Patient: Just how could she do that, how could some-one just do that, how selfish is she, I still feel that now, how selfish that’s well and how could she just want to end it. What about people like me and the train driver that, that had a bird’s eye view of what she did, you know, like, has to be other ways of doing it if you what to do it, you know. I know that people when they are feeling like committing suicide don’t think of that sort of stuff, you know, it makes it hard when.
Student: Yea, it does make it hard.
Patient: That’s basically, you know, why I can’t understand how she could have done it and I hate her for it and I hope she’s in hell. For leaving me that scar in you know, and for me having to live with it for the rest of my life. You know, just driving my partner to work and I’ve had to watch that.
Patient: But, then on the other hand I feel sorry for her that she’s had to feel that bad that she actually had to go and do that, you know, it’s sad that someone is feeling that sad, bad about their life that they actually, you know, do it.
Student: Ok, moving from that time what happened in the next year or two?
Patient: Nothing, I think everything was quite smooth, um, I met ….. so I had to leave ….., um, to be with ….. and that was a very laid back relationship, like we sort of lived together for probably one year out of the nine years together, and I was living at home, he was living at his mum’s we were more like friends, we would go fishing, go to the football, and I wanted a bit more, he never gave me more.
Patient: So, it was like a real laid back relationship really.
Student: And, family wise around that time how was that?
Patient: Um, no I think that was, think that was fine, like, yea, cause all, everyone had moved out, there was no, …….. and everyone had moved out and on with their lives, it was quite good really, I had the house to myself.
Student: Ah ha, ok, then that relationship broke up?
Patient: Ah ha, I met, I met, ….., my husband now, um, um and then I sort of was still seeing …… and then I thought no, um then I, then I chose ….., you know, by then and ….. decided to propose to me after I said I wanted to split up with him. He gave me an engagement ring, um, which I turned down, kept the ring, turned him down. I deserved it, nine years, he didn’t believe in jewelry, um yea so, but I couldn’t, I’ve found the best partner now, I’m happy with who, you know, like I’ve got a supportive, who is great with me being sick all the time, you know, putting me down all the time, with me putting on weight all the time, he doesn’t say, you know, you’re frumpy, um, you know, he’s great with ….., he’s a great dad, he’s a great husband, so I’m lucky I’ve got, finally found a perfect man but then I don’t like the other family.
Student: Ok, so this is his second marriage?
Patient: Yea, he’s, yea, ….., got an, wife, ex wife and two children who are 11 and eight and his ex wife is a pill, doesn’t give anything, just takes everything.
Patient: And I feel like I’m working my butt off, to support the other family and that plays on me too.
Student: Ok, when you are saying you feel she’s are taking everything, um, the kids don’t live with you?
Patient: No, no, we have the kids every second weekend, where we have to drive to ……..to pick them up.
Student: Ah ha
Patient: And drop them back and that’s because we had, we moved, made it our chose to move out to …….., she reckons, but that’s only because that’s the only place we could afford, um, you know, who can live inner city, cause who could possibly afford to live inner city, um, but yea so, she, she makes sure that she won’t, like give an inch, like with the payments and all that, like ….. has never missed a payment, or he doesn’t, he feels, he knows he has to support, you know, but we’ve asked, well, look instead of making it the hundred, do you want to make it seventy cause our mortgage has just gone up and you’re now living with someone else, you know, you’re are doing it easier, oh no can’t do that, so..
Patient: Those sort of things
Student: How is that affecting you how are you feeling about that?
Patient: Angry, angry and pissed off that she gets to work 20 hours a week and gets to live the high life and she gets to have her children at home the whole childhood when my son’s been in care since he was eight weeks old.
Patient: And like, you know, that plays on me and ….., you know, ….. can’t support us, me and ….., because basically by the time he pays his 22% or whatever it is to his ex wife, and then, then it’s every fortnight $50 to pick them up with e tag, and bring them back so that’s another $100 a month and then, then you’ve got to entertain them, feed them, and clothe them, cause she won’t provide clothes either we have to provide our own clothes, um that’s all an expense, so all ….. pays for them plus a personal loan that he’s paying off, from his debt before he met me um and his ex wife, there’s not a hell of a lot left over.
Patient: You know, without me being the main bread winner. We would have nothing, but you won’t let …… hear any of this will you?
Patient: Cause I would hate for him to know how I really felt.
Student: What, I’m trying to find is, with everybody, everybody feels about different situations and this is how you feel about this situation, and what I’m trying to connect is, what I can find out what you are feeling whether it, obviously affecting you physically cause you have got the nausea and the sleep problems.
Student: Ok, so what I’m trying to find, is what you are feeling. You are feeling angry and feeling pissed off, (poor use of words) you’ve had a lot of violence in the past, whether it’s you or those around you that’s still affecting you.
Student: Um, when you are saying you feel like you are wanting to hide away with any violence now.
Student: What I would really like to know is what you are feeling emotionally, what is the upper most emotion that you are feeling at that time.
Student: You are scared, Ok
Patient: Yep, I’m scared that I am going to get hurt.
Student: Ah ha, and that’s an understandable emotion.
Patient: Yea, I’m just scared that, I remember that a big broad, at work a bloke was angry and threw a chair and I was that scared, not in my recent job, um, I was that scared that I hopped under my desk in a foetal position crying cause I thought oh my God, he’s, he’s going to hurt me, you know.
Student: Ah ha, ok that’s why I’m asking, you can tell me as much as you like or as little as you like.
Patient: No, well there’s heaps, I was living in ….. with …., I was the first time we decided that we would try and live together, I was attacked, cause walking in the park across the road from Safeway.
Student: Ah ha
Patient: Um in broad daylight a man jumped on me, tried to rape me, um, lucky he didn’t I got away from him, um, and that you know, so, you know, that’s something else, like, there are just so many things, you know a lot.
Student: Ah ha
Patient: A lot really
Student: Yea, and it is a lot and sometimes, you know we deal with a lot of
Patient: My mum’s is such a stress head and you know like, you know she’s like that sort of breed, you know, maybe I’m bringing it all on to me, saying ok come on I can handle this and I can’t handle it you know, cause.
Student: Yea, we all have genetic tendencies and I will delve into that a little bit later, but those influences still affect you, they affect everybody, and whether you know, they are in the positive or the negative I don’t know, I’m not the one to comment on it, but what I want to know how these situations are affecting you. Then I can.
Student: Help, ok, you were feeling angry.
Student: Ok, the next couple of years?
Patient: No that was fine, everything sort of, when I got with ….., I was fine, fell pregnant more or less straight away.
Student: Ah ha
Patient: Had …….,
Student: How’s that?
Patient: Um, like the birth was an emergency caesarean.
Patient: 27 hours of labour and then they had to, um, and then I was upset cause I wanted to have a caesarean and I wanted a natural birth cause ……. two other kids were caesarean and I wanted to give him the natural birth and I couldn’t. So, um, but yea, no, um perfect, you know the happy family.
Student: Ah ha
Patient: You know, got a wonderful child, a loving child, which I’m and healthy, except for his younger years where he had pneumonia three times and had to be hospitalized. But apart from that he’s a healthy kid.
Student: Ok, so you got pregnant had …..
Patient: Got my new job, been working where I am now for a year last week, um, and that’s good, you know, it’s a family business, they look after you, you know, they are friendly and that sort of stuff, so.
Student: Ok, so that’s going well?
Patient: Yea, that’s going really well.
Student: That’s great and anything that’s been happening out side in the last few years?
Patient: No, no, not, I had the funeral last week of ….. and he’s been a friend of the family for as long as I can remember and that’s going to hurt my dad and then I will worry about my dad cause he’s lost his best mate, so it’s another thing that I can’t control but I will just worry about it, so, but yea, the last year has been quite good except for my mum being, like, this time last year she nearly died,
Patient: It’s when they told me she’s lucky she’s made it and she’s gone downhill ever since then but she has her days, like I took her shopping today
Patient: She couldn’t walk because the thing was falling out but she was happy to be out
Student: Mm, Yea
Patient: So everything’s fine now.
Student: Ok, when you were saying you were depressed, how long have you been feeling like that for?
Patient: I would probably say that I was feeling like that for a 5 months, but I, I know that I feel depressed but I didn’t, I guessing that I was depressed but I never ever said that I was, you know, I never sort of put my finger on it.
Patient: The only reason why I took antidepressants and it’s sort of like wow I feel better
Student: Are you on antidepressants or have you been on them in the past?
Patient: No I’m on them know, um, Serepax.
Patient: Um, I’ve been on them for a week, but within that week, the nausea is still there.
Student: Ah ha
Patient: But nowhere near as bad or as often, um, so that’s why I’m guessing that it’s more to do with you know like more feeling depressed than actually, cause I’ve had so many tests to find out what’s wrong with me but they can’t find anything.
Student: Ok, so what tests have you had?
Patient: I’ve had colonoscopy, gastroscopy, I’ve had my gall bladder removed cause they thought that, was what was making me sick, this is all after having ……., um, and I can’t remember, I had a ECP.
Student: An ECG?
Patient: No they put up um, a camera down your throat and they were checking for stones in my bile duct. Which wouldn’t be there anymore because it would be removed with the gall, gall oh I don’t know.
Student: Your gall bladder yea
Patient: I had something to see if I still had gall stones in my stomach.
Student: Ah ha
Patient: Um what other, I’ve had blood test to check whether I had hyper, hyper, thyroid.
Student: Ah ha, and that’s all come back ok has it?
Patient: Yea, that’s probably what I’ve had done to find out the nausea, but nothing, except for like, two weeks ago when I had the camera down my throat, throat, they’ve said that I’ve got a hiatus hernia, and that’s, else looked fine.
Student: Are you on any antacids or anything else like that?
Patient: I take Nexium
Student: Nexium, how often do you take that?
Patient: Cause I have reflux, I take one a day and I take 20mgs,
Student: Ah ha. How much Serepax do you take?
Patient: One and it’s 30mgs
Student: 30mgs, um, you saying, that they say you have reflux.
Patient: Well, that’s yea and that’s one of the symptoms of the hiatus hernia is the reflux.
Student: How long have you had the reflux for?
Patient: I’ve been on not Nexium but Somac and Zantac like basically since I was 20 so for about a good 10 years I’ve been on something for my stomach.
Student: Ok, you’re say that’s when you are 20 I’m just trying to connect things here.
Patient: Well that’s probably when, when the girl committed suicide, um 20 I was probably knifed then, yea so it was all around about that time.
Student: Ah ha, ok, and it’s been a problem ever since, ok what does the reflux feel like, is it a burning or?
Patient: Yea, it’s like a burning, I was getting it before and I could feel it rising up, and it was just burning and you can feel it coming up your throat.
Student: Ok, what childhood diseases did you have?
Patient: I had hepatitis when I was a child, I was yellow and I was about three
Patient: I was just limp like a doll. Yea, I was limp, and they kept saying that to my mum that I was ok and mum kept saying that this is not my child so I was just like a rag doll apparently
Student: Ah ha
Patient: Um, I can’t think of anything else when I was a baby
Student: Yep, any recurring illness in the teenage years?
Patient: I had my appendix out
Student: Ok, um, anything twenty onwards till now?
Patient: No, I think we have covered everything that has happened in my life
Student: Ok, no I mean illness, are you prone to chest infections, asthma?
Patient: No, I used to get really bad eczema between my thighs when I was a kid
Patient: Walk like a cowboy and bright red um, but I don’t suffer that anymore
Student: Ok, ok, I’m just going to go through your symptoms top to toe. Anything headaches, migraines anything there?
Patient: No, I’ve got black spots in my eyes that look like sperm, look like, like a dot and a little tail
Student: Ok, ears?
Patient: No fine
Student: Mouth, teeth?
Patient: Teeth are crap, sensitive,
Patient: Yep, very sensitive the other night, I had to go and buy Sensadine yesterday, at 10 bucks a tube
Student: Ah ha, ok, have you had bad teeth throughout your life?
Patient: Yep, yep, it’s not through not looking after them, I think like ….. we have got the bad teeth of the family
Student: Ok, um, fillings, teeth out?
Patient: Lots, lots of fillings, probably a filling in every back tooth, and probably no back teeth, yea, probably one there and one there on the bottom. (Indicating to each side of the jaw)
Student: Ok, any problems with your tongue or your gums?
