Clinical Cases

Depression, Nausea and Suicidal Thoughts

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This case has been briefly edited for conciseness and duration but displays the total case as taken by a fourth year student. All names and places are represented by “Patient and “Student”.

Although longer than the other cases, it is a reminder of how we only need parts of the whole case to get the totality.  Many patients (in particular this one) cannot vocalise their emotions very clearly and that combined with the judgement of the practitioner can lead to an incorrect mental analysis.  This case displays the use of circumstance to choose rubrics – an accurate and objective way of finding a remedy that suits the patient.

This case also reminds us of the following

  • ·        Use leading questions with physical symptoms
  • ·        Use open questions with biography and “feelings”

When a case is presented in this format we can clearly see when a leading question during a biography or emotional expression closes down the flow of information or worse, leads to the patient “agreeing” with our interpretation; however conversely a lack of leading questions during the physical case taking can bring about a lack of generals and specifically modalities – so vital to the totality of symptoms.

CASE

Student: Ok, as you know I am a homoeopathic student and I have to present a written transcript, an audio tape and 5 photos of the case to my lecturer. This is all private and confidential, is that okay with you?

Patient: Yes that’s fine.

Student: As a student, I need to present this case to my supervisor. I won’t be able to provide any remedy without their supervision – as I need to make sure I’ve got the remedy correct as well as things that are relevant to the case.

Homoeopathy is where we look for patterns that are recurring in your life. We all have different type of stresses, and they will represent themselves in different patterns in your life. We are looking at how those stressors affect you both emotionally and physically.

Homoeopathy treats you by choosing a substance that is found in nature that is known to help people with these illnesses and patterns.  Homoeopathic remedies are completely natural and have been proven to assist in many different types of illness over the last 200 years.

We’ll be doing an analysis, including your history up to now and situations or events that have been stressful for you have and how they have affected you.

At the end we also look at your facial features and take some photos.

Student: So how can I help you today?

Patient: I basically suffer from nausea.

Student: Ah ha

Patient: Which is it, it happens every day.  And any time of the day so it doesn’t have to be anything in particular that sets it off.  It could happen at 3 o’clock in the morning where it gets to the extent where I want to vomit. But I can’t, I don’t and it’s been getting bad.

Student: Mm

Patient: It’s been going on for at least six months at least

Student: Ok, so what was happening around six months ago – can you think of   anything that was happening?

Patient: I think my stress levels, my mum got really sick.

Student: Mm

Patient: So I think you know I think it’s more stress related than anything else.  Like I’ve got um, more work to do at work and like I got more responsibility now, then with my mum getting really sick…

Student: Ah ha

Patient: I think it’s all just sort of turned into you know, into that.

Student: Ok, when you say that your stress levels with your mum being sick what was happening to you, how do you relate that stress to you, what did you feel?

Patient: Sad, hurt, worried.  I was just so worried about her and still am worried about her.

Student: Ah ha

Patient: Cause no-one knows what’s wrong with her and she’s just someone else for you to look to, cause there’s no one else, no-one knows what’s wrong.  And that plays on me. You know. Cause she’s just my mum.  My best friend.

Student: Absolutely, yea.  That’s understandable

Patient: Like I think I’m depressed, I’m trying to give up smokes, I can’t, I’ve put on so much weight, I’ve never been this big before in my life.

Student: Ah ha

Patient: And I think that everything has just got on top of me.

Student: Ok, um, now long have you been smoking for?

Patient: Oh, since I was 15 and I’m 37 now.

Student: Ok, How do you find it stressful, what are the physical symptoms of your stress?

Patient: Um, I don’t

Student: Don’t know? That’s OK.  You were saying that you were having more to do with work.

Patient: Yes,  I’ve got, like I was just doing Hire , like I’ve got glass now, I look after two glaziers as well, so now I’m looking after two as well.

Student: Ah ha

Patient: Um, you know I did get a pay increase to do that but it is more, you know, responsibility, you know, which I don’t think it plays on my mind but obviously these things do, must play on the back of your mind, I’m obviously thinking of stuff, you know what I mean, you know I’m guessing, that’s what is making me sick

Student: Ok, what is the physical stuff, how is your sleep going?

