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Mr B. was admitted to the coronary care unit with advanced cardiomyopathy possibly due to alcoholism but with a history of treatment for schizophrenia. Carrying a psychiatric consultation slip marked "As soon as possible," I went expecting to encounter the usual case: a patient who was restless and confused with a debilitating disease that contributed to a low level of manageability.
I saw a man who looked younger than his 40 years. His chest bare, he was soundly asleep, head back, arms strapped to the bed.
"Why the restraints?" I ventured.
The nurse replied, "When he is awake he's wild; the only thing that calms him down is intravenous morphine." "Why intravenous?"
"He has prolonged prothrombin times and hematomas develop if we give it IM."
The problem was no longer simple. Was this alcohol, medication, or drug withdrawal; an acute psychotic break; hepatic encephalopathy; or delirium due to one of
Alverno L. Whose Schizophrenia Is It, Anyway?. JAMA. 1984;251(19):2512. doi:10.1001/jama.1984.03340430018008