediated inflammatory response, with the formation of granulomas where the mycobacteria can lie dormant for many years..."

"If they're lying dormant, why not let them be..."

"Because yours aren't anymore. You got sick on your last trip across Asia, your body's immune system went down, and the TB you picked up on your first trip re-activated. We call it post-primary TB..."

"But I've been travelling for 30 years..."

"And you could have had it for thirty years. If I did chest X-rays on all my elderly patients, a lot of them would show signs of old TB infection..."

"So you're treating all of them with urine-staining poison?"

"No because they have no symptoms. Their TB is inactive. But yours is open, which means you could get seriously ill without treatment. You might even die"

"Are you trying to scare me?"

"No, I'm just giving you the facts."

"Well, allow me to tell you how I feel. When I was in Johnny's I felt like shit. That place has a serious karma problem. The walls are grey, there's no sunlight, there's no privacy, you can't get any sleep, the food's inedible and the staff are miserable as sin.

"And yes, I did think I might die. But since I've stopped taking the drugs and come home, I'm eating well, getting some sunlight and healing myself And I feel much better already,"

"What do you mean, healing yourself?"

"Through meditation and prayer. Focusing the mind's capacity to heal the body through the third eye. And then there's Mrs Linton."

"Who's she?"

"A healer here at the Rainbow Valley. She's harnessing a harmonious paraphysical healing energy and transmitting it through her to me."

"Mphphp."

"What?"

"You don't believe all that bollocks, surely?"

"Yes I do actually. I can feel the energy running into me - like a warm sensation - and my aura feels much better after. So, I don't need you drugs, thank you doctor."

"Listen Mr Bourner. I don't care whether you live or die. But active TB is highly infectious and you're putting others close to you at risk. So you'd damn well better take the tablets. Or else."

"Dr Thornton, can I ask you - have you ever any communication skills training?"

"No"

"Now why doesn't that surprise me? Ah, Mrs Linton's calling me know. See you around."

"I'll be here when you get out..."

What should Dr Thornton do?

Continued next week...

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