Patient: Well, to be honest, I’ve been taking tablets that is making me go to sleep, um, before that I would be waking up at least three, three times a night.  Um, yea, feeling ill so that would wake me up.  But I’m sleeping a lot more to, I’m tired all the time.

Student: Yea

Patient: So, and it’s because I’m a beached whale now, I’ve got no energy, you know, like I feel tired, like before coming here I said to my partner about 6 o’clock, I could go to sleep know.  Like that’s ridiculous I’m 37, I should be able to stay up, I’m in bed by 9.30 every night, every night.  If I stay up to 10.30 that’s a late night, wow that’s a late night.

Student: When you say that you wake up three times a night, roughly what times were they?   Was there a pattern to them?

Patient: Yea, I would, I would say 11, 1 and about 4

Student: Would you get back to sleep reasonably early?

Patient: Yes, I would say if I didn’t feel nauseous I could easily go back to sleep.

Student: Ok was it the nausea that was making you wake up?

Patient: No, not always.

Student: No? But you would feel nauseated when you woke up?

Patient: Yea

Student: Ok, were you having problems getting to sleep?

Patient: No, because I’m that tired that I want to go to sleep and I think that well, I feel sick that I would want to go to sleep to get over it.  Try and get over cause if I’m ….

Student: Ah ha

Patient: If I’m asleep then I can’t feel it

Student: Yea, would you have problems when you wake up or to wake up?

Patient: No, that was pretty good, I was pretty good at waking up

Student: Ok, were you feeling that it was a refreshing sleep?

Patient: No

Student: Ok

Patient: I still felt tired

Student: You still felt tired, when you woke up.  So what time do you roughly wake up?

Patient: I wake up every morning a ¼ to 6.

Student: Ok so its 9.30 to ¼ to 6 is your ….

Patient: Yea, 9.30 to ¼ to 6 is my sleep.  Like 9.30 is late I usually go to bed at 8.30.  930 is a late night.

Student: Ok so you. Ok

Patient: I would be sleeping a lot, I would be having my eight hours and still feel tired

Student: Ok, did you be feeling tired throughout the day where you would go and have a cat nap?

Patient: No, yea, yea I would, I’ve done a few at work, lunch time I would go into my car

Student: Ah ha

Patient: Feeling, when I would be feeling sick I would curl up and go to sleep and then I would be drinking a lot of those V drinks (energy drink) thus the weight gain.

Student: Ok

Patient: Cause I would be drinking those energy drinks to keep me awake.

Student: Ah ha, Ok, how many of those would you take a day?

Patient: Two, not every day, but I haven’t had any today but yesterday I had two.

Student: Mm, would it be like a Monday to Friday thing?

Patient: Yea when I’m at work.

Student: Just for that pick me up?

Patient: Yep

Student: Ok, now the nausea you are corresponding to six months ago, a lot of stress with your mum in hospital, what was happening at work, what was happening around you?  Obviously mum being in hospital was very stressful.

Patient: Mm, and um, I can’t remember what was happening, so many things were happening.  That does happen you know what I mean, um, I just know, I don’t know. As I’ve said I’ve tried in the last six months I’ve tried to give up smoking.

Student: Ah ha

Patient: And that makes you depressed because you can’t do it. You know, you do it for three hours and then you have a smoke.  And so that thing that then that depresses me, and I think that there are so many factors that I’m just depressed.

Student: Ok, when you are saying that you are depressed what are you feeling emotionally?

Patient: Um, sometimes I feel like I could just cry.

Student: Mm

Patient: Just at nothing.

Student: Ah ha

Patient: Um, but yea just, emotionally I’m just feeling drained just, that’s the main thing. Just tired, feeling sick.

Student: Ok, some people when they are talking about depression feel like they are in a black hole.

Patient: Yea, I feel like I’m in a hole and can’t get above it.

Student: Mm, ok

Patient: Doesn’t matter what I do, like some positive thing happens then two negative things happen and it sort of, you know, drags you down.

Student: Ah ha

Patient: So I’ve got …….’s mum wanting to living with us, she’s there for six weeks to try it.

Student: And how’s that going?

