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Korsakoff's syndrome

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Martin and I continued our shift and were next called to a residential home for people with mental health problems. We were there to see a lady of about fifty years that I shall call Jean, who was complaining of stomach pains. We were soon to discover that assessing Jean wasn’t going to be easy; as Jean had Korsakoff ’s syndrome.

Korsakoff ’s syndrome or psychosis as it is also known, is a problem characterised by short term memory loss, usually following a long history of alcohol abuse, which can damage the thalamus in the brain though a deficiency of the B complex vitamins. This can happen either because of poor dietary intake or damage to the stomach lining by alcohol which can affect absorption of these vitamins and lead to a deficiency. Where the memory is lacking, a person with Korsakoff’s may confabulate to conceal the loss of memory and the subsequent confusion this causes.

When we arrived we entered the room where Jean and two staff members sat waiting for us, and I introduced myself and Martin to Jean. Jean was unkempt and looked tired and worn down by life; she was clutching her stomach.

“Oh yes – I’ve been expecting you” she sneered at me “I’ve received the photo of you, with your blonde hair and too much make-up. I recognised you straight away.”

“Will you let me take a look at you then Jean? – You seem very uncomfortable, are you in pain? Perhaps you will let us help you.”

“Don’t you touch me – I know that you have been sent to kill me” she snarled, leaning away from me. At this point, realising that the chances of Jean allowing me to examine her were slim, I decided that I would be content to settle for simply giving her a lift to hospital where someone else would be picking up the challenge.

“No Jean, I am a paramedic and my colleague here is a doctor; we are here to help you, let us pop you down to hospital.”

“YOU are a trained killer, you want to assassinate me, and you want to take me away from here, kill me and dump my body.”

“Now what kind of paramedic would I be if I did that?” I attempted to reason; but Jean was having none of it.

“I’m going nowhere with YOU” she answered resolutely.

“I have the uniform, headed documents and an ambulance service car is parked right outside, and look – I even have a badge with my name on; surely that is enough to convince you that I am a real paramedic Jean?”

“You can get all that stuff on eBay” came her reply – point to Jean on that front! (I won’t link to it but a quick ebay search turns up all sorts of ambulance related articles).

Thankfully, I eventually convinced Jean of the fact that I was a mother with children and therefore must surely be of sound character. As a mother herself, this seemed to strike a cord, so she very tentatively agreed to step outside and at least take a look at the car. Once we had gained momentum she continued to climb in the car and came to hospital without any further argument. All the way to hospital I got the suspicious eye from Jean in my rear view mirror and despite my attempts at a reassuring smile, I never received one in return.

In the majority of those affected with Korsakoff’s the effects of the illness can be partially reversed if they abstain from alcohol and take vitamin B complex; but sadly about a quarter of them will make no recovery. This was certainly a challenging call and highlighted how paramedic practice is not always about the actual practical skills you learn, but also about the strength of your communication skills, empathy and trust.

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