“I had a triple whammy: my illness and the two serious antibiotic complications of low white cell count and severe acute hepatitis”

In this memoir Dr Patrick Mbaya, a consultant psychiatrist, gives a personal account of his diagnosis, treatment and recovery from a brain abscess and its complications including depression.  What makes the book especially valuable is that it is written from the perspective of both a patient and a psychiatrist.  It is divided into short chapters, each 1 to 3 pages in length.  Dr Mbaya frankly describes the impact of his illness on himself and his family.  Medical concepts are explained using language and a style that is easy for a layperson to follow. For example, he explains how the position of his brain abscess led to the particular neurological symptoms he experienced, that depression has been linked to reduced levels of noradrenaline and serotonin in the brain and how some drugs, in his case antibiotics, can occasionally cause liver damage and a low white blood cell count.

The story takes place in 2010 when Dr Mbaya was 55 years old and working as an NHS consultant psychiatrist.  Until then he had never suffered from any significant illness and as he explains ‘life revolved around home and work’. He woke one morning to find he had a mild right-sided facial weakness.  He and his GP assumed this was Bell’s palsy and not particularly serious.  An Ear, Nose and Throat (ENT) specialist he was referred to was of the same opinion.  He continued to work but his condition quickly deteriorated with speech impairment, right sided weakness, unsteadiness and emotional lability appearing.  This culminated in an emergency admission to a local hospital where he briefly became confused and paranoid. By then he had lost the ability to speak and so he sent a text to his GP asking for his help in arranging his discharge.  His GP immediately texted back, explaining that he needed to remain in hospital and would get better.

Some aspects of his early care were not ideal.  A hospital cleaner avoided him when it was queried that his illness could be HIV related; a subsequent blood test excluded HIV. A doctor questioned him insensitively about whether he had used intravenous drugs, a nurse dismissed his concerns about medication side effects and a speech therapist seemed to see him primarily as an ‘unusual and very interesting’ case to teach her juniors.  Dr Mbaya reflects that some of these memories could be coloured by his confusion at the time.  Nevertheless, his account highlights the importance of health care professionals being empathic and treating patients with respect.

After three days in hospital, a brain abscess was diagnosed and he was urgently transferred to a regional neurosurgery unit where he was an inpatient for four weeks.  In his book, Dr Mbaya explains that a brain abscess (also termed a cerebral abscess) is a collection of infected material within the brain.  It can arise as a complication of a nearby or a distant infection in the body, for example an ear infection or a chest infection respectively.  It can also be a complication of a skull fracture but in about 10% of cases, as with himself, the source of the infection is never identified. Even with modern treatment about one out of ten people with a brain abscess die and some of those who survive are left with a disability. The day after his transfer, he underwent an operation to reduce raised intracranial pressure, drain the abscess and identify the bacteria involved.  For the first two weeks after surgery he could hardly speak, could not write and needed to communicate by texting with his non-dominant hand. His recovery after surgery was not straightforward.  He developed a low white blood cell count and hepatitis (inflammation of the liver), side effects from two different intravenous antibiotics that he received.

Immediately prior to his operation, Dr Mbaya realised that he was suffering from depression.  He experienced low mood, tearfulness, low self-confidence and negative thinking, even worrying at one point that through his illness he had disgraced his family.  These symptoms were worse in the mornings.  His mental state improved significantly following surgery but his mood remained low. He considered antidepressant treatment but instead opted to manage his depression through distraction, including listening to music and visiting a hospital garden, trying to think positively and where possible gain a sense of control over his situation.

He quickly became accustomed to the routine on the neurosurgical ward with its regular times for blood tests, administration of medicines and meals.  He is complementary of the staff and care he received there, commenting ‘the ward felt like a community in a supportive and caring environment where everyone did their bit’.  He was apprehensive when he was discharged home.

Following discharge, he gradually recovered despite setbacks and frustrations.  His speech and energy levels slowly improved.  He kept a daily record of events after his operation.  He found writing therapeutic as it gave him a purposeful activity and helped him to channel his emotions.  Later he referred to these notes when writing his book.  After five months, he returned to work on a graded basis but looking back reflects that this was probably too soon.  Driving regulations require that anyone who has had a brain abscess must inform the Driving and Vehicle Licensing Agency (DVLA) of their condition and not drive for a minimum of 12 months.  Regaining his driving license was an important milestone as it gave him greater independence.  He concludes that he was very fortunate to eventually make a full recovery. A strong theme is how the support of others, primarily his wife and two grown up children, helped him. It is also clear that despite his condition being potentially life threatening, he maintained a positive outlook and a determination to recover throughout.

This is an excellent book that will be of value to anyone who wants to gain a better understanding of what it is like to experience a brain disorder such as an abscess, stroke or encephalitis.  The author’s description of his emotional and physical symptoms shows how the boundary between neurological and psychiatric illness is often blurred.  His positive outlook through adversity, and his recovery, make it an inspiring account that should give hope to patients and families dealing with similar illnesses.  I also recommend this book to health care professionals so that they can better appreciate illness and health care from a patient perspective.  Dr Mbaya is a long-term friend and colleague of mine.  As such it has been a particular pleasure to review this book.