Volume 11 Issues 3 March, 2021
It was a hot summer evening when I attended to this lady. I was pursuing postgraduate training in psychiatry and was about to complete first year of residency. Though it was the month of summer vacations for the institute, the time was rather busy for junior residents like me. My alma mater generally gets more patients in summer months and at the same time, the number of working hands is less. By this time of the year, the final year residents have either completed their residency or are counting last days of the same and if we are not lucky, the new ones are not in sight yet. Even the senior residents are going through a phase of uncertainty about future prospects at this point of time. And the increased workload is shared by the first- and second-year junior residents.
At this point, I attended to this lady who was around 60-years old and was brought by her son to the psychiatric emergency with the complaints of confused behaviour, inability to identify family members, agitation and sleeplessness for two days. The complaints had a fluctuating course and were worse in the night. I was clear that I was dealing with a patient of delirium. However, on detailed assessment, I couldn’t find any obvious cause for the same. The only remarkable finding was mild tremors in her hands. I was thinking of medical causes but the patient had already visited medical emergency. Her routine blood investigations including serum electrolytes, ABG, chest x-ray and CT-Head were all normal. The patient was admitted for further assessment and observation. She had a tough time in night as she was confused and agitated and had to be given injections for sedation. In the morning, the case was discussed with the faculty in-charge. After listening to the case, he asked if I had inquired about alcohol intake. I smiled, so did my colleague sitting beside me during the rounds. We emphasized that the patient is a 60-years old LADY. We didn’t see any justification for this query. However, our teacher was not amused and so we all went to the ward. I had a serious gut feeling that we were all going to embarrass ourselves today by asking about alcohol intake to a 60-years old lady. At the patient’s bedside, we asked the patient and her son about alcohol intake. To my utmost surprise, they came up with a positive history of alcohol intake in the patient. Few more questions and it was clear that the lady was alcohol dependent and we were currently dealing with delirium due to alcohol withdrawal. Appropriate management for the same was started immediately.
My gut feeling turned out to be true, but in a manner different from what I had expected! In this entire affair, it was only me who was embarrassed. Nevertheless, I learnt a very important lesson. Alcohol dependence among females is less common and it is not encountered frequently in clinical practise. But when you see a patient with typical clinical features of the same, you shouldn’t hesitate in inquiring about the same. I also learnt that I must not tinker with different aspects of clinical assessment (history and examination) as per my knowledge (or rather lack of knowledge) and convenience. If I maintain sanctity of the same, I am far less likely to miss critical findings and to commit errors.
