Tuesday, 8 October 2013

Episode 4: Danger Man and the mystery of the plasma-free PSA

The story so far: John Drake, a seemingly healthy 40 year old, has grappled an intruder to the ground in his hotel room. He discovers it is Dr Sixsmith, his GP.
“I have to say that your devotion to my health is well beyond the call of duty,” said Drake, pouring his doctor a glass of water. “So let’s get this straight. You phoned my home with my test results, and my wife told you I was in Lisbon. You happened to be coming to Lisbon anyway for the International Blood Pressure Society meeting, so you called in to my hotel. Is that correct?”
Dr Sixsmith was sitting hunched on the sofa, pressing a damp towel to his bleeding head. “That’s right,” he said.
“So why were you behind the curtain?”
“It’s a strange thing,” said Sixsmith, sipping the water as if it were Scotch. “When I told the receptionist who I was, and showed her my identification, she suggested I wait for you in your room. I waited for an hour and then heard someone scratching at the lock of the door. I assumed it was you and was about to let you in when someone clearly put their shoulder against the door. Twice, three times they slammed against it, and I’m ashamed to say I was frightened. So I hid. It wasn’t you was it?”
“It stopped, but then someone tried the key again, so I stayed where I was. It turned out to be you.”
Drake paced back and forth between the window and the coffee table, deep in thought.
“I’d recommend a biopsy,” said Sixsmith.
“Hmm? What?”
“Your PSA test results Mr Drake. Its why I’m here. Let me explain. A normal level of PSA in the blood would be below a reading of three. Your reading is four. That’s not worrying in itself, but your plasma free PSA looks rather low.”
“What does that mean?” Drake had stopped his pacing. He looked pale.
“I’m afraid I can’t explain that for reasons of dramatic brevity,” said Sixsmith. “But to be on the safe side, I think you ought to go to hospital for further tests. Nothing to worry about.”
Drake reached into his pocket, drew out a pill bottle, tipped two into his hand and flung them into his mouth. Sixsmith looked disapproving.
“What are those?” he snapped.
“Blood pressure tablets,” said Drake. “You should know. You prescribed them.”