Emergency visit after adverse reactions to Tegretol

Emma’s emergency visit after adverse reactions to Tegretol turns a psychiatric medication problem into a difficult passage through ordinary hospital care. Rajid Panjani worries about the development of her symptoms, and Emma is sent from the PAAZ to Spoedeisende Hulp. Weak and struggling to remain upright, she makes the journey without an escort, waits for hours, and then faces an emergency physician who questions a possible pulmonary-embolism diagnosis because it came from a psychiatrist. The assessment ends with a practical recommendation: stop the pills. The episode’s significance lies not in a dramatic medical resolution, but in the mismatch between Emma’s bodily distress, the uncertainty surrounding its cause, and the institutional assumptions that shape how she is treated.

Symptoms and the decision to seek emergency care

Rajid Panjani is concerned about how Emma’s symptoms are developing, particularly because during her previous admission she had a severe reaction to new medication. He has consulted Doctor Valk, who shares his concern. The consultation places the present episode against a difficult treatment history: another medication problem has emerged, and the prospect of repeating a familiar cycle hangs over the discussion. Emma is acutely aware that Doctor Valk had once been a source of steadfast support, and she feels ashamed that he must now know she has been admitted again. Her distress is therefore not only physical; it is entangled with the feeling that she has failed to provide him with the recovery he deserved.

By the time the physical examination is over, Emma describes herself as having almost no strength left. She leans against the door to the closed ward, too exhausted even to press the call button for a nurse. Iefke and Linda see her and ask what has happened. Emma tells them it is a side effect and that she needs to go to the hospital for a check-up. Although they remain worried, she assures them she has already called and says they need not wait. Her insistence on being left alone sits uneasily beside her evident weakness: she manages the practical arrangements by reassuring other people, even as she is barely able to continue.

Bas opens the door after Rajid has already called ahead to say that he examined Emma and that she needs to be checked at the hospital. Bas is willing to take her, but the ward is unsettled: someone has been placed in seclusion, and he asks whether they can leave in about an hour. Before he closes the door, Emma reminds him that the food trolley has arrived. She takes satisfaction in having ensured that the ward will receive its dinner on time, even while she is seriously unwell. The small act of attending to everyone else’s routine becomes a pointed contrast with her own increasingly difficult journey.

The journey and the emergency assessment

Emma sets out for Spoedeisende Hulp on her own. The stairs are not the greatest obstacle. After them comes a laborious passage along walls, handrails, and doorframes, each offering something to hold on to as she feels gravity pulling her down. By the time she reaches the waiting area, she is soaked with sweat. Hospital staff wonder how a psychiatric patient has arrived without a referral letter or an accompanying person. The waiting room is busy; people come and go while Emma waits for two hours, watching and listening in a haze as exhaustion drains what little energy remains. She describes herself as reduced to the function of a person waiting, and even wishes the suspended, empty interval would not end.

During the examination, Emma is asked about allergies. She mentions that she once had serotonin syndrome while at the PAAZ, but initially minimizes it: she did not fall into a coma. The previous reaction nevertheless involved a racing heart caused by antidepressants, treatment with beta blockers, and a year of follow-up with a cardiologist before the problem passed. The emergency clinician is surprised that she did not disclose this sooner and treats it as a serious sensitivity. Emma’s account reveals how she can downplay an experience with substantial medical consequences, measuring its seriousness against the most extreme outcome rather than against the prolonged treatment it required.

The physician then reviews the diagnosis of pulmonary embolism and questions that a psychiatrist made it. Emma chooses not to argue; she sees herself as the bearer of bad news rather than the person qualified to explain it. Asked what she thinks caused the problem, she connects the symptoms to the medication because they began when she started taking the pills. The physician sees no reason to keep her in the emergency department and recommends stopping them. The advice is clear, but it does not make the larger treatment dilemma disappear: stopping this medication means beginning another, and Emma anticipates that the next change will come the following week.

A wider context of unstable certainty

The emergency visit occurs within a broader account of Emma’s rapidly shifting inner states. When asked how she feels, she struggles to explain the transformation from depression into a condition she experiences as sudden, almost overwhelming clarity. She reaches for images of the world becoming visible after a mist lifts, but recognizes how difficult that experience is to communicate to a psychiatrist. Elsewhere, she describes depression as taking away her energy until she is reduced to fragments of herself, with a remembered pull toward the depth beyond a balcony. Those descriptions make the medication episode part of an ongoing struggle with changes that are at once psychological, bodily, and difficult to translate into clinical language.

Emma also distinguishes between hallucinations and delusions, and between knowing that an idea is not logically true and feeling that it is profoundly true. She recounts a suicidal conviction that had felt less like a plan than an inevitable beginning, accompanied by a sense of calm and universal oneness. In another account, she explains that believing she could fly did not feel like a strange thought arriving from outside; it felt like discovering that the world was finally normal. These experiences help clarify why clinical assessment is difficult in the book: Emma can describe a conviction’s force and its effects, while also recognizing that the certainty itself may be part of the illness. The emergency physician’s practical instruction about the pills addresses an immediate possible cause of physical symptoms, but does not settle the larger questions of diagnosis or treatment.

Consequences and narrative significance

The visit resolves the immediate decision about the suspected medication reaction without offering Emma a simple route back to health. Her expectation that stopping one medicine will mean starting another makes the instruction feel less like an ending than a turn in an ongoing sequence. The following week was supposed to mark her return to work; instead, the change in medication means remaining on the ward through a weekend away from Sergei. His reassurance that there will be another weekend does not comfort her, because she hopes not to have another weekend as a PAAZ patient.

The episode also makes the costs of care visible in small, concrete arrangements. Emma has to remind the ward about dinner, travel alone despite her weakness, and wait without a referral letter or companion while staff determine how to handle her. At the emergency department, her psychiatric status frames the questions asked about her diagnosis, even though her immediate complaint is physical. The result is neither a declaration that the symptoms were imagined nor a definitive account of their cause: the physician acknowledges the timing of the pills and advises stopping them. That restrained outcome fits the event’s larger tension. Emma wants her experience to be taken seriously, yet she often minimizes it herself; clinicians act on incomplete information, while she must carry the consequences of treatment changes into a life already shaped by recurrent illness.