Patient: Well, she’s only been there a week at the moment, so, ok, she’s a lovely lady but she’s incapacitated, so she’s not the healthiest of woman, so I sort of, this week I’ve sort of come home from work, cooking a meal and putting it on the table for her and taking the plate away, and it’s sort of like, hello, I don’t think I need this in my life you know, but I don’t know how to say that.

Student: Mm

Patient: You know, but I’m not going to, but I will say something but I will wait until the end then I will say to ……., no.  For her to live with us full time in our house we don’t have a separate area, she will be just there.

Student: Mm

Patient: So that’s something else that’s playing on my mind, as well you know.

Student: Mm, there’s a lot of pressure when you have other people live with, come into the family, you know live there 24/7.

Patient: That’s what I just asked ……., how he felt you know with his daughter living with him.

Student: Mm

Patient: You know, and I said be honest, he said it was alright but he didn’t like …., you know.  But you know I did mean.

Student: People react to any situation so.

Patient: It’s not like a holiday.

Student: What I trying to find out how you are reacting to situations that you have got going on now.  One your mum not that well, she was in hospital 6 months ago and recently, she’s home now isn’t she?

Patient: Yea came home last week.

Student: Yep, you know they can’t find out what’s wrong with her, you’re feeling depressed, you’ve got a young babe, what he’s 18 months?

Patient: No he’s three

Student: Where did that three years go.

(Laughter)

Student: You know, you’ve got a three year old, your working, you’ve got your mother-in-law.

Patient: Over-weight

Student: Over-weight, these things impact on your health and what Homoeopathy does is, we try and even out the scales, the more pressure that you have and the more stress, your energy goes down. And we’re trying to even out those scales with more energy for you.

Patient: That would be wonderful if you could even out those scales.

(Laughter)

Student: So, ok you’ve had, the last six months have been pretty stressful with your mum, what’s happened, let me go back to your childhood and we will work through everything up until now ok.

Patient: Yep

Student: So how was your childhood?

Patient: I had an alcoholic father

Student: Ah ha

Patient: Um, I had my Nanna used to live with us.

Student: Ah ha

Patient: Full time, um, my brothers would fight a lot.

Student: Mm

Patient: Punch me up.

Student: On a regular basis?

Patient: Yea, once a week

Student: How did you cope with that?

Patient: ….. was violent, my younger brother was violent, very violent especially when he got to sixteen.  Um, he was, he was bad, he would hit me over the head with a cricket bat, broke my nose.  He was shocking.  I dealt with it, I was put on antidepressants to help calm me down, cause, yea, I was nervous I suppose, yea, around him.

Student: Ok, obviously that would cause people to react differently but when you say nervous what do you mean?

Patient: Um, on edge all the time, you know, just edgy you know, if someone comes, any noise, even now, if some-one is fighting, I’m under the table, I’m hiding.

Student: Ah ha

Patient: I’m not, just don’t want to be there.

Student: Ah ha

Patient: And that’s just stemmed back from ….

Student: Ok

Patient: From then I think

Student: What else was happening, what was your primary school like?

Patient: Primary school was good.

Student: Yea,

Patient: Had um, good friends, I think my live changed when I met a boy in high school, um and I was, a real long story but to cut it short, we split up and he went out with another girl, we were at my mum’s place one night me and my friends, and a girl friend came up and said they were on their way to get you, and they are going to beat the hell out of you, um, she was completely smashed up and these other people came to my parents house and started kicking it in, and yea, from then on it just sort of my life was just, you know, it was just on this roller coaster.

Student: Ah ha

Patient: Cause then ….. went around to their place and with my dad and punched them up and it was, you know, then they broke into my mum’s house and stole her handbag, and it just kept going on for, you know, a year.

Student: Ah ha

Patient: You know, there was just, knives were found out the front of my bedroom window where they had slashed the flyscreen to come and get me, and it was shocking.

Student: Mm

Patient: You know, that was, that was scary I reckon.

Student: Mm, how did you cope through all that?

Patient: Um, my mum sent me to Queensland.

Student: For the whole year?

Patient: No, sent me to Queensland just for the initial bit of it, um, but once again I would be siting in the corner in the foetal position.

