Ashish J Mathew

10 months ago

Evenings in the hospital have a language of their own. The corridors breathe faintly of antiseptic and exhaustion; and the ward holds its chorus of beeping monitors and murmured prayers. That night, I walked into one such hum of half-light and half-hope, where a 24-year-old newlywed lay on the bed, her wedding bangles still clinking softly against the rail. Her file said: “Seizure — under evaluation.” Her pulse raced at 126, but her blood pressure was steady. The CT was normal. No past illnesses, no family history. Just a young woman two days into marriage, now in a hospital bed, eyes half-open, lost somewhere between sleep and shock. Her mother stood beside her, face pale with worry. “She went to the washroom after lunch,” she said, voice trembling. “We heard a thud… she was on the floor, eyes rolled back… some blood from her mouth. We thought she was gone.” I went over her chart again — no meningism, no focal deficits, no rash, no infection. Yet something gnawed at me. Her pupils were dilated. Her skin was hot, I could feel the heat rising off her. “Did casualty use dilating drops for fundus?” I asked my junior. He shook his head. “No, sir.” That was the moment my mind began to wander — that restless medical curiosity that never sleeps. I went back to my old mnemonic VITAMIN D — Vascular, Infection, Trauma/Toxin, Autoimmune, Metabolic, Inherited, Neoplastic/Nutritional, Developmental/Degenerative. But nothing fit. Then, like a spark from memory, something I had read just a week before surfaced — one of those odd coincidences that make you question your own mind. The Baader–Meinhof phenomenon, also called the frequency illusion — when you learn about something new and suddenly start seeing it everywhere. And what I had read about recently was the “4 D” toxidrome: •Dry as a bone •Dilated pupils — blind as a bat •Delirium — mad as a hatter •Decreased bowel sounds It was atropine poisoning. At first, it felt absurd. My junior frowned. “But how would she get atropine?” “Not directly,” I said. “Maybe through something natural — something she didn’t know was dangerous. Like Datura.” The mother, catching fragments of our conversation, leaned closer. “What are you saying, doctor?” I showed her a picture of the Datura plant — those innocent-looking white trumpet flowers that bloom in the wild, sacred in some rituals, fatal in others. Her eyes widened. “Yes! That grows near our home… She… she didn’t eat it!” A pause. Then came the moment when truth and fear meet halfway. “She saw a video,” the mother whispered. “It said grinding those flowers and leaves makes the skin fairer. She started applying it last week… before her wedding.” And everything fit — the dryness, the dilated pupils, the delirium, the tachycardia, the fever. The 4 D pattern I had just read about had walked out of the page and onto my ward bed. We borrowed physostigmine from anesthesia that night — the antidote that reverses the anticholinergic storm. Slowly, her pulse eased, her pupils shrank, her consciousness returned. The next morning, the bride woke up — bewildered but alive. Before discharge, I told her softly, “Don’t trust every voice that tells you to change what’s already beautiful. Don’t apply or swallow anything just because it’s ‘natural.’ Even nature hides its toxins in petals.” A year later, a newspaper headline caught my eye: “Three women hospitalized in Kannur after applying Datura paste for fairness.” I remembered her face instantly — the fear, the innocence, the irony. Medicine, I realized again, is not just about treatment. It’s about pattern recognition. Sometimes, the pattern is a toxidrome. Sometimes, it’s human behavior. And that night taught me that the true antidote is not always physostigmine — Sometimes, it’s awareness. #Rheumatology #Immunology #Sullysrounds #MedX #Medtwitter #Mnemonics #Medicine #History @DrAkhilX @IhabFathiSulima @Janetbirdope @CelestinoGutirr @aditya_gan3500 @theliverdoc

IlliasulK's tweet photo. Evenings in the hospital have a language of their own.

The corridors breathe faintly of antiseptic and exhaustion; and the ward holds its chorus of beeping monitors and murmured prayers.

That night, I walked into one such hum of half-light and half-hope, where a 24-year-old newlywed lay on the bed, her wedding bangles still clinking softly against the rail.

Her file said: “Seizure — under evaluation.”

Her pulse raced at 126, but her blood pressure was steady. The CT was normal. No past illnesses, no family history. Just a young woman two days into marriage, now in a hospital bed, eyes half-open, lost somewhere between sleep and shock.

Her mother stood beside her, face pale with worry. “She went to the washroom after lunch,” she said, voice trembling. “We heard a thud… she was on the floor, eyes rolled back… some blood from her mouth. We thought she was gone.”

