Tuesday, June 26, 2012

Anorexia Nervosa: Hobson's Choice!

©2012 Am Ang Zhang

 am sure we all have been asked the great “what if…..” question. I was fortunate enough in my practice to have had some “lucky” breaks.
         Given my interest in the very young, now and again we had some strange cases that tested our ingenuity to the limit.  No amount of SSRI (Selective serotonin reuptake inhibitors) would be able to help.  Often it was a clear battle of wills, a battle between the consultant and someone barely one sixth his age.
         That this particular child had already beaten two adults with a combined age well over ten times hers should have been a clear warning to me on what I was to take on.
         The contestant was a little girl nearing five years of age who had developed an addiction to Huggies. Yes, Huggies.
         It could well be the success of advertising or it could be the future of the human race, I joked to the nursing staff as the desperate parents agreed that the girl should be admitted to the children’s ward for “nappy withdrawal”.
         The problem was simply this. She needed to put on a disposable nappy in order to pass urine, or do No. 1, as she put it.  At her age, she required the biggest size available.  The cost had been piling up.  As it seemed so trivial, the parents never sought help until now when school days were imminent. It would not be possible to contemplate her going to school with nappies.
         With our enlightened staff, admission to the paediatric ward was no longer the traumatic experience it used to be.  This little girl soon settled in and was promoted to be the No. 1 helper around the ward.
         However, whenever she needed to, she helped herself to a nappy, and after performing, took it off and put it in the appropriate bin. She worked that one out in no time at all.
         One nil.
         I needed to come up with a battle plan quickly.  The ward was fast running out of the giant nappies and I had no intention to make a special requisition.
         “That is it. I HAVE AN IDEA.”
         I found a large clean plastic bag and put all the nappies in it.  There were three.  I gave it to my opponent and said, “These are the last three and, when you have finished, there will be no more.
         Unperturbed she snatched the bag from me as if to say, “Not a problem, doc.”
         I went on with the rest of the morning round and went to the clinic.
         After the day’s main clinics, I decided to have a peep.
         “She used two of the nappies and is now down to the last. She carries it around with her. It is becoming quite a sight.”  Sister told me.
         Everybody knew I was not going to win this one, but were prepared to see it to the end.
         By now she was quite urgent and you could see she was struggling a bit. Her last performance was over three hours ago.
         She looked at her nappy, thought about it, and then something curious happened.
         She went to her favourite nurse and took her by the hand, “Will you take me?”
         She sat on the toilet and passed urine, still holding on to the nappy. There was a sudden cheer from all the mothers. My head was visibly doubling in size.
         “Well done!”
          Shortly after, Sister took me to the side and asked, “What if she did use the last nappy? What would you have done?”
         “Sometimes there just is no what if. You have to do certain thing as if it were the only way.”
         Her family went on their planned camping holiday in the South of France and from there they sent a post card.
         “Yes! It is still working. We have truly cracked it or you have. Thanks a million. We are all having a lovely time.”
         In early 2007, a female astronaut wore a nappy in order to drive non stop to threaten another woman, a rival in love.
         No, she was not my patient.

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