The patient comments he asked his wife to remain in the waiting room for several minutes while he discussed something personal with the doctor. The eyebrows of the physician rise as he asks whether it would be OK to have two medical students and an observer attend as well. The man tips his head forward slightly and says sure as he sinks slowly into the office chair. He glances at his watch and begins speaking in a low breathy voice.
Someone is trying to poison him. He’s sure of it. With some effort he takes a pill from his shirt pocket and places it on the desk in front of the doctor. The doctor frowns, gazes at the pill and asks whether he has been taking Seroquel, because the pills looks like the 50 mg tablet. Turning to the computer the doctor brings up the list of the patient’s medications as the man across from him states he found the pill in a bran muffin, that morning.
The physician nods once, and holds one finger up to the patient, who continues to expound on how he can no longer live with people who put pills in his food. He reads the note he wrote after the previous visit, aloud.
Reviewed with patient and spouse the benefits of Seroquel, or quetiapine, and how it diminishes the frequency of visual hallucinations when taken during the day and improves sleep, when taken at night. Suggested patient begin with a 25 mg tablet at night to induce sleep…
The doctor looks over at the man with the white dense eyebrows and asks whether he takes a small pink pill in the evening. The patient nods, his wife always brings him his night- time dose. He takes two and sleeps well. The doctor asks whether he takes any during the day. The patient’s eyes drift towards the ceiling, until he is looking upwards and he replies he prefers to see the things he does, than feel sleepy and dullwitted.
A light rap on the door makes all turn their heads and the nurse and spouse appear in the doorway. Motioning to the empty seat, the doctor invites the wife in and mentions they have been discussing medications. A similar age to her husband, the wife has her white hair tied back in a pony tail. She nods as the doctor continues speaking affirming the patient’s preference for hallucinations over Seroquel during the day. Her cheeks redden, and she concedes her spouse was a painter at one time and his passion for visual images might be understood better, knowing his background.
The physician approaches the patient and asks him to sit on the examination table, where he feels for rigidity in the wrists and elbows. While he examines the man, he asks who prepares his breakfast in the morning. The patient works on tapping one hand into the palm of the other, the wife replies the day nurse prepares breakfast for her spouse because she is usually out of the house by the time he wakes. As they return to their seats the physician makes eye contact with the patient, and asks whether this is an appropriate time to share the concern. The husband makes a gruff sound as he lowers himself into the seat and the doctor raises the white pill in his forefinger and thumb. The wife looks on with expectation and puzzlement as the physician explains her husband found the pill in his breakfast muffin. Her expression changes radically and she takes the arm of her husband and speaks into his expressionless face, whispering loudly she will speak with this woman.