James Leavey's Corner
Request For Medical Advice

FORCES - Link to James Leavey's Corner Main Page

by James Leavey, editor, The FOREST Guide to Smoking in London
and The FOREST Guide to Smoking in Scotland

Write to
James Leavey
Date: 30 November 1999 09:09
Subject: Request for medical advice.

Professor Dr James Leavey M.D., MSc, F.R.S.
Royal Institute for Diseases of Combustibles,
27-45 Burntleaf Lane, Burnt Oak, Middlesex.

Dear Professor Leavey,

I regret to announce that Malcolm is dying. On entering his isolation ward last night in order to change the humidification system on which his health relies, I observed an abnormal lineal fissure extending from the frontal convolution of the brain to the petrous portion of the temporal bone on his left side.

The patient was immediately taken to O.R. where a preliminary assessment of the fissure was made. I have, with a colleague, ascertained that although superficial, extending no deeper than the epidermis, the condition appears to be deteriorating. Malcolm was returned to his isolation ward and the humidifier was slightly increased. I have noted, however, that the ward's temperature varies considerably between the day and night. During the day it may be as high as 22 degrees Celsius, but at night it is as low as 10 degrees. Relative humidity has been calculated at approximately 30% at 22 degrees, and there is no condensation with any drop in temperature.

Malcolm's general state of health is otherwise good. There is no inhibition of reflex responses to stimuli on his body, nor does there appear to be any necrotic discoloration of the skin. Application of mild pressure to the surface surrounding the fissure, however, results in the exposure of the inflamed corium and attempted expulsion of bodily matter, an oedema accompanied by a pungent odour.

My diagnosis is acute hydremia resulting from over hydration at night coupled with hypertrophy during the day, agitated by circulatory and renal de-compensation. The prognosis is not good. Malcolm does not respond to elevation or direct stimulation of the fissure; nor does his condition improve with a better management of his hydration system. I and my colleague would be very grateful for your greater experience and knowledge of such matters. As far as I am able to determine, my available courses of action are as follows:

  • Immediate removal from the isolation ward followed by conspicuous consumption.
  • The application of a temporary elastic bandage before reverting to (1) at some later date.
  • Radical surgery: bisection involving an incision across the median plane just below the nuchal cavity.

Please advise.

Yours faithfully,

Dr Roman Golicz M.D. BSc,
Institute of Experimental Fumigation,
Bluevapor Boulevard, Snuff Mill, Surrey

From: James Leavey
Date: 01 December 1999 12:01
Subject: Re: Request for medical advice.

Dear Dr Golicz,

Please forgive this belated reply but for the past 24 hours my attention has been fully engrossed in an urgent major operation -increasing the contents of my humidor by funds obtained through the repeated application of work.

I am pleased to report that this concentrated effort has been a great success and is mostly due to the stalwart, expert support of my team of Cubans: Havana's leading throat and larynx expert, Dr Fidel Montecristo; Pinar del Rio's renowned lungs and trachea consultant, Dr Ernesto Punch; ably assisted by Vuelta Abajo'stalented, dedicated anaesthetist, Nurse Gladys Bolivar.

I have noted your patient's symptoms with great interest and concur they are symptomatic of the disease you refer to, which I believe is terminal.

The only course of action I can recommend is option 1, i.e. the immediate cremation of the patient.This, of course, is in breach of the medical code of ethics but I'm sure we are both of the same view that the patient's wishes should be paramount, and Malcolm would no doubt welcome respite from his unfortunate condition by voluntary, or indeed, involuntary euthanasia.


Professor Dr James Leavey

Head of Burns Unit
Royal Institute of Diseases of Combustibles
Sir Walter Raleigh Buildings.
27-45 Burntleaf Lane
Burnt Oak

Copyright James Leavey, 1999.All rights reserved. Reprinted with permission from the Author.


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