Case 2

It was a day on which I was on call. A male patient arrived, around 40 years of age, with his collar open to reveal a gold chain, wearing a red silk shirt, patent leather shoes, and trousers ironed to perfection. I later found out that he was a newspaper reporter.

He was accompanied by two persons who were also newspaper reporters. According to the information they provided, the patient had split up with his girl friend and was very sad. He was holding nonsensical talks. He became absent minded and then returned. He talked about his girl friend as if nothing happened and cried.

I asked if he was using any chemicals. They told me he was not. I questioned him in detail and carried out internal and neurological examination. These did not reveal any pathology.

During this time both the patient and his friends were becoming impatient. They wanted me to prescribe medication and sent him off. They said “Doctor, whenever this man is sad he does similar nonsense, in fact he faints and we have to take him to the A&E”. By these kinds of statements they were trying to condition me towards a particular illness, conversion. All signs of conversion were really present. By the way, conversion is the name given to a psychiatric picture which mimics neurological disease but where in spite of all investigations no abnormally can be found.

In spite of all their objections I kept the patient under observation. I told them that I will hold him for 24 hours. The reporters could not understand the reason for this and called the hospital chief in order to summon the supervisor on duty. The hospital chief was a man who placed great importance on relations with the press. He spoke with great anger. I was very hurt. But I did not lose my belief that the patient should be kept under observation.

The hospital chief arrived, the assistant chief came, I tried to explain that it was a picture resembling delirium. The chief was a very honourable man. During my early professional years as a young doctor he gave me support instead of crushing me. We sent the patient by ambulance to a university hospital.

In conclusion it was established that the young man had a brain haemorrhage (sub-arachnoid bleeding). He underwent an operation and returned to life.