I was still unaccustomed to Houston. I was still surprised by how ludicrously hot it gets, even before six o’clock in the morning, even in May. In England, the summers would often begin in mid-July and end six hours later. When I was a kid, if we had three sunny days in a row, we used to think we must have done something to offend the gods e.g. coveting our neighbour’s ox or something equally serious.
In Houston it was the opposite. It seemed to be sunny and hot most of the time (apart from the occasional flood, so I was told). Which is why nobody really minds getting to work early. That morning I was on the day-time shift which began at six, and even by then the heat was going at full blast. Just crossing the car park was enough to make you sweat as if you were a human colander i.e. as if your body had suddenly been turned into a hundred boiled Brussels’ sprouts which were being drained, through your skin into your shirt, before serving.
Muttering and cursing in true British style, I went through the Emergency entrance into the E.R. (or ‘Emergency Room’ if we’re being formal) where at least it was cool and pleasant. And pretty well empty, as it always is during the midweek mornings at St Helen’s.
Basically, the Walking Wounded of Houston’s Downtown Core district like to rest up most Wednesday mornings, in order to gather their strength for Friday evenings. So, for the first part of that morning in the E.R., my physicianly job was relatively light, and I unhurriedly assessed a small number of people who had nothing really wrong with them, a group known in most E.R.s as ‘The Worried Well’.
Then, just before lunch time, a man strolled in with a note from a nearby walk-in clinic asking us at St Helen’s to assess him because he had suddenly had a severe headache and they had found his blood pressure to be very high.
His name – and it wouldn’t be a name blazoned across the front-page of the Houston Chronicle for at least another month – was Roger Mulholland.
At first sight, Roger was one of those rather good-looking people in their mid-forties who look so confident and comfortable (and well-dressed) that almost everybody gets a little pang of envy when they see them. Well, I did anyway. Casually Roger told me, in his obviously Australian accent, that he’d had a really bad headache which came on very suddenly at the climactic moment when he was having sex about two hours previously.
I must say that my envy of him escalated astronomically right there and then. Mainly because he was a well-dressed, good-looking man who had been having sex at 9.30 on a Wednesday morning. In Houston for goodness’ sake.
Maybe it was because he was Australian and not Texan, but in any event there was a lot to be very jealous of.
He said he’d got out of bed a few minutes later and the headache suddenly got even worse while he was peeing, so he got dressed and, still feeling headachy, went to a nearby walk-in clinic. In the clinic, they’d found his blood pressure was very high. They’d given him a bottle of Advil capsules (or, to give the drug its formal name, ibuprofen) for the headache, and a referral letter to St Helen’s. He’d taken a couple of the Advil, and had then driven over to St Helen’s, by which time his headache had disappeared completely.
This was a fairly unusual and rather impressive story compared to the average chronicle of constipation, or whatever, that we usually hear at St Helen’s, so I showed due medical diligence and asked him a whole slew of questions about the headache. My last question was (because we modern doctors are supposed to get a brief overview of the patient’s social and family support) what I thought was a simple and reasonable one. The conversation went like this:
Me: “Was your wife concerned when you got this pain after sex?”
Patient: “I don’t know.
Me: “Ummm…you don’t know?”
Patient: “She wasn’t there. I suppose she might have been concerned if she’d known about it. So I’d say ‘potentially, yes, she might have been concerned.”
Me: “Ah!”
Then there was a short pause. Followed by a longer pause.
I was thinking – as every good physician should – that there are several things that can cause serious health problems as a result of sex. Furthermore there are some published reports that have shown that health complications are actually more common if the sex in question is adulterous. For the most part, the medical problems are heart-attacks and strokes, except in Chicago where research studies have shown that the frequency of adultery is statistically correlated with the incidence of gunshot wounds.
Still doing my due diligence, I checked Roger over very carefully including taking his blood pressure and doing a full neurological examination to make sure the headache hadn't been caused by a stroke.
There were no problems. In fact his blood pressure was now completely normal, even though the doctor at the walk-in clinic had found it to be very high. However, you need to understand that I – like many keen and nerdy junior doctors - wanted to make a Brilliant Diagnosis Of An Incredibly Rare Condition Causing A Common Symptom. And Roger’s case was the perfect place to try my hand.
Allow me to explain (NOTE TO READERS: If you want to skip the following explanation, please do go ahead and jump over it and we’ll meet again at the bottom of page 10. OK?)
But for those of you who want the full tour, please follow me into the next chapter.
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