A Midsummer Night’s Dream

aka Postcards from the Edge 007c

Nick Bottom: I’ll speak in a monstrous little voice.

Act 1, Scene ii. A Midsummer Night’s Dream. William Shakespeare (~1596).

One day, as a trainee doctor working in rural Zambia, I walked through the gates of the hospital to be greeted by what seemed to be the “eeyore-ing” of a demonic donkey. My eyes and ears scanned the courtyard and corridors but could not locate the source of this bizarre noise. After a brief pause I resumed my brisk walk to the male medical ward. As the ward round started, the source of the noise arrived and found me.

Mr D was a young-and-healthy-looking man in his twenties. His presenting complaint was intractable ‘hiccups’ that had tormented him (and everyone else within earshot) for over two months. The hiccups were violently loud, rapidly repetitive, and associated with a great deal of belching and tic-like facial movements. Interestingly, the hiccups subsided whenever Mr D had food in his mouth and when he slept at night. An obsessive clinical examination yielded no other findings of note. A psychogenic cause was suspected.

I learned from Mr D that he had been cursed by a local village woman. I also learned that the purpose of the curse was to prevent him from working on his father’s farm, and to ruin his marriage prospects. It was clearly working. With the help of the nurses I tried to reassure Mr D that there was nothing physically wrong with him and that the curse would only be effective as long as he believed in it’s power over him. Unfortunately, his conviction in the power of the curse was strong, and thus the curse was powerful. Mr D did concede, however, that the curse would wear off eventually. For his (and everyone else’s) benefit we tried to convince him that that time would come sooner rather than later. Mr D even agreed to a trial of chlorpromazine to control the hiccups, but the drug simply didn’t work.

In the end we resorted to encouraging our patient to keep working despite the hiccups and even to try walking around with food in his mouth. He was discharged soon after, donkey-like hiccups and all. I was left to reflect on my therapeutic impotence in silence. I still wonder what happened to Mr D.

Faith in the gods or the saints cures one, faith in little pills another, hypnotic suggestion a third, faith in a plain common doctor a fourth.

William Osler ‘Medicine in the nineteenth century.’ In: Aequanimitas

Puck: Lord, what fools these mortals be!

Act 3, Scene ii. A Midsummer Night’s Dream. William Shakespeare (~1596).

LITFL Zambia related notes

Postcards from the edge LITFL 700


from the edge

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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