Thursday 24th September 1992   Evening surgery 17:00

“A continuous cough? I am not sure what you mean, Mr Russell.”
“It’s just a continuous cough. I don’t know what else I can say.”
“Do you know,” my Dad turned to us, “in all my time in the practice, I don’t think I have ever seen a patient with what I would regard as a continuous cough.”
“What about babies with whooping cough, Dr Dennis?”
“That’s very true, Dilys. I hadn’t thought about babies with whooping cough. They can’t stop coughing. Are you worried that Natalie has whooping cough, Mr Russell?”
“No, I hadn’t thought of whooping cough either.”
“To be honest, we hardly see any whooping cough these days. I suppose some patients with chronic, severe chest conditions like pulmonary fibrosis cough all the time. Do you remember Mr Perkins’ cough?”
We all nodded. Mr Perkins had had an awful cough. He and his wife found it very distressing.
Nathan Russell cleared his throat. “Actually, I’m following the criteria for our departmental definition of a continuous cough, Dr Dennis. I think the definition has been nationally accepted so you must be aware of it.”
“I see.” My Dad raised his eyebrows.
“Yesterday morning, Natalie coughed for 48 minutes.”
“You timed it?”
“Not really. She started coughing just after my alarm went off at 06:45 and she did not stop until she came down for breakfast at 07:33. If she comes down then, it gives her exactly enough time to eat her cereal, get dressed and catch the bus.”
“I was fine for the rest of the day.” Natalie smiled.”
“Would that be considered a continuous cough, Mr Russell?”
“Not quite. You need to be coughing a lot for one hour for it to be counted as continuous.” Nathan Russell paused. “This morning, she had two further bouts of coughing.
“Did either of those last for an hour?”
“No . . . no . . . it’s not just that . . . our criteria for a continuous cough is that the patient either coughs a lot for an hour or they have 3 episodes of coughing within 24 hours.”
“I see,” my Dad nodded.
“Natalie started coughing at 09:25 this morning so, unfortunately, we couldn’t include yesterday’s episode within the 24 hours.”
My Dad seemed confused.
“Even though it wasn’t a continuous cough at that stage, Natasha, my wife, was worried and decided to book an appointment with you. Then, on the way here in the car, just before we arrived, Natalie started coughing again. That was the third episode today so we can now regard her cough as continuous.”
“Mmm . . .” My Dad looked at Natalie and Mr Russell as he considered the situation. “Dennis, have you got your dictionary?”
“Yes, Dad.” I got my Concise Cambridge Dictionary out of my pocket.
“Before he decided to go into Medicine, Dennis had considered becoming a journalist.”
“A sports journalist, Dad.”
“I don’t think Mr Russell needs to know all the details, Dennis. Anyway, with wanting to be a . . . journalist, he got into the habit of using the dictionary every day. Can you look up continuous, Dennis?”
“Yes, Dad.” I opened the dictionary to find the correct page. “According to this, it means without pause or interruption.”
“Does it mention occurring a lot for an hour?”
“No, Dad.”
“What about occurring 3 times in 24 hours?”
“No, I think that would be regarded as intermittent as far as a cough is concerned.”
“I agree with that, Dennis. Mr Russell, have you got a dictionary in Public Health?”
“We haven’t, doctor.”
“I think it would be very useful to have one. If you and your team made a point of referring to it regularly, I am sure that all of us and, when I say that, I mean the public in general and not just the medical profession, would find it easier to understand what you were trying to say.”
“It is a good point, Dr Dennis.”
“Have you got a spare dictionary, Dennis?”
“Yes . . . but, it’s just a learner’s dictionary.”
“That’s perfect.” My Dad looked pleased.
“Mr Russell can have it. I don’t use it any more.”
“I will bring it in in the morning, Mr Russell. You can pick it up from reception.”
“Thank you. I won’t keep it, Dennis, but, if you don’t mind, I would like to lend it until we can get one of our own.”

A continuous cough?