Reading of demonic possession in the BMJ of 6 October (“A memorable patient” 2001;323:794), I was reminded of a salutary experience in the warmth of a Cypriot night many years ago. It had been a warm September evening with the temperature close to 27°C, the sort where you sit out in the gentle breeze, watching the brilliant stars, enjoying a brandy-sour (when not on duty), and reflecting on life as a young army doctor on a Mediterranean island.
I was the duty casualty doctor at a military hospital and was called in the small hours of the morning to see an hysterical patient causing problems in casualty. I arrived to find a young officer cadet thrashing about on the bed, having just been admitted in delirium from a training exercise. He was one of the Royal Military Academy Sandhurst cadets on their regular overseas exercise.
The patient's incoherent babblings were causing real concern, and, while I was trying to take a history and then examine the individual, the duty psychiatrist was called. It was going to be some 15 or 20 minutes before he could arrive, and so the normal observations for admission were being duly performed by one of the nurses. My history taking efforts were rewarded with a confused message from the young African cadet, who was speaking in a broad dialect. He asserted in a loud muddled voice that he had had a spell cast on him and kept repeating that his witchdoctor had said he was going to die. This message became more and more positive, to such a degree that I used my initiative and rang the appropriate high commission to seek advice. They were not too pleased to be called before dawn but did say that they would speak with someone more senior and call back.
In the background, the young nurse was diligently recording pulse, blood pressure, respiration, and temperature and eventually plucked up enough courage to tell me that the thermometer was broken. Investigating this diversion while we awaited the psychiatrist (who was going to master the situation and relieve me of my difficult patient), I checked the thermometer and found it to be intact. The nurse, meanwhile, had gone one better and found the low-reading thermometer to take the cadet's temperature again. After three readings, it was found to be 32°C.
We (should I write I?) had neglected to discover that, while we were in the warm calm of a seaside location, the cadet exercise had been up in the hills. It had been showery, and the young man had become soaked and subjected to a considerable wind-chill for several hours.
He was warmed gently and within two hours spoke with a wonderfully cut-glass English accent, reflecting his public school and university education, by inquiring, “I say, old chap, I hope I haven't been too much of a nuisance, but I don't seem to remember much of the past few hours. Could you let me know what has been happening?”
The psychiatrist was amused, the witchdoctor was not needed, I kept quiet, and the nurse was congratulated on persisting with and declaring her thermometer problem.