Filler

Useless again

The next patient on the post-take ward round was a "straightforward" overdose. The senior house officer reported that the 21 year old girl was now well but had been having to look after her 91 year old grandmother. The ward sister confirmed that the girl was the "principal carer."

She looked, despite her age, like a child. She was obese, had pale, child-like skin with a flushed red face, and she was clutching a soft toy. Yes, she wanted to die. Then, quite spontaneously, she volunteered that her dad had died young of mesothelioma and that I had looked after him. Her manner implied unspoken gratitude for care given to a loving parent. She told me that she now lived away from home because she and her mum had blazing rows. Her general practitioner had wanted to help and had sent her to a psychiatrist. Unfortunately, the senior house officer who saw her made her feel even more useless than before.

We arranged for her to see our psychiatric liaison nurse. Then, as we left, she reached across and held out her hand to shake mine. As we walked back down the ward, I asked the ward sister if the mother had been in touch. Yes, she had been and had asked what the problem was. When she heard it was an overdose, the mother had commented, "There she goes. Once again, she has let her grandmother down."

Desmond Murphy, consultant physician. 

St Mary's Hospital, Newport

We welcome articles of up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. If possible the article should be supplied on a disk. Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for "Endpieces," consisting of quotations of up to 80 words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.