Spooked

I have a patient who presented with a very bizarre history.

He came in 2 days ago, claiming to have no recollection of the events over the last 6 days!

The last thing he could remember was approaching an ATM machine to withdraw RM 6K to use as his ‘mas hantaran’ for his upcoming engagement. He smelled the cigarette smoke, and felt a tap on his shoulder. That was the last thing he remembered.

He came to himself 6 days later, at his home (he did not know how he got home), RM 6K poorer and could not remember anything else. He also has a severe headache in the occipital region, strange marks on both his wrists (looks like ligature marks), sees double when he gazes to his right, could not remember his friends AND his fiancee (!!) but could remember his family members and there were a few hotel receipts in his wallet. He subsequently discovered that his money was withdrawn from 2 separate ATMs in 2 separate states!

Clinically he is well except for the diplopia which the ophthalmologist think is a refractory error. The CT brain was normal as were all his other blood works. There were no signs of infection or trauma to the head.

He is well and I am sending him home today. He is regaining his memory bit by bit. And yeah, he can recognise his fiancee again, so the wedding is ON!!!

Frankly I don’t know what to make of it (and it’s kinda silly to write the final diagnosis as, well, ‘Acute hypnotism and robbery’ or ‘Supernatural Possesion’ or simply ‘LOST’).

I guess this one will remain an enigma. I have my own theory of course but they are a bit non-medical.

Wed, 241007 @ 1213; I wish the sun would shine a bit; I am running out of dry clothes!

Mas hantaran: Malay word; a pre-wedding gift (I am told the going rate now for non-VVIP/VIP/Celebrity/Angkasawan is about RM 6-7 K!)

Medical Calligraphy

One of my pet peeve is receiving badly written referral letters. When I say ‘bad’, I refer to either referral letters with legible handwriting but have zero substance, or letters with substance but suffer from horrible ‘cakar ayam’ or both! I received this letter in the clinic the other day which fell in the last category.

It’s true that doctors are well known to have bad handwriting but I really think it defeats the purpose of a referral if the person to whom the letter is referred to absolutely cannot make out what was written! I for one do not think doctors should conform to the ‘norm’ of having horrible scribbles disguised as handwriting.

It took me all of 15 minutes to try and figure out what was written (I gave up in the end). I could make out words like CABG, IHD, pulse rate of 54-62, giddiness, >5 weeks, he is under your follow up, stress test/IJN. The rest I had to use my Sherlock Holmes + Hercule Poirot + CSI Miami/Vegas/NY ability as well as asking the patient what the referring doctor actually wanted. The patient was a bit flustered. He was probably thinking “Oh dear! I’ve got myself a doctor who can’t read!”

It turned out that he was referred to me because the patient was told that his heart rate was slow (54-62/min according to the letter ~ in the parts that I could actually read).

The patient was on beta-blocker for goodness sake! His heart rate is SUPPOSED TO BE SLOW!!!! Duh!!!

Good grief.

I would have written a carefully worded response letter to the referrer (to broadly hint to him regarding the bad referral letter) if not for the fact that this person is a very senior doctor in the hospital. Sigh…

If you can’t write, type- la!!!

Wed, 241007 @ 0730

cakar ayam: a Malay idiom, literally meaning ’scratches made by a chicken’; used to describe bad handwriting.