Monday, August 23, 2010

Mind over matter

Many illnesses are directly linked to brain activity. Two patients who came one after the other illustrate this. This happened just a week ago.

This patient who is on blood pressure medication records her pressure at home and more often than not it is within the normal range. But whenever I take her pressure it is way above normal. I tried consoling her that this is a well known phenomenon and we have even coined this as white coat hypertension. She was not convinced and said,’ I am a calm person, I have known you for many years and there is nothing here to get excited about [this is true!], your measuring instrument is showing wrong reading’. I have learnt not to argue with some patients and this is one of them. I said, ‘right then, you bring your instrument tomorrow and we will check the pressure with both the machines and see which one shows the correct reading’

She came next day. I don’t know which one of us was more anxious! She took her blood pressure which showed even higher reading than the previous days! Then I took her pressure using her instrument first and then mine. The readings were actually less than hers! She was convinced but wanted to know why the reading done by me was lower than hers. ‘The excitement was already over when I took the reading, therefore the figures were lower’ I said. I presume she will have more faith in me and my equipment henceforth!

The Swoon and after
I have heard and read stories of persons collapsing and even having a heart attack sometimes resulting in death when they hear distressing news. In my 40 odd years of being a doctor and having broken unpleasant news to many of my patients and having watched their agony, I had not come across anyone who has swooned, had a stroke, heart attack or who died. That is till a week ago, soon after the above mentioned patient [lady with high BP] left.

This 50 year old Mrs. P came in with a young man; Mr S. Mr S is a house guest with Mrs. P and will remain with her till he finds an accommodation. The reason why she brought him is that Mr S had fever since the past three days and felt very dizzy the previous night and with difficulty prevented a fall. She made fun of the youngster saying how little resistance the modern youngsters have when compared to people of her age and gave her own example of good health and how infrequently she saw doctors. In fact she asked me,’ when was the last time that you saw me?’ I really did not know and in fact her face was just vaguely familiar, if she had not told me I would not even think she was ever my patient. I told her truthfully that it must have been long time ago. ‘See, what did I tell you?’ she said looking accusingly at Mr S, as if by falling sick he has committed some form of crime.

There was not much wrong with the young man except for lower than normal blood pressure which combined with his fever must have caused some momentary dizziness. I reassured him of the nature of illness which would probably limit itself and he should be alright in couple of day’s time. Mrs. could not help saying,’ I told you it is nothing to worry, but you would not listen, see now doctor too tells you the same’. The tone clearly indicating that it is waste of time coming over to see me.

She would not leave. ‘Doctor, she said, will you please check my blood pressure also’. This kind of free additional consultation is part of the game and I don’t mind doing it these days. I proceeded to check her blood pressure and to my surprise this super fit [her assumption] had pretty high blood pressure. I told her so and get back in the evening for a recheck and take a note for some basic tests before beginning the treatment. She did not answer; instead she said she is feeling giddy. I made her sit in the waiting area and proceeded to see the next patient. Few minutes later comes Mr S and says,’ doctor come and see her, she is not talking’ I went out and found her head had rolled to one side. We put her down and she threw a fit [convulsed]. Soon after that she opened her eyes and obviously surprised at finding herself on the floor instead of sitting on the char. By now I had again taken her blood pressure which had dropped to near normal levels, heart rate and rhythm were normal and she seemed to be fine.

She wanted to go home having profusely apologized for creating a scene. I would not let her. A person with high BP who swoons and had an observed fit and BP drop could have had a heart attack or a stroke or even a tumor in her brain for all one knows. I had explained why it is necessary for her to go to a hospital. My suggestion that I call an ambulance was vetoed by her. By now she had recovered well enough to call a friend to come over to take her to the hospital. The friend duly arrived and the prostate lady was slowly moved to the car and taken away.
The drama took over an hour of my time. I went back to work. After half an hour Mr S comes in and asks,’ doctor do you know where Mrs. P lives? They have left me here and have gone to the hospital. I don’t have her phone number or her address. I don’t know how to go back!

Now I am faced with a new problem. How to get this man home? I did not know where MRs P lived except somewhere nearby. I told him that he has options of sitting in the waiting room till such time MRs P and or her companion realizes that they have left him behind or go over to the hospital and chase them. Poor man’s face fell, faced with this daunting task. He quietly returned to the waiting area.

I went out an hour later and found that he had gone.

The consultant from the hospital called to say that the lady’s BP was normal and her ECG was also normal and they are waiting for the brain scan reports to arrive.

It is nearly a week since the incident; Mrs. P came to see me with all the reports. All were normal. It only confirmed that what she had was indeed a syncopal fit on hearing the bad news!
She has reluctantly agreed to begin taking medications for her raised blood pressure.

1 comment:

Gopakumar said...

This is a lovely post, Uncle. From personal experience I know that even a minor irritation in the throat or a cough can play up in one's mind, when one is in an area without access to a doctor, such as a forest. The more one prays that it not become fever, the more feverish one feels!
The approach you take on occasion, as a Doctor, of allowing nature to take its course, is itself a panacea to the patient