Monday, 10 December 2012

Leprechauns in boxes

Week 6 was helpfully titled ‘Confused Drinker’.  I was a little apprehensive of this week, as previously, when we had been on MAU we had been kept away from confused patients.  Even if they had perfect signs, we were told to avoid them as we wouldn’t get anything from them.  I wasn’t sure what had changed in the few short weeks since that made them think I would now be ok to literally search these confused patients out.  It is a clinical manifestation of Wernicke’s encephalopathy which, if left untreated, develops into Korsakoff’s psychosis.  It is a result of a thiamine deficiency which, in alcoholics, is due to malnourishment and alcohol impairing GI absorption and hepatic storage of thiamine.  Korsakoff’s is irreversible but has been known to spontaneously resolve. 

We had a bit of a slow start to the placement as we were sent to a gastro ward to wait for a hepatologist.  There were 5th year students also on the ward, so whilst the Consultant had rung the ward and told them to find us some patients, the juniors on the ward told us to go to the staff room and gave our patients to the 5th years.  5th years don’t normally see patients in the same way we do, so everyone was a little confused.  After nearly 2 hours of waiting, the consultant finally caught up with us and we were allocated a patient each.  My patient was having a bed bath so I went and read his notes while I waited.  This was just as well, because when I finally got to talk to him I couldn’t understand a word he said.  He mumbled quietly and had such a thick accent I was at a bit of a loss.  The few words I could catch didn’t make any sense to me either – something about going on a trip and it being all my fault he was here. 

I noticed that he hadn’t taken his pills that morning and looking around the ward, all the nurses were busy trying to keep a rather sprightly but deranged gentleman in his bed by bribing him with biscuits.  He was instead trying to clean the ward with rubber gloves.  I decided to forgo clerking for that morning and instead help this gentleman take his tablets.  He had a broken arm so he wasn’t co-ordinated enough to take the tablets himself.  Over the course of the morning we had quite a good chat as his world was pretty special.  There were apparently two leprechauns sat in glass boxes opposite him, and on the end of one of the patients’ beds there was a woman who later turned into a goddess.  He had kittens in his bed and their mewing kept distracting him from our task.  I stayed with him until it was time to go and feedback to the consultant, by which time a nurse and a doctor had come to give him a nebuliser.  It was quite upsetting to see the state he was in, but I was proud of myself for persevering as I previously would not have had the confidence to approach such a psychotic patient as I had no idea how to handle it.  It’s not something I had come across before, so I didn’t know what to do or expect. 

The rest of the week was spent on MAU and in endoscopy watching oesophageal varices being fixed.  It was quite a depressing week in all to be honest!  Some of the patients we saw were so young to have drunk themselves to such an irreversible deranged state, it was awful.  It’s definitely not a specialty I can see myself in.  

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