Marie, just turned 40, has been admitted onto the day case surgical ward. She has a history of anxiety and depression for which you are currently supplying fluoxetine as the hospital pharmacist. Today Marie is awaiting elective surgery to explore and possibly repair a suspected torn medial meniscus (knee fibrocartilage tissue). By coincidence you saw her being dropped off by her husband. You noticed she was having difficulty getting out from the car.
It’s a very cold icy morning. There's been a surge of people coming into the Accident and Emergency (A&E) department with various injuries caused by slipping on ice.
Due to unforeseen circumstances in the theatre department, Marie has had a long wait. She has become frustrated at what she perceives to be a lack of progress, and poor communication about how much more she will need to wait. She is no longer even sure she will be taken for her operation today.
After waiting for over 4 hours, Marie gets up from her chair and limps purposefully down the corridor, waving her arms in frustration, shouting angrily that she is 'sick of waiting' and is ‘going outside for a cigarette.'
The hospital Trust operates a no smoking policy in both the buildings and outside areas. The hospital has very large grounds. To leave them entirely would require at least a 15-minute, painful walk for Marie, who is already unsteady on her feet.
Note: This issue was originally created by Vanessa Peutherer.