Dr Scrooge's casebook.
‘ Dear Doctor,’ I wrote to the medical registrar, ‘This woman appears to have surgical emphysema extending from her chest into her neck and face … ’ 

I saw the patient three days before Christmas. I had just completed my last surgery before going off for two weeks’ break with my family. There was one home visit to do, then Christmas lunch with the team, and my work would be finished for the year.

I set off in the car to do the visit, but the Christmas traffic was backed up for nearly a mile, and I decided to turn round so as not to miss the lunch. No matter, I thought, I could do the visit on the way home when the traffic might be lighter. It sounded as though the patient only needed a quick eyeballing anyway.

I had already talked on the phone that morning to the domiciliary care manager who had asked for the visit. The patient was a woman in her sixties, a known alcoholic who lives alone and frequently has falls. The manager was concerned about an escalation in the drinking and the falls, with the woman …