Thursday 21st November 1991   Morning surgery 11:11

Dylan and Dilys looked sheepishly at each other as they came into the room.
“We’ve just seen Adam Andrews for you, Dr Lewis.” They both accidentally spoke in unison and laughed.
“You start, Dilys,” said Dylan.
“Adam is 12 years old.” Dilys cleared her throat. “He has had lower abdominal pain since Tuesday. It started off in the middle of his tummy and has now moved to the right hand side. It’s there all the time and he says it’s really severe. He has never had this pain before.” Dilys turned towards Dylan.
“He has hardly eaten and is not drinking much,” Dylan continued. “He feels nauseous and was sick twice last night and once this morning. He has had a bit of diarrhoea. His Mum said that she didn’t think he’d had a temperature.”
“He looked pale and his tongue was dry,” said Dilys. His pulse was 104 and his temperature was 37.8°c. He was tender in his right iliac fossa with some guarding. We both though that he had rebound tenderness.”
“Definitely,” said Dylan. “We checked twice.”
“We got Harriet to test his urine. It was clear. Do you want to sum up for Dr Lewis, Dylan?”
Dylan took a breath. “Adam is a 12 year old boy. He has had worsening abdominal pain for two days. On examination he has a raised pulse rate and a low grade temperature. He has signs of appendicitis. We think he needs to go into hospital.”
“Definitely,” said Dilys.
“Very good,” said Dr Lewis. “I am very glad to see you working in harmony at last.”
“Adam’s Mum has brought his pyjamas and his toilet bag. Do you want us to phone the hospital?”
“I think so, Dilys,” said Dr Lewis. “Once you have done that, you can both sit down and write the referral letter.”
Dilys looked pleased but Dylan groaned.

Working in harmony.