Old Kath’s rocking chair
This is a patient story from my experience when I first came to Mackay in 1983. I set up a private practice and offered to help at the slightly primitive psychiatric unit at the local public hospital. In those days it was quite small and the psychiatric unit was an old wooden building tucked away at the edge of the hospital compound, overlooking the Pioneer River. Quite a pleasant situation from which to watch the crocodiles.
On the veranda I met a lady, she was then in her late 60s, agitatedly rocking back and forth in a rocking chair, and from time to time muttering about the awful and wicked things that she had done. I only went to the public hospital for a couple of sessions a week, so it was a while before I reviewed her. I do not claim to be able to remember the details, but in essence she had a long history of depression, starting post-nataly, and had spent a great part of the previous five years in hospital (something like 40 weeks of each year) and had been sent numerous times on the thousand-kilometre trip to Brisbane, the capital city of Queensland, to have ECT in the hospital there. Over this period, she had had a very large number of ECTs, around 100.
She had chronic delusional depression. Nobody gets a prize for guessing I put on Parnate straight away.
She responded very well.
She left hospital quite soon after and I remember when I reviewed her total time in hospital some five years later, she had only had to be admitted on two occasions for a couple of weeks or so for adjustment of her Parnate, or whatever, I cannot remember exactly. Needless to say, she never required any more ECT.
For outpatient follow-up she came with her daughter, who herself was getting close to being a pensioner. I maintained her on a minimum of 80 mg Parnate, which had to be increased from time to time. I do not recall her ever being more than 120 mg.
In those days our dogs were always in the private office, entertaining and calming the patients. I also established a private psychiatric inpatient unit at a small local private hospital – but Kath did not have private insurance, so was not eligible for admission there. Patients could be admitted to my unit with their dogs.
I have written a little about our first generation of dogs, ‘Tess’ and ‘Jess’ in another post, so if you wish to search the website for “Tess” you will find that. She was an extraordinary dog and her various talents attracted a number of nick-names – one of these was ‘Nurse Tess’, because she seemed so solicitous of people’s welfare.
Apart from the chairs by my desk, there was also a couch (which I could sleep on if I got called in during the night). When Tess wanted a rest from her duties attending to the patients in the waiting room, or if she got too hot snoozing in the tropical sun outside the office, she would come to lie on my couch, from where she supervised the proceedings.
The routine with Kath was well-established, with her having her blood pressure measured regularly on every visit, siting and standing (as described in the PDF you can download from the MAOI section). Needless to say, her blood pressure tended to drop quite a lot (like down to 80 mmHg systolic sometimes), and we had well-established routine precautions for preventing this causing her harm (in all this time she never fell and injured herself). Tess was on the couch next Kath’s daughter, who was gently rubbing her ear for her. On this occasion Kath over anticipated the blood pressure measurement and went to stand up before anyone had positioned themselves next to her, in case of a fall. She fainted. Tess looked up from the couch, got down and went over to inspect Kath’s face carefully, paused, gave her a little lick on the cheek, and then climbed back onto the couch. We laughed, ‘Tess thinks she is OK’.
Her visits became less frequent and eventually we heard she was in an old folk’s home. My services were not requested by the GP in charge of the home, and, as happens, we sort of forgot about her.
One day her daughter visited to the office to let us know that they had buried her a few days previously (she lived into her 80s). She had come in to say thank you and to bring me up-to-date with the news that her mood had continued to be very satisfactory right up to the end. She wanted to thank us for making the last 15 years of her life so satisfactory.
One of the advantages of practising in a small town, much of the time I was more or less the only psychiatrist in town, is that with a little effort you can almost always find out what happened to people even if you have not seen them for years.
If there are worries about treating older patients like this with large doses of Parnate, please remember Kath’s story.
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