Personal View

A hollow victory

BMJ 1995; 311 doi: (Published 05 August 1995) Cite this as: BMJ 1995;311:397

It was a Friday and another on call period had begun. The day had been quiet but as expected there was the normal evening rush in the accident and emergency department. I was the duty psychiatric senior house officer. One patient was said to be deluded and another threatened suicide. As I was attending to the first patient I overheard a name which had become familiar to me. The casualty officer and charge nurse said that this patient had come in several times in the past 24 hours complaining of recurring epileptic fits. The patient was said to be as “mad as a hatter” and promptly referred as a psychiatric problem.

Three weeks ago I had reviewed this woman for a parasuicide attempt on the medical ward. At the time I had thought that there was probably not another patient who was as unlucky as she was. She had an extensive medical history with hypopituitarism and related hypothyroidism, hypoadrenalism, and diabetes insipidus. In addition, she suffered from epilepsy and osteoarthritis and was about to be investigated for gastro-enterological problems. She was a habitual overdoser and she had been on long term antidepressant treatment.

In view of all this I asked the casualty officer to ensure …

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