It looked like an opiate overdose and we couldnt deal with it
19-Feb-2004
GPs tell their stories
TO add a dash of spice to the curry of general practice, I work one morning a week at the local remand centre.
A few years ago Dr T, local bodhisattva and GP, talked me into it. I was a shy registrar somewhat lacking in self-confidence, but these days, I really don’t mind going there. Partly because of the very experienced drug and alcohol nurse who usually works on my allotted morning, but also because it’s so interesting.
I learn new skills, like how to say politely: “No, I will not prescribe Valium, and you telling me how awful your back pain/sleep/nerves is/are is not going to change my mind. Now would you like me to give you some suggestions about how you can sleep/relax/manage better or would you like to go back to your cell?”
I diagnose a new case of hepatitis C every week or two and spend a lot of time demystifying this illness to the punters. I get to initiate methadone and sharpen my drug and alcohol skills in general, and occasionally there are some wild cards thrown in, just to keep me on my toes.
Like the angel-faced young man who was on five (or so) psychotropics, and was suddenly, for no obvious reason, nodding off in the chair. It looked like an opiate overdose and we couldn’t deal with it in our one-room clinic while there were more detainees to be seen. So I bundled him off to A&E for some Narcan and observation.
It emerged that someone had stopped his carbamazepine a few days previously, and when this drug was no longer inducing his liver enzymes, his 90mg of methadone suddenly packed a lot more whack.
The same young man was back in the clinic some weeks later with a gross tremor and barely able to move. As he had respiratory rate of 30 breaths a minute, I focused on what I thought was his anxiety. He appeared to calm down.
A few days later one of the other visiting GPs observed a positive glabella tap — it emerged that the young bloke had a history of a head injury a year or two previously, and had a trauma-induced Parkinson’s syndrome. Now there’s a cautionary tale, as well as some astute clinical examination.
There’s no shortage of other sad stories in correctional medicine. Recently one of our young and rambunctious charges was found “out of it”, and no one could work out why.
He wasn’t admitting to anything, with no sudden changes in his usual medication — methadone and olanzapine — to account for his clouded mental state.
The story emerged eventually — someone in his cell admitted that our friend had been smoking Buscopan, diverted from another detainee. He woke up in due course and no doubt will continue his forays into pharmaceutical oblivion, whether in or outside of the correctional setting.
My response to these capers varies between amazement and amusement. But most of all, I am just grateful for my nice, middle-class life, and that I can walk through those security doors at the end of the morning, back to the ordinary madness of general practice.
Submit your feedback here: