When the patient comes back

Abstract

It had already been more than 6 years since I left clinical medicine to become a “paper doctor”, working in health economics and business consultancy. Early that morning, I was out on the first few hundred metres of a long run, in a quiet area of Berlin. I saw a man in a track suit stumbling towards me. He suddenly stopped, tried to gain control by holding onto a lamp post, and gradually sank down to the ground. I approached him, and addressed him. He must have been around his early forties, lean and well built. I suspected that he was suffering from either alcohol consumption, a psychiatric disease, or an acute vascular event. It was early in the morning and I could not smell anything, so alcohol did not seem too likely but then again it was Berlin, where many things happen. He did not look at all unhealthy, but nothing could be ruled out. Having worked for some time in psychiatry I was a bit inclined towards a psychiatric disorder, but there was nothing in the man's behaviour pointing towards it. He did not answer my greeting but made a gesture indicating that everything was fine and I should go on my way. Again, I addressed him, asking whether he needed some help. By that time, he had almost got himself standing again, gesturing once more that he was fine and there was no need for help. I continued with my run but could not stop thinking about him. I finally decided that he must have been on a drinking spree the previous night and he probably felt embarrassed because of his inability to walk home.