Head First by Alastair Santhouse

Author:Alastair Santhouse [Santhouse, Alastair]
Language: eng
Format: epub
Publisher: Penguin Publishing Group
Published: 2021-08-30T00:00:00+00:00

ACCEPTANCE

When I first saw Marianne, sitting in a chair by her hospital bed, I had to suppress my shock. I had heard about her from a junior doctor, who had presented her case in our weekly team meeting before our ward round. A forty-two-year-old woman, she had spent three months in the hospital some years before, as a result of severe bowel disease. She had now been admitted to the ward because of her weight, which had been declining significantly. Initially, and understandably, this was thought to be a result of a recurrence of her inflammatory bowel disease, yet she had been investigated and nothing had come to light. Eventually, with her weight dangerously low, she was admitted to the hospital, in an attempt to uncover the problem and feed her, so as to reverse her weight loss. She felt too nauseated to eat, so a feeding tube was inserted up her nose and down her esophagus into her stomach, with nutrients delivered through bottles connected to the tube. Unfortunately, the tube kept coming out, mostly at night when she would catch it on something as she slept, so her weight continued to drop.

As is common for the referrals to psychiatry in a general hospital, she had been seen by several different departments before us. Gastroenterology had investigated her bowel function and had looked into whether her weight loss was being caused by poor absorption of food. Other teams looked for a possible cancer to explain her weight loss. Scopes, probes, X-rays, and scans had all been done, but the medical team were no nearer to understanding her weight loss. She had been in the hospital for nearly two weeks by the time the admitting team wondered whether psychiatry might be able to help solve this puzzling case.

After the team meeting, as we made our way from our team base to the ward where Marianne was wasting away, I wondered whether psychiatry would have anything to add to her care. I always find it useful to think through the diagnostic possibilities before I meet a patient, and as we walked, I speculated about what we might find. It crossed my mind that the physicians might have missed something that they would later kick themselves for, yet I knew them as meticulous and careful clinicians, so this seemed unlikely. But how might I account for a nonphysical cause? I had seen depressed patients stop eating and lose weight as a result before, but rarely to this degree. And surely it would be hard for the nurses, doctors, physiotherapists, and other staff who routinely care for patients in a hospital not to have noticed that a patient was too depressed to eat. In my experience of such cases, patients who are this depressed speak very little, and in a slow, monotonous tone. Their bowed posture and dejected demeanor would surely have been obvious to everyone, so depression seemed improbable as a cause of weight loss.

I wondered whether illicit drug use might have been responsible; it is often an explanation for things that can’t be explained otherwise.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.