Student: Ah, chest, asthma, bronchitis
Student: Ah, apart from you reflux and your hiatus hernia anything else?
Patient: No but I had Irritable Bowel I think for the last four days, where tonight, it’s the first tonight, just being here hasn’t hurt, like, to hurt, like ah, na if I press it really, really hurts in my bowel,
Student: Ah ha
Patient: I’m guessing that it’s my bowel, cause like I’ve had the runs for the last four days which is normal that’s a normal thing as well
Student: What sort of pain is it?
Patient: Um, like a cramp, it feels like, ah, yea, I don’t know, it’s like I want to pass wind or something
Student: Ah ha
Patient: Um, yea, it’s like it knots up, like a knotting pain
Student: And have you had irritable bowel syndrome before?
Patient: Yea, I’m never normal to go to the toilet
Student: Ok, can you describe me a pattern?
Patient: Ok, at the moment, in the last six months it’s actually now it’s like’s like I’ve got gastro, it’s like water. I could be four times a day, you know, and that’s what could happen and that’s why I get this pain, from the toilet like a bug that I’ve got and then. Then I will get constipated.
Student: Ok. How often would you have the diarrhoea, what sort of cycle are you having, is it diarrhoea then constipation?
Patient: No, I have diarrhoea for probably two days than hard
Patient: And diarrhoea again
Student: What colour is the diarrhoea?
Patient: Um, like a greenie,
Student: Ah ha is there any smell?
Patient: No not really
Student: Anything that makes it worse?
Patient: No, like it could happen if I have eaten or not eaten
Student: Ok, anything that makes it better?
Student: Ok with the hiatus hernia did you have any symptoms, of, or pressure or pain around that area?
Patient: Well, two last year, was it last year, before I got my gall bladder out
Patient: I use to get this pain around here that was crippling and like I’ve had an ambulance to my house three times, the emergency department four times, um doubled over in pain cause the pain was that bad, worse than labour pains, that’s why they took the gall bladder out but now I’m wondering if it was actually the hiatus hernia popping out, cause it’s like a spasm it would just get you and then it would, it would eventually go. Sometimes I would call an ambulance, by the time the ambulance actually got there the pain had actually subsided, it was like a spasm sort of thing
Student: Ok, how often would these attacks occur?
Patient: Um, probably once every two, once every two to three weeks I would probably be in the emergency department on Morphine
Student: That’s pretty bad pain
Student: What was the pain like?
Patient: Like, I tried as I said it was like a spasm, it was like, unbearable it was terrible, I would be hyperventilating through the pain, where they would tell me to slow my breathing down, the pain was that bad
Student: So they thought it was your gall bladder
Patient: Yea, so they removed that. I did get the pain after the gall bladder was taken out but to this day, I could feel a little bit of a tingle, um, and then when I feel it coming on, now I could feel it, when I know that the pain is coming I will have something to eat and it will help it
Student: So it is slightly better with you eating
Student: So what sort of stuff are you eating?
Patient: Um, well I don’t have breakfast, for morning tea I might have a vegemite sandwich,
Student: Ah ha
Patient: For lunch I will have what everybody else is having, you know a sandwich or Singapore noodles and dinner I would have like what everybody sort of, you know you meat and three veggies, stew or lasagna.
Student: Any problems with your urine, or urinary?
Patient: No but as of last month, I had my period then got my period again then got my period two weeks later again and then I got my period on the date that I was meant to get it.
Student: Ah ha
Patient: I ended up with it in the middle of the month, of the cycle.
Student: Ah ha
Patient: Um, but it hasn’t happened to me again I don’t feel, it happened about two months ago that cycle, I wasn’t sure what was going on. But usually I get stomach cramps, period cramps which I have always had since I’ve had my period and I’ve had that since I was 11. Just down here (indicating to the lower abdomen) where just ohh, you know, just your normal every day, I think most girls get a cramp. I get back pain.
Student: Ah ha
Patient: Um but yea, a lot of girls at work will walk around with those heat bean bag things, but I don’t do that I just put up with it, it will eventually go away, it’s just.
Student: Ok, what’s the flow like?
Patient: Good, but um, it’s usually very heavy the first day, um, the second day is light, you know, I’m only usually heavy for one day, and then it’s dying off, by day three or four it’s gone altogether.