I went over her chart again — no meningism, no focal deficits, no rash, no infection. Yet something gnawed at me.

Her pupils were dilated. Her skin was hot, I could feel the heat rising off her.

“Did casualty use dilating drops for fundus?” I asked my junior.
He shook his head. “No, sir.”

That was the moment my mind began to wander — that restless medical curiosity that never sleeps.

I went back to my old mnemonic VITAMIN D — Vascular, Infection, Trauma/Toxin, Autoimmune, Metabolic, Inherited, Neoplastic/Nutritional, Developmental/Degenerative.
But nothing fit.

Then, like a spark from memory, something I had read just a week before surfaced — one of those odd coincidences that make you question your own mind. The Baader–Meinhof phenomenon, also called the frequency illusion — when you learn about something new and suddenly start seeing it everywhere.

And what I had read about recently was the “4 D” toxidrome:
•Dry as a bone
•Dilated pupils — blind as a bat
•Delirium — mad as a hatter
•Decreased bowel sounds

It was atropine poisoning.

At first, it felt absurd. My junior frowned. “But how would she get atropine?”
“Not directly,” I said. “Maybe through something natural — something she didn’t know was dangerous. Like Datura.”

The mother, catching fragments of our conversation, leaned closer.
“What are you saying, doctor?”

I showed her a picture of the Datura plant — those innocent-looking white trumpet flowers that bloom in the wild, sacred in some rituals, fatal in others.
Her eyes widened. “Yes! That grows near our home… She… she didn’t eat it!”

A pause. Then came the moment when truth and fear meet halfway.

“She saw a video,” the mother whispered. “It said grinding those flowers and leaves makes the skin fairer. She started applying it last week… before her wedding.”

And everything fit — the dryness, the dilated pupils, the delirium, the tachycardia, the fever. The 4 D pattern I had just read about had walked out of the page and onto my ward bed.

We borrowed physostigmine from anesthesia that night — the antidote that reverses the anticholinergic storm. Slowly, her pulse eased, her pupils shrank, her consciousness returned. The next morning, the bride woke up — bewildered but alive.

Before discharge, I told her softly,
“Don’t trust every voice that tells you to change what’s already beautiful. Don’t apply or swallow anything just because it’s ‘natural.’ Even nature hides its toxins in petals.”

A year later, a newspaper headline caught my eye:
“Three women hospitalized in Kannur after applying Datura paste for fairness.”

I remembered her face instantly — the fear, the innocence, the irony.

Medicine, I realized again, is not just about treatment. It’s about pattern recognition. Sometimes, the pattern is a toxidrome. Sometimes, it’s human behavior.

And that night taught me that the true antidote is not always physostigmine —
Sometimes, it’s awareness.

#Rheumatology #Immunology
#Sullysrounds #MedX #Medtwitter #Mnemonics #Medicine #History
@DrAkhilX @IhabFathiSulima @Janetbirdope @CelestinoGutirr @aditya_gan3500 @theliverdoc

17K

Prof Ajesh Maharaj @ajesh01

10 months ago

@IlliasulK Congratulations, Illias. So proud of you🫡 Your passion for hard work, tenacity and eagerness to keep learning are exemplary qualities that will always be appreciated by colleagues and patients alike.

Ashish_Matt retweeted

over 1 year ago

Imaging in the diagnosis and management of peripheral psoriatic arthri... https://t.co/n2funl7dc4

257

Who to follow

Rheumatologist based at Thrissur,Kerala state India

DrMG

@giannini85

MD, PhD, Rheumatologist, Physiologist, University of Strasbourg, researcher in Myositis and Sarcopenia

about 2 years ago

Reporting Sacroiliac Joint Imaging Performed for Known or Suspected Axial Spondyloarthritis: Assessment of SpondyloArthritis International Society Recommendations | Radiology https://t.co/bzM739uM1k

215

about 2 years ago

Reporting Sacroiliac Joint Imaging Performed for Known or Suspected Axial Spondyloarthritis: Assessment of SpondyloArthritis International Society Recommendations | Radiology https://t.co/bzM739vjQS

181

Ashish_Matt retweeted

Lihi Eder @lihi_eder

over 2 years ago

Very interesting, congratulations👏👏

567

Ashish_Matt retweeted

GRAPPA Network - Official @GrappaO

over 2 years ago

🧠Mnemonics in rheumatology 🎯 Location of auto-antigens in inflammatory myositis #sullysrounds #rheumatology #MedTwitter #Mnemonics

IlliasulK's tweet photo. 