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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