Wednesday, 23 April 2008


My work gets pulled in many different directions. I seem to have absorbed many roles and am often asked to pitch up and help out with stuff that's not really my core work. A post on this use of Consultant time is for another day. Last week, a Consultant Geriatrician and Consultant Anaesthetist were stuck on how to manage a chap of 66 with multiple health problems. Let's call him Arnold.

Arnold is profoundly deaf. He has a lot of aches and pains. He told his Consultant Geriatrician that he had leg, foot and chest pains that were severe and stopped him from sleeping. He also had cramps at night. He would like all pain abolished, thank you kindly. The Consultant sought advice from an Anaethetist who's an expert at this. The Consultant Anaesthetist had a number of clever suggestions (which were helpfully introduced) and Arnold's pain wasn't abolished but did reduce.

The Consultant Anaesthetist found Arnold to be unusual. He thought something was wrong and that Arnold was mentally unwell. When speaking with Arnold, Arnold didn't grasp everything that was said and became feisty with colourful language and wild gesticulations with his walking stick. I was asked to see him to determine if he had dementia or a mood disorder.

When Arnold was told something, he wanted it doing. Right away. He wanted a scan, wanted it in the hospital and wanted it that day. He didn't seem to grasp that this wasn't realistic.

I happily traipse on over and meet with Arnold and a senior nurse from the Geriatrician's unit. I go through his mood, checking symptoms and signs and biological features. I shout a lot since he's so deaf, I write some things down. After the near hour's consultation the staff outside said they could hear everything I said since I was shouting, so much for confidentiality and dignity on medical units. Pet peeve. At least I was given a private clinic room (rather than curtains around a bed) even if it wasn't sound proofed. They didn't hear his answers, so that's something.

Having gone through mood problems, I went through cognition. Orientation, attention, praxis, memory, sequencing, language, executive information processing, all of it. As is my wont, at one point I push Arnold with stressful questions which he handles appropriately but assertively, there's no hostility or impulsivity or loss of control or disinhibition.

When I'm older, I'd like to be like Arnold. I attended the Consultant Geriatrician's team's multidiscplinary meeting this week and fed back my findings. He's in perfect mental health. No mood disorder, no cognitive deficits, no dementia.

So why his feisty behaviour at times? Because Arnold's a quirky, idiosyncratic and curmudgeonly old chap who elects to be like that. Fantastic!

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