Benjamin Daniels - Further Confessions of a GP

At this point I absolutely fell about laughing. The painful awkwardness of the long silence accompanied by the hilarious sight of Jess wearing these ridiculous old-fashioned glasses was just too much for me to bear. Jess started laughing as well, still absolutely clueless of the relevance of the glasses to the whole meningitis diagnosis but aware that putting them on her nose in case she might be able to see the rash better had clearly not been Dr Bowskill’s intention. Particularly as the strength of the lenses meant that she could see practically nothing at all.

By far my least favourite part of being a junior doctor was covering the medical wards at night. As darkness fell, one or two of us would be on duty to cover any potential emergencies that might crop up in any of the many medical wards that were spread over several floors of the hospital. I say emergencies – the reality was that many of the jobs were far more trivial. The nurses wanted us to rewrite a drug card or re-site a drip. Occasionally, though, a call would come through on my bleeper that wasn’t quite so routine.

‘I need you to prescribe something for one of our elderly gentlemen,’ the nurse was saying. ‘Something to calm him down sexually.’

‘Eh?’

‘Is there anything you can prescribe to reduce his testosterone levels or something?’

‘What, you want me to chemically castrate one of your patients at 3 a.m. on a Sunday morning. What is he doing?’

‘He keeps touching all of the nurses up. He rings his call bell every five minutes and as soon as we come anywhere near his bed, or the one next to him, for that matter, he reaches out his hand and grabs whatever he can.’

‘Can’t you tell him not to?’

‘He doesn’t understand English.’

When I arrived at the ward in question, I was greeted by a group of very irate looking nurses who led me over to the gent causing all the problems. Mr Lorenzo looked too frail and decrepit to be creating such a debacle, but as the nurse in charge escorted me over to his bed, sure enough, he made a grab for her behind. Clearly ready for this, the nurse nimbly dodged his flailing hand and gave him a hard stare. Mr Lorenzo looked at me, gave me a wink and then let loose a massive toothless grin and cackle.

‘You mustn’t touch the nurses,’ I told him firmly.

‘Funnily enough, we’ve tried telling him that. He only speaks Italian.’

‘No touchee the nurseees,’ I tried again, this time shouting in English but with a terrible Italian accent.

In the very unlikely scenario that Mr Lorenzo did understand me, he chose to ignore me and instead continued to give me his toothless grin before this time trying to grab the bosoms of a health-care assistant who had foolishly strayed within his groping range.

‘Senore Lorenzo, por favori, no touchee. No touchee!’ I shouted firmly. I then turned around and decided to stride away purposefully as if I had successfully resolved the issue when of course I hadn’t. The nurses didn’t bother waiting for me to be out of earshot before loudly commentating on how bloody useless I was.

I’d almost forgotten about Mr Lorenzo when about an hour later I got a frantic call from the nurse back on Mr Lorenzo’s ward.

‘It’s Mr Lorenzo. He’s fallen out of bed and he’s unconscious.’

I ran to the ward to find the nurse in charge in floods of tears. They had become so fed up with Mr Lorenzo’s constant bell ringing and subsequent groping that, despite it being against the rules, they had moved his call bell just out of his reach. He had reached and reached to try to get it and had fallen out of bed. Sure enough, down on the floor Mr Lorenzo was lying on his back, motionless and grey.

‘I think he might be dead,’ blubbed one of the nurses.

‘We’ll all lose our jobs,’ another wailed.

‘Stop crying and help me check for a pulse,’ I interrupted.

We all stood over the moribund Mr Lorenzo, then just as the nurse in charge leaned over to try to find a pulse in his neck, as if by magic, his arm sprung into life and reached up her skirt. He opened his eyes, gave me that toothless grin and a wink and the rest of us collapsed into relieved laughter. So relieved were the nurses that they weren’t going to have to explain to a coroner’s inquest how they had moved his call bell out of reach that they happily tolerated his wandering hands for the rest of the night; well, for an hour or two at least.

A pseudoseizure is a pretend fit. The person flails their arms and groans a bit as if having a real epileptic seizure, but in fact they are completely conscious and are in full control of their actions. This may seem to you as a very odd thing to do, but surprisingly they are really quite common. In fact, when I qualified as a doctor I witnessed three pseudoseizures before I saw a genuine epileptic fit. As I have become more experienced, it becomes easier to differentiate between a pseudoseizure and a real one.

Barry, the nurse I work with in A&E, is particularly unsympathetic to the condition. When he sees one of our regulars coming in pretending to be fitting, he rubs his knuckles hard on the patient’s chest. If the patient sits bolt upright and tells him to ‘fuck off’, we can all be reassured of the true diagnosis. Personally I prefer a slightly subtler approach. By gently stroking the eyelash, someone conscious won’t be able to help but flicker their lower lid. It avoids unnecessary swearing or potentially bruising the chest wall of some poor bugger who is genuinely having a seizure.

As an A&E doctor, I viewed pseudoseizures as yet another odd preserve of the crazies who dog the department, but as a GP I have been given the opportunity to gain some insight as to why people have them.

Carrie has them frequently, and recently she had one in my surgery waiting room. Picture the scene: Carrie comes to the desk wanting to see me on a busy Monday afternoon. The receptionist tells her that there are no appointments until the following day. Carrie then falls to the floor dramatically and shakes all her limbs. Everyone in the busy waiting room clambers over to help her and I get an emergency call interrupting both myself and the patient I am seeing. As I rush into the waiting room, I think I can see just the faintest of self-satisfied smiles on Carrie’s face. She has got the attention she was craving. If the waiting room had been empty, I could have told Carrie to get up and stop making such a scene. This of course looks a tad on the unsympathetic side to her worried audience who are expecting me to offer suitable emergency treatment for what they believe to be a poorly epileptic.

I compromise and help Carrie into my room, apologetically upending the poor patient I had been seeing and delaying the remainder of my afternoon surgery. Carrie gets my attention and the appointment she wanted at rapid speed.

Her pseudoseizures also commonly occur when her boyfriend splits up with her or when she has had a big row with her mum. In these situations, the pseudoseizures are a brief and effective distraction from the current unpleasant realities of her life. They also result in her receiving the sort of sympathy and attention that she normally struggles to elicit. Carrie offers plenty for a psychotherapist to get stuck into, but for a lowly GP like me it is just a matter of trying to manage the situation as best as possible in the 10 minutes I have. I do feel sympathetic towards Carrie and hope the psychotherapist I referred her to helps her to manage her symptoms. Having said that, I can’t say there aren’t moments when I wish I had Barry at hand to offer a couple of hard knuckle rubs on her sternum the next time she dramatically collapses in my busy waiting room.