She thought her husband was unfaithful

According to the typed list in front of me, the next patient scheduled to see me was Mrs Thuku. As I was sitting in my office, waiting for her, she failed to appear.

I, therefore, sauntered into the waiting room to see what was happening. There I saw Mrs Thuku flat out and my nurse and secretary trying to revive her. “What’s happening?” I enquired.

“It seems that Mrs Thuku has passed out,” my nurse replied.

“Strange”, said my secretary, “she came a few minutes ago and showed me her appointment card. I told her we were running a bit late because of an emergency but it won’t be long before she is called. Then when her turn came and I called her name, I saw her faint. Luckily the patients around her prevented her from hitting the floor.”

“I loosened her clothes, stretched her out on the carpet and lowered her head,” my nurse added.

I could see no sign of distress on Mrs Thuku’s face and she seemed to be breathing normally. “I have checked her pulse,” the nurse went on. “It is not fast, is of good volume and regular.”

“Let’s check her blood pressure,” I said, went in my office and brought the BP apparatus. I tied the cuff around her arm, and pumped the rubber balloon. As I noticed the mercury going up and down, with the dial of my stethoscope placed in the crook of the elbow, I registered her blood pressure and remarked: “Normal systolic and diastolic BP.” I opened Mrs Thuku’s eyes and noticed that her pupils were of normal size. I pulled the pen size pocket torch from my white coat and shone it in her eyes.

“Normal reaction,” I said and went over her chest with my stethoscope and found her heart and breath sounds normal. I pinched the skin on her cheek and she winced.

“I think she is coming round,” I said and went into my office to look at her file. She was a new patient, 35 years of age and a lawyer by profession. Attached to her file was a letter from her family doctor who had referred her to me for pain in the right breast. When I went back to the waiting room I could see Mrs Thuku beginning to stir. She rubbed her eyes and asked “Where am I?”
“In the surgeon’s waiting room,” I replied.

While Mrs Thuku was coming round, I started seeing the next patient. When I finished, supported by the nurse, Mrs Thuku walked in my office, slightly unsteady on her feet but otherwise looking normal. As I took her medical history, I realised that Mrs Thuku had come round completely. “Is the pain in your breast constant?” I asked.

“Yes, but worse before periods,” replied Mrs Thuku.

I asked some more relevant questions and then examined her. Both her breasts were lumpy, more so the right side where she had the symptoms. They were also tender.

“You can dress up,” I said and, to allay her anxiety, gave her my tentative opinion. “You can relax because I don’t feel anything terrible in your breasts.”

Having examined more breasts than I can remember, I know that the uppermost fear in women who come to see me with breast problems is that of cancer. Where I am quite sure, I make a point of dispelling that dreadful suspicion straight away. The result is obvious. Instead of the face puckered with anxiety, it suddenly breaks into a smile of relief.

Not being sure of Mrs Thuku’s cause of brief unconsciousness, I considered stress as one factor and thought I could relieve her of that straight away. When she dressed up, I elaborated: “You have what we call fibrocystic changes in the breast. They are usually hormonal in origin and common at your age.”

As she looked relaxed, I wrote – KNOTTY – on my desk pad and added: “This hormonal imbalance makes the breasts feel lumpy, described in surgical textbooks as knotty.”

Then to explain why I wrote the term in capital letters on the pad, I added: “I make a point of spelling it correctly because a couple of years ago when describing the clinical findings in fibrocystic breasts, most students in their written examination wrote that in this condition, the breasts are NAUGHTY!”

That little story made Mrs Thuku laugh, convincing me that she was now completely stress-free. “Just to be sure though, we will do a baseline mammogram and I will review you in three months.”

It was a month later, when I was operating on an emergency case of strangulated hernia, that the sister in Accident and Emergency sent me a message. “Mrs Thuku, a patient of yours, has been brought in, unconscious, by her husband, who tells me that she did the same in your waiting room about a month ago”.

“Tell the casualty officer to deal with her until I finish here, when I will come and see her,” I sent a message back.

I quickly finished the procedure I was doing, ran into the surgeons’ changing room, put my white coat over my theatre garb and rushed to the Accident and Emergency Department. The clinical picture was the same as it was in my office, except this time it took longer to revive her.

I could see the anxious husband hovering around her as we put an oxygen mask on her nose and put a glucose drip up. “I think we better admit her for a day,” I told Mr Thuku. “We can observe her and also obtain a second opinion from my physician colleague.”

“What do you think is causing these attacks of coma?” He asked, looking extremely worried.

“I don’t know,” I confessed. “Episodes of coma are not in my line and that’s why I am contemplating a medical opinion.”

My physician colleague was as puzzled as I was except that he ordered a battery of investigations and interrogated Mrs Thuku thoroughly before coming to the same conclusion as I did.

“You know when a team of an experienced physician and surgeon can’t make head or tail out of a patient’s clinical conundrum, I think it is time to call a psychiatrist on the case,” he suggested.

Accordingly, I rang Prof Nderitu. “Please ask the ward sister to send Mrs Thuku to my office,” he said. “I believe that a psychiatrist’s couch is the right spot to solve difficult puzzles.”

The next day, I was told by the ward sister that Prof Nderitu wanted to see me in his office to discuss Mrs Thuku’s case. I was wondering if he wanted to use the charm of his couch on me as well! But happily that was not the case.

As I entered his office, I saw him looking seriously at an illuminated model of the human brain lying in a glass case on his desk. I have always believed that most psychiatrists are victims of their own specialty. I remember my professor of psychiatry come to lecture us medical students wearing one red sock and one yellow.

“Strange,” he remarked when the anomaly was brought to his attention by a bold student. “I have a similar pair at home!”

“I am here to discuss the case of Mrs Thuku, I referred to you,” I reminded Prof Nderitu after I sat in his hallowed chamber, unattended.

“Ah, a fascinating case,” he replied. “She suffers from severe depression and has developed suicidal tendencies. I wondered why a successful lawyer would suffer from such vile delusions.”

Looking at the model of the brain, he continued: “Initially she refused to come out of her shell; her high IQ proved a hard armour to penetrate but in the end I managed to pierce it.” As I was wondering when he would get down to brass tacks, he explained: “The cause of her illness resided in her husband. She was suspecting him of having an affair.”

As I listened with great interest, he explained: “One can lose consciousness the same way one can lose appetite from anxiety and stress. Superseding all these emotions, she wanted to draw attention, and she did.”

“So how will you treat her?” I asked.

Prosecutor, judge and jury

“I interviewed the husband,” replied the good professor. “It is strange how our objectivity deserts us when we are dealing with our own personal relationships. Here is an eminent lawyer who has condemned her husband without any evidence or without giving him an opportunity to defend himself. It is a classical case of one acting as prosecutor, judge and jury!”

The professor took a thoughtful pause. “The poor husband is very worried about his wife’s funny turns and has no idea that she holds him responsible for them. He told me that he simply has no time for affairs because he is working hard to succeed in his business and give his wife and children a better lifestyle and secure future.”

After thanking the professor, I went back to the ward. Mrs Thuku was packing her valise in preparation to go home. On her face I could see glowing signs to indicate that the crossed wires in her psyche had been uncrossed.

“Thank you,” she said. “I must apologise for giving you all this trouble when the cause of my problem lay within me.”

“Don’t mention it,” I said, “Just promise that if I ever get arrested on a Friday evening to be brought in front of a magistrate on Monday, you will come immediately and bail me out to spare me the weekend in remand!”