Tuesday, 1 May 2012

Alcoholic nurses?


My last week on ENT this week, and another slightly late post. Sorry about this, but I keep getting distracted by other things in my life. Don't feel too taken aback, though, as these distractions are affecting the work I am meant to be doing as well - its nothing personal... This week I spent some time in ENT outpatients with a fantastic consultant, but spent a lot more time trying to help out a friend who has had some form of psychotic breakdown and has now fled the country.

The time in ENT outpatients was spent mainly with a fantastic friendly consultant. He showed a lot of concern for my ex-tonsils and was very jokey, while staying formal enough for (most) patients, and sharing a lot of knowledge. When I say formal enough for most patients, I mean things went swimmingly with all patients but one, where his joking fell embarrassingly flat. Here he was (for some reason) joking about the nurse who sits in the corner of the consultation room to help with the preparation of equipment, and saying that she needed to drink gin throughout the day in order to put up with him and the other doctors, and if the patient needed, they could borrow some of it. The patient took this a little too literally, and started an outraged monologue about how it was unacceptable for nurses to be drinking on the job, and the state of the NHS. Despite the consultant and nurse's best efforts, the patient wouldn't believe that this was a joke (because it sounded far-fetched that they were back-tracking now...) and was grumpy with the doctor and 'drunkard nurse' for the remainder of the consultation. Perhaps there will be a law suit coming this way!

A scope used to look down patient's noses to their vocal chords - one of the things the 'drunk nurse' had to prepare for the ENT doctor.

Fortunately, the other consultations were conducted in fully professional ways, and no more problems were had. The most interesting of these 'normal' consultations was a man who had come for the results of a biopsy of a lump in his neck. He had come in with another male, who we assumed to be his partner because of how they were acting with one another, and I noticed the consultant carefully avoiding any labels for this other person in the room (it would be embarrassing to wrongly call a brother a partner, and visa versa!) The biopsy had unfortunately shown a lymphoma, and this news had to be broken in a skilful and optimistic way. The two people were evidently very upset by the news, both crying, though the consultant tried to reassure them that it was very treatable. At the end, as they left, the questions they were both asking the nurse were the same things that the doctor had tried to explain. Usually, when bad news is broken to a patient, they don't hear much afterwards due to shock, and the 'you have cancer' bouncing around in their head.

Despite these clinics, by far the most exciting thing that has happened to me this week is that one of my friends has had what seems like a severe psychotic breakdown. His mum called me to let me know that things were not right, she couldn't really get hold of him and asked me to go and check on him. I went over to his house, as I couldn't get him on the phone, where he then proceeded to tell me how everyone was persecuting him. The police had it in for him, had sensors in his rooms in his house to monitor his movement and the phone companies had hacked his mobile to use the camera to watch him (this was why he wouldn't call anyone). The university had hacked his laptop, so he bought a new one, which had then been hacked and they had uploaded documents detailing how to plagiarise work efficiently (he assumes to get him in trouble) which had then mysteriously disappeared. There were people opposite his flat who were recording him all night in his room, which he could tell by the faint glow of what looked like a burglar alarm in their window. He knew there were people watching him as he could hear their voices mocking him, and talking about what he was doing. He hadn't left the house in a week, as he was afraid he would be kidnapped. And there was more.

He was clearly not feeling well, and being a good medical student, I took a full history. Key to note was the fact that he had been taking a lot of Ritalin, which he claimed was for his ADHD, but I think it was to help him do his essays and increasingly heavy work load. He had been taking more and more as his deadlines approached, and was now feeling like this. I thought this was probably related, but he was adamant that he had never had any problems before and needed it to be normal. He wanted to get away from this 'persecution' so I offered to let him stay at mine for a few days to get away from it and think about what he wanted to do. He was going to finish Uni in a month or two, so I didn't want him to do anything rash.

Anyway, he had a lot of stuff and wanted to pack clothes, so I took some of his items back in the bus (this was still too soon after my op to be cycling), did some research online finding out about stimulant psychosis (my best guess for cause) and then drove to his to pick him and his items up. I double parked my car due to no close parking with the hazards on, and spend the next 45 minutes ringing his bell and calling him to no answer. Annoyed with how he would just not open the door now, I tried to go home, but found that my car had now run out of battery. Very embarrassing given its stupid parking location! 

Either way, I sorted that out in the end, and then later that night his mum called again to tell me he had gotten a taxi to a nearby airport, and was taking a plane to get to another country. I don't know how he afforded this, as he had been buying a lot of new things recently (possible mania?) but he is now in a different country and trying to sort things out is ongoing. All of his items are still in the UK, from his mobiles to his clothes and expensive laptops. Crazy trying to deal with the fall out from this, but scary to see how someone who seemed (relatively) normal can flip to being so paranoid and uproot their life like this!


  1. Sorry to hear about your friend! Ritalin is an amphetamine derivative isn't it, which could explain some of the mania? But other than that it sounds like a classic case of schizophrenia and I am thinking you should have called someone to get him sectioned.
    Now that he's not in the UK he's at risk (and I don't know how their mental health schemes work) so ideally someone needs to get him back into the country and then to hospital!

  2. Yeah- I'd second that schizophrenia diagnosis. Persecutory delusions are a first rank symptom.

  3. Thank you both, I agree it does sound very much like a first rank symptom of schizophrenia.

    Mental health were put in touch with him a few days before I saw him (by his mum), he wouldn't let them into his flat (paranoid) but from his supposedly measured answers through the door, there was nothing they could do to him.

    Other than schizophrenia, amphetamines can lead to similar symptoms when taken in high doses / for prolonged periods so this could be the cause. He seems a lot better now he has stopped taking these drugs, which is good, but I still have my eye on him (as much as you can do from a different continent!)