she’d focus on being professional.
Their third patient in the TB clinic that afternoon was a nineteen-year-old girl who’d taken a gap year before starting university and had worked at a school in Borneo.
‘I’ve been home a couple of months,’ Cara said, ‘but for the last month I’ve been coughing a lot. I’ve tried about ten different sorts of cough mixture but none of them works and I just can’t get rid of it.’ She bit her lip. ‘Then last week I started coughing up icky stuff, and there was blood in it. I panicked a bit and Mum dragged me off to the family doctor. He …’ She caught her breath. ‘Mum looked it up on the Internet. It’s a sign of cancer. And so’s losing weight without trying. And I’ve been really hot and sweaty at night.’
‘Have you been eating normally?’ Joni asked, thinking about the weight loss.
‘I haven’t been feeling that hungry,’ Cara admitted. ‘And I’m tired all the time. Mum says that’s a symptom of cancer, too.’
‘Losing your appetite and being tired can be symptoms of a lot of other things, not just cancer,’ Aaron said gently, reaching out to take her hand. ‘It’s good that the Internet is making people aware of their health, but sometimes you can really scare yourself with what you read, so it’s always a good idea to go and check with your doctor to stop yourself worrying unnecessarily.’
‘The doctor sent me for an X-ray. I think he thought it might be cancer, too.’ She shivered. ‘I’m nineteen. I’m too young for this.’
‘As Mr Hughes said, there could be lots of things causing your symptoms,’ Joni said gently. ‘Your family doctor sent you for that X-ray so he could start to rule things out, not because he was sure it was cancer. And I can tell you that as a doctor I normally start by ruling out the nasty stuff, because I don’t want my patients worrying any longer than they need to.’
Cara nodded. ‘The guy who did the X-ray said there weren’t any signs of a tumour. But he said there were white patches on my lungs and it might be TB.’
‘That’s why he sent you to us for the next lot of tests—TB comes under tropical medicine and infectious diseases,’ Joni explained.
Aaron brought up the X-ray file and turned the screen so Cara could see it, too. ‘There is some scarring on your lungs, here and here, and those white patches are a classic symptom of TB. Plus you mentioned those other symptoms—night sweats, loss of appetite and losing weight. That’s all adding up to a picture for me.’ He looked at the screen. ‘I see that your family doctor also sent you for a skin test.’
‘Last week.’ She frowned. ‘But I don’t see how it can be TB. I don’t even know anyone who’s ever had TB. I mean, I didn’t think people even got it any more. How could I get it?’
‘TB is a bacterial infection, and it’s still pretty prevalent in parts of the world,’ Aaron explained. ‘It’s spread by droplets—coughs, sneezes, that sort of thing. It can affect the lungs, which is why it makes people cough and why your doctor sent you for an X-ray to check your lungs, but it can also affect other parts of the body. That’s why we need to check you out here. Not everyone who has TB is infectious, so you won’t catch it by just sitting next to someone on a train—but if you share a room with someone who has TB then there’s much more of a chance of you picking it up. And you said you’ve spent a few months in Borneo, yes?’
She nodded. ‘Three months, working as a teacher.’
‘Borneo has quite a high rate of infection, so if your skin test is positive then I’d guess that’s where you picked it up.’
Cara looked worried. ‘I shared a room with some of the other students working out there. Does that mean they might be infected, too?’
‘Either one of them infected you, or if you picked it up from somewhere else then you might have infected them,’ Joni said. ‘So it would be a good idea to get in touch with them and ask them to go and see their doctor to get themselves checked out.’
‘I don’t have everyone’s number,’ Cara said. ‘But I can call the agency that did the placements and ask them to pass on an urgent message to everyone.’ She bit her lip. ‘Oh, God. I feel so bad that I might’ve passed this on to other people.’
‘It’s not your fault,’ Joni said. ‘You didn’t know you were ill, and TB takes a while to show up.’
‘So you had the skin test on Friday?’ Aaron asked, double-checking her notes. At Cara’s nod, he examined her lower arm. ‘There’s definitely a hard red lump there, so the skin test is positive.’ He measured the lump and Joni updated Cara’s notes with the details. ‘I’ll need you to do a sputum test for me as well, but we have to culture the bacteria so it’ll take a couple of weeks to get the results back.’
‘So what happens while we wait for the results?’ Cara asked.
‘I’m pretty sure from the results of the skin test, plus what I can see on the X-ray and the symptoms you’ve described, that you have TB. So I’d like to start treatment now,’ Aaron said.
‘The good news is that you can be treated at home—you don’t have to stay in hospital,’ Joni added, seeing the flicker of dread on Cara’s face. ‘We’ll give you a course of antibiotics. You need to take two different types to make sure the infection clears up.’
‘You’ll start to feel better after a couple of weeks,’ Aaron said, ‘but it’s really important for you to keep taking the medication for the next six months and don’t stop taking it just because you’re feeling better.’
‘Six months?’ Cara looked shocked.
‘Six months,’ Aaron confirmed. ‘Otherwise the infection won’t clear up and the bacteria might become resistant to the antibiotics we give you. If that happens, it will take even longer to clear up.’
‘OK. I promise I’ll take the medication, even after I feel better,’ Cara said.
‘Good. Sometimes people get side effects from the antibiotics,’ Joni told her. ‘If you do, you need to come back and see us so we can change the medication you’re on to something that will deal with the TB but won’t give you the side effects.’
‘So that’s if you feel nauseous or you’re actually sick, if you get a rash or itching, or you have any numbness or tingling in your hands or feet,’ Aaron said. ‘And I’d want you to come straight back and see us if your skin goes a bit yellow and your urine’s dark, or you start getting blurred vision.’
Cara looked worried. ‘Blurred vision?’
‘It’s one side effect, but we can sort it out. I know it’s a lot to take in, but we’ll give you a leaflet with all this information so you can talk it over with your mum,’ Joni said. ‘As well as a leaflet with advice on how to stop TB spreading to your family, friends or anyone you’re in contact with at work or college. You need to cover your mouth when you cough or sneeze or laugh, and put any used tissues in a sealed plastic bag. And don’t sleep in the same room as anyone else, as you might cough or sneeze in your sleep.’
‘Because that’s how it spreads,’ Cara said.
‘Exactly. For now, you need to stay at home—we’ll see you once a fortnight and keep an eye on you, and we’ll
