Tuesday, August 11, 2009

Case Review

I have had a patient who has been in hospital for a long period of time. At first the doctors have labeled her the mystery patient as they could not figure out what was wrong with her. She came in with malnutrition and abdominal pain. A serious of tests including blood, CT's and MRI's came back normal - they could not figure out what was wrong.

In the meantime i was working with the patient as she had pressure areas on her sacrum and heel, and she had de-conditioned and the simplest thing was hard for her e.g. pulling her pants down to go to the toilet - let alone getting to the toilet.

The patient was a 34 year old female, living in a HNZ flat with her flatmate (ex-partner).
She had no mental health history so know one had thought of perhaps she had an eating disorder. This was the doctors last resort - to get the psych team involved. Although it never really was a clear case she is now on an eating management plan and will be discharged once she gets to a certain weight.

2 weeks of assessment by the doctor had gone by, and im trying to think back of the time spent with this patient. Was there any indication that the patient may have been suffering from an eating disorder.

I remember thinking "how could someone get so sick without seeking medical treatment or intervention e.g. not getting out of bed and not making it to the toilet on time.

Maybe she was ashamed of herself, maybe her mood was affecting her drive to get better, maybe she was in denial that she even had a problem...

I remember her saying "i use to love food..but i cant eat it any more because it all tastes funny. Maybe this was an excuse. Maybe this was her reasoning for no longer enjoying food or no longer wanting to nourish herself

I remember her refusing PT input, maybe this was low drive affected by mood. in some ways the cues were there - but i never really analyzed them until afterwards

I guess i just expected that there was a "medical reason" for her illness because of her presenting complains e.g. pain and malnutrition

Just goes to show the process of assessment is a complex one and so very important - so many cues and hypothesis to think through and problem solve through

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