Student: And it’s not excessively long?
Patient: No, no I think I’m coming to the end of my time of being a woman, thank God.
Student: And it’s quite regular?
Patient: Yea, every, on the dot it’s28 days. That’s when I got it in the middle of the month I thought oh my God may be I’m pregnant like, it was just so unusually.
Student: Any problems with your arms, legs?
Patient: No everything’s fine .
Student: Your back?
Patient: No everything is fine.
Student: Feet, joints?
Mother – emphysema from smoking
Father – diabetes untreated, high blood pressure
Mother’s mother – heart
Mother’s father – emphysema
Father’s mother – diabetes
Father’s father – cancer?
Student: Do you have any dreams, or remember any dreams?
Patient: No, I had a dream last night that ….. went off with a couple of prostitute’s what the insecurity coming in. But, yea no, just no, I can’t really know, I can’t really remember them anyway.
Student: What’s your greatest fears?
Patient: Um, I don’t know, what am I really scared of? I can’t think, I’m not, I wouldn’t say I was scared of heights, um, probably scared of my mum dying, can that be my greatest fear?
Patient: Cause that’s my greatest fear of my mum dying and leaving me alone, um, yea and oh I don’t know, not really that scared of that much really. Like I’m scared of being knifed or, you know, attacked or something you know. I’ve got fears but yea, I’m not really scared of stuff.
Student: Dietary preferences?
Patient: Um, I’m not really that fussy, I will eat anything, um, I’m actually a savoury person over a sweet person. So I would rather have chips or something over chocolate. Um, but yea I’m not really a fussy sort of person, like I don’t like sushi or that sort of stuff. I’m not into the gourmet food, I’m not into olives or the sun dried tomatoes, I’m more into your bangers and mash your ocker style food.
Student: Ok, um, I can’t, I think that’s about it.
Patient: That’s it
Summary of case
Wants to hide
Ailments from viewing suicide
|Sleep – wakeful, 11pm 1am 4am, unrefreshed, fatigue|
Menses – short, cramps
Nausea – > eating, > lying down
Eyes – black spots
H/o eczema – thighs
Reflux – burning, > eating
Gall bladder – crippling pain
Diarrhoea – green, frequent, watery
Chest – ache
Teeth – sensitive/decay
Rubrics chosen (Macrepertory complete)
MIND; VIOLENCE, vehemence (124)
MIND; SUICIDAL* disposition (136)
MIND; STARTING, (267)
MIND; ANXIETY (511)
STOOL; COLOR; green (121)
STOMACH; HEARTBURN (233)
STOMACH; NAUSEA (492)
SLEEP; SLEEPLESSNESS (542)
*This rubric is an example of using circumstance to represent a mental symptom. The impact of another person suiciding was so distinctive to this patient. Rather than interpreting her emotional state (grief, shock, anger etc) the event itself holds the energy of the remedy.
Ars, Nux vomica, Bell, Sulph, Chin, N Mur, Sep, Phos, Calc, Lyc, Verat, Merc, Plb, Aur, Acon, Alum
Green remedies – Chin, Phos, Calc, Acon
Aconite 200 single dose – 23 June 2007
Six days after initial dose given on request from patient.
For the first 3 or 4 days felt “fantastic” after waking up the next morning after taking the remedy.
Ã˜ No nausea at all.
Ã˜ No abdominal cramps
Ã˜ Appetite good
Ã˜ Feeling less fatigued not having a nap during lunch at work
Ã˜ Sleeping more at night – not waking up, going to be at 2030hrs and waking up at
Ã˜ Bowels – no diarrhoea, having a normal motion once a day no green colour
Ã˜ Cut down smoking from 25 – 30 per day to 2
Ã˜ Coryza – green, anytime, < morning, stringy, no taste
Ã˜ Continues to worry about everything and is anxious about things still
Ã˜ Continues to have black spots in her vision
However the symptoms started to return after 4 days with the nausea coming back but not to the level that it was, feeling more fatigued again but again not to the level that she was on the initial consultation. Also had a sore throat which was worse on swallowing with a sharp pain and some chest pain which was checked out by the GP who did an ECG and everything was normal.