Student: Mm

Patient: I think, yea, but my mum is a highly strung person.

Student: Mm

Patient: So, I think that I’m inheriting her highly strung thing.  I wish I didn’t, I don’t want to be worrying about two flies on the wall that might break a wing.  But I seem to worry about, I know cause my partner would be saying to me in the car, you know, I would be saying we are going to be late for work, we are going to be late for work, and we are not going to be late, but I just, and he would be saying, well, Patient you can’t do anything about it, if you’re going to be late, your late for work.  You know but, there’s nothing you can do you know but I will worry about everything.  Other people, some people cannot just worry about it go on with live but I worry about money, you know, just being late for work, or what the boss, is the boss going to be in a good mood today, is he going to be in a bad mood today, is …… going to be settled at crèche, and which school am I going to put him into, just everything you know and I don’t think I’m coping with it.

Student: Ok, when you are saying that you are feeling worried about all these things, what is happening physically?

Patient: I think, that’s when I know that I’m getting really stressed, I know that’s when I’m starting to feel sick.

Student: The nausea and the vomiting?

Patient: Yea it is, it’s that and its, you know, I can feel it coming on, you know, I know when it’s coming on, you know, I know that’s when I’m something, fizz, that’s not even a word, I can’t, 10 to 15 minutes later I’m lying in the back seat of my car at work feeling like I want to vomit.

Student: Mm do you when you feel like I want to vomit do you actually bring anything up?

(Should have but didn’t enquire about if lying down made her feel better)

Patient: No

Student: Do you dry retch?

Patient: No

Student: Nothing?

Patient: No it just sits there, I just really want to but it just doesn’t, it gets to the stage when I think oh no I’m going to get gastro or something, cause, cause you are that sick, but, you know, should I leave work you know cause I’m going to vomit, you know, cause it’s an hour trip home you know, but I never am sick, I just want to, so I don’t know you start to wonder if its in my head, you know, but I am sick, I can tell, people can tell at work, I go from this bubbly you know, happy person to this sort of quiet person and when I and they can see it you know, but I slide down.

Student: When you say it sits here, you are indicating to your chest.

Patient: Yep, I found out recently through a camera that I have a hiatus hernia.

Student: Ah ha,

Patient: Um, but nothing else was found, and that doesn’t, you know, cause anything.

Student: Mm, what’s the feeling that you feel?

Patient: No it’s just feels like the sick, sick is just sitting there and it wants to come but it just doesn’t.

Student: Is it a pressure, is it an ache, is it a sharp pain?

Patient: No, it’s just more like an achy sort of feel.

Student: Ok, now you’ve, going back to your high school years.

Patient: Ah ha

Student: Apart from that year, was there any other really stressful incidences?

Patient: Mm, I got hit by a car but um, that was about it really.

Student: When was that.

Patient: Um, I was probably in about form one, took the girl next door roller skating in ……… and we were crossing the road with the green light and a car came around the corner and hit me.  And I just hit the bonnet, hit the roof and the boot and fell in the gutter and it was pouring with rain. And I hopped up and I could remember him saying do you want me to call an ambulance, and I said my parents can’t afford an ambulance because that they were broke, so I still took ……. to roller skating cause I promised her I would, after being hit by a car, and um, we didn’t stay very long cause as the adrenaline passed the actual pain set in.

Student: So, did you have any actual injuries?

Patient: Um, no I don’t think I did, I think, I think I survived.

Student: Ok, I’m glad about that.

Patient: But yea, I’ve got injuries from ……. throwing a stone at me, from riding the bike with my girlfriend on the handle bars at high school we tried, we were stealing his bike as he kept pulling my bike apart so I stole his bike, had my friend peddling her little heart out down the road and ….. throws a rock, she’s gone flying and I’ve gone flying and my dad came down and I said I’m going to kill him and I must have swore and my dad got me, belted me across the bum, had he said don’t you swear, and my mum said don’t you thinks she’s hurt enough and bleeding everywhere, don’t you think she’s in enough pain.  So I’ve had good brothers.  Been there supporting me all my life.

Student: Ok so they weren’t that supportive during your growing up years, what we, ah was it easy to make friends at school?

