Tales of a Medicine-Watcher: 5. You Don’t Need A Silver Fork

Tales of a Medicine-Watcher are true stories from 50 years in medicine. Names and dates changed, staff names real (unless otherwise noted). The term Medicine-Watcher is used in The Youngest Science, the autobiography of Lewis Thomas, which I use with respect. 

“Well, we have a drink before dinner. Usually a single-malt whisky. Or two. With some anchovies and Gruyere. With them Swedish crackers”. Jack paused, moved his wiry frame in the chair, wiped some dust from his eyebrows, coughed, scratched his neck, and continued. The brilliant central Australian sun shone though the window and caught his battered Akubra on the other chair. July in Alice Springs. It would be freezing outside that night. “Go on” I said, making notes, not believing what I was hearing.

Jack was not a local. He’d been in Alice for just over 40 years. He wasn’t working now, in his mid-seventies, and enjoying his retirement. He was tough as, tanned and scarred, and had worked at everything from station-hand to real estate. You could describe his attire as understated outback. I was at my regular clinic at Alice Springs Hospital, one of 4 or 5 trips annually I would make for about 12 years. I would stay a week each time. He’d come to see me with 3 months of chronic urticaria, hives over his body every day. There was no particular early or ongoing trigger to his problem. I was going through his diet. Most of the time he would camp out with his old mate Bill. Usually somewhere along the mighty Fincke. He was describing the usual campfire dinner.

“Go on, Jack”. “Well, main course we usually BBQ a steak, nothing special, just tenderloin, rare. The sauce depends on the day. Most just a white wine reduction I make with some shallots and tarragon. depends on the day, mate” Wagyu beef was not around in Alice in 1995. had it been, it would be on his menu. “Do you..um..have some sides with the meat?” “Course we do. Roast potatoes, carrots, sometimes honeyed, some roast zucchini with melted cheese. Sometimes we’ll have a salad. Caesar or Chilean are our favourites”. Drinks with dinner?”. “Wine, mate. Depends on the meal. A nice Wolf Blass Grey Label Shiraz with beef. Or a Margaret River Chardonnay if it’s fish. Depends, mate. Depends” They would make one of several types of pudding for sweets.

The Fincke River runs to the west of Alice, 140km away, accessible by 4WD. It meanders 600km north-south, and is usually dry, occasionally flows. I’ve seen it both dry and wet, it’s one of the most beautiful parts of the Outback. Locals in Alice often spend weekends camping somewhere along its dry bed. Jack talked for 10 minutes on the range of cuisine he and Bill would enjoy while out there. Which was most of the time. I filled two pages of notes with those culinary details.

Examination was pretty normal, just hives, and a bit of chronic lung, I organised some bloods and radiology, subsequently all normal, put him on the non-sedating antihistamine terfenadine (later replaced by fexofenadine), one daily and a small dose of doxepin, a sedating antihistamine, at night. This was a reasonable regimen in the nineties. I reviewed him several weeks later, and saw him annually for about 5 years. He had a bit of itch, the occasional hive, but didn’t complain.

Did I trial him on a low salicylate, low food-chemical diet? You have got to be joking!

“You don’t need a silver fork to eat good food” Paul Prudhomme

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