“There is a mad man we want you to see, doctor,” said the medic in charge of the out patient department. After having done some teaching on recognising mental health problems a few weeks ago, I was delighted to be consulted. While the medic related the brief history, I observed the patient. He was in his early thirties, casually dressed, fidgeting with his hands, pulling at his shirt. He had obviously been escorted to the clinic by his family, as his mother and wife sat on either side of him, trying to prevent him from fleeing. His eyes were wide with terror, and he kept a giving furtive glances over his shoulder as if he thought something menacing was behind him. He was trembling with fear.
The medic said that the patient had had several episodes of being very afraid over the past two years. He said that he could see things that no one else could see. “What kind of things?” I asked. “I didn’t ask him,” replied the medic. I explained how important this was, and eventually we found out that he saw ghosts of people. He looked down at his feet, and started scuffing at the linoleum with his toes. I looked at the medic and drew his attention to the patient’s behaviour. “What’s he doing?” I asked. “I don’t know,” replied the medic. “Can we ask him?” The man said he could see the television on the floor, and it was coming inside his body. “Does he hear any voices?” I asked. “Yes, he can hear our voices,” said the medic. “Any other voices?” “No, he just sees things that aren’t there,” said his mother.
I asked the man to get up onto the examination couch, but he spent a minute scrutinising the surface, brushing away invisible contaminants. When he did settle down, I examined him but could find no signs of any organic illness. The patient clearly did not want to be in the clinic, and despite his mother trying to keep him calm, he walked off into the courtyard.
I found out from his wife that they had been married for two years. “And was he like this when you married him?” I asked. “Yes. He’s always like this when he stops drinking,” she replied. It became clear that this man drinks as much as he can, whether it is local hootch, bottles of beer, Thai whiskey, Burmese rum, basically anything he can get his hands on. He didn’t look well off, so I asked where he got the money from to drink so much. “Oh, his friends buy it for him,” his mother replied. He last had an alcoholic drink two days ago.
He was suffering from delirium tremens, with hallucinations, delusions, agitation and confusion, caused by withdrawing from alcohol. I have dealt with many alcoholics in my medical career, but I cannot recall seeing someone with “DTs” for over 25 years. Medical students learn about heavy boozers allegedly seeing visions of pink elephants when they stop drinking. I have even bought a bottle of very strong beer in Belgium with pink elephants on the label. But I suppose everyone’s hallucinations are different.
We tried to get him to stay, but he refused. We loaded him up with thiamine and other B vitamins, gave him some diazepam to reduce the risk of his having an epileptic seizure, and asked him to come back for review today. He didn’t turn up for his appointment. I’ll probably never see him again. Unless he turns up in the Big Four bar, round the corner from my guesthouse.