Patient: Yea, I had really close friends,

Student: Yea, are you still in contact with them today?

Patient: No, oh, I still ring her up occasionally, you sort of drift apart when, cause she has, um, I think she has four kids now, and they are all primary school age, so she started a lot younger than what I did.  So she had her kids and so I just thought, well I was single so whatever, so I still went out.  But like I still ring her and say hello and that sort of stuff.

Student: Yea, so, what year did you finish school?

Patient: Year 10, I started year 11 but because my girl friend, my best friend had finished year 10 and I thought it wasn’t the same without her so I left.

Student: Ok, then what did you do?

Patient: Um, I think I just started working just jobs um, where, I worked at ….. night shift with her.

Student: Ah ha, and how was that?

Patient: Yea that was good.

Student: Ah ha

Patient: Until I stuck my finger in the embroidery machine, and in where they make the shoes.

Student: Yea

Patient: And they’ve got a big bar and I lent down to clean the needle and I’ve grabbed the machine to start it, it started embroidering in my finger, I’ve had a good life, when I actually write all this down I’m going to be more depressed than when I’ve started.

(Laughter)

Student: Ok

Patient: So that needed surgery, cause the needles was stuck in my finger

Student: Ok, so it actually need surgery?

Patient: Yea, I had to have a plastic surgeon, I’ve still got the scar across there. (Indicating a scar in the inside of the index finger of left hand) as the needle got stuck.

Student: Ok, so

Patient: Your lecturer is going to think that I’m a twit, he will think that that girl needs a lot of medication.

Student: Have you had any other injuries?

Patient: No I think that’s enough, I didn’t, I was only there for a year.

Student: Ok, so after …… what did you do then?

Patient: I think I just worked , I can’t remember, oh you’re going to laugh again .cause, I worked as a receptionist in …….., and my mum had to drive me to work cause I didn’t have my licence.

Student: Yep

Patient: And my mum had a bad accident on the roundabout, and my dad, my mum, mum, had to call my dad, to come and save us, and my dad had to come down and was blaming my mum in front of everyone, and my dad being as supportive as he should be, which went to court and we won by the way.

Student: Ok, but any injury

Patient: So that didn’t last long that job cause I couldn’t get there cause mum didn’t have a car.

Student: Any injuries sustained in that accident?

Patient: No

Student: No? Ok so it was quite a minor one and no-one had to go to hospital.

Patient: No, no we didn’t have to go to hospital .

Student: Ok, after that job what happened?

Patient: I can’t really remember then cause I had a few little jobs, I had a job in ….., job in ……. and um, every time there’s a job right, and I had this boss that um, that came on to me.

Student: Ah ha

Patient: And um, yea, he in the tea room, it was and I was the only receptionist, it was a panel beaters, it was no-one else there, and he came on to me and throws me to the ground and, and my dad went around there and sorted him out.

Student: Ok, you are taking this very well.

Patient: No just that I look, when you look at all this no wonder that I’m depressed.

Student: Ok, so your dad sorted out that assault.

Patient: Yep

Student: Did it get reported to the police or anything?

Patient: No

Student: Did it go any further?

Patient: No

Student: Any injuries sustained?

Patient: No

Student: Ok

Patient: But then, I suppose the next year I was knifed.

Student: Ok, hang on, where about’s is this, was it in that job?

Patient: No, it wasn’t to do with this job, it was a at a milk bar, it was Queen’s birthday long weekend and I went to buy a packet of cigarettes in …… and I had just finished buying them and I was just walking to my car and a bloke asked for my money, and I said … you’re not getting my money and then I looked down and he had stabbed, slashed me four times up my arm so I handed him my 10 dollars that I had and for a thank-you gift for the 10 dollars he stabbed me in the neck and he ran off.

Student: He stabbed you in the neck as well?

Patient: Yep, yea, right, just, it was a millimetre away from the main artery thing or whatever it is.

Student: Mm

Patient: Once I got to hospital they said I was very lucky but no I didn’t go straight to hospital, I went straight home to pick up my boyfriend to go looking for him with a baseball bat.

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Leanne Satherley

Leanne Satherley

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