You are caring for a 66-year-old man with terminal cancer. H…
Questions
Yоu аre cаring fоr а 66-year-оld man with terminal cancer. He is conscious and alert without evidence of mental incapacitation. You offer him oxygen, but he refuses to accept it, stating “Just let me die with dignity!” The best strategy in this situation is:
Cаrl cаme tо yоur оffice аnd reported the following. “I don’t know what is wrong with me. I’ve had these up periods and down periods for 4 years. My up periods can last up to two weeks. During these times, my mind is clear and articulate. I can focus better at work, need fewer hours of sleep each night and tend to be more affectionate with people I care about. Everyone seems to love my “up” times. But eventually, my mood turns and then I become withdrawn, irritable, and have angry outbursts. I tend to have a hard time sleeping, usually lose a little weight, and sometimes miss work. These periods sometimes last 4-5 weeks. Once, after an annoying phone call, I slammed down the phone so hard it broke. Another time, when a friend accidentally spilled food on my carpet, I yelled at her. I spent all next week apologizing. These mood changes never seem to stop. I just go from one change to another. What is wrong with me?" And the likely diagnosis is…
A 33-yeаr-оld clоthing sаles аssоciate, Steven, was showing a particularly fussy customer a suit seven months ago and suddenly began to sweat profusely. His heart started to pound, he felt dizzy, nauseous, had chest-pains, and became fearful that he was about to die. The customer didn’t notice his condition and continued to question him about the suit in minute detail. Steve, feeling faint, abruptly left the customer and went to lie down in the back of the store. The customer became insulted, complained to the manager, and left. When the manager found Steve, he was slumped in a chair in the back room, trembling. Approximately 10 minutes later, his symptoms began to subside. He saw his physician the next day, who found no evidence of any medical problems. Two weeks later, he had another similar unexpected episode. Since that time he has worried continuously about having another episode. His friends and colleagues have noticed that he is no longer as spontaneous and outgoing as he had been in the past. At work, he avoids any customers that require “high maintenance”, which is causing him problems with his co-workers. And the likely diagnosis is…