About 6 months ago, I came onto a night shift (I'm a nurse in an MAU) and one of my patients was a young British African man, who had been admitted, funnily enough with a suspected kidney stone. He was complaining of severe abdominal pain, back ache, difficultly passing urine and was clammy. Obs wise he was stable with nothing out of the ordinary, though slightly on the cold side, around 35 degrees. dr's had seen him, impressions was ? kidney stone, plan, KUB with possible ultrasound if needed, and pain relief. An hour later, my patient was writhing around in bed, and was sweating absolutely buckets. Temp now, tympanically was 33.4. Rectally, 34.5. Otherwise obs still normal, sats 98% on air, BP 130/70, pulse 65, resp rate 18. However, GCS was a bit tricky, if you did it sloppily you could get about 11, if you really tried GCS was 15. By this point I was a little concerned. My inner 'something isn't right here' feeling had gone into overdrive and I was starting to annoy the drs with my constant, 'this pt needs reviewing, something isn't right'. They didn't agree, they felt he needed more pain relief. 10mg IV morphine settled him for 5 minutes, then he was writhing around the bed again, this time crawling onto the floor from his hi-lo bed we had had to put him on because he was so agitated. Myself and my colleague had come to the conclusion that although he was supposed to have a kidney stone, he had something neurological going on as well - as my colleague descriptively called it, he had 'brain itch'. Bizarrely, again, although his temp was still low all other basic obs were still normal although by now his GCS was 5 and he was obviously extending when he was subjected to painful stimuli. ITU came and reviewed at this point, and his was the quickest transfer I have seen to ITU where he was tubed on arrival. They took him for a CT scan where he was found to have severe cerebral oedema. He coned and died at 3.30am that morning. An LP they did showed he had meningitis. It surprised everyone I think, because it was such an atypical presentation, no neck pain, no photophobia, no high temperature or rash, no headache (not initially anyway); nothing that indicated he had meningitis. Its taught me a lesson anyway, things are never quite what they seem! This is a situation will stay with me though, and everyone else who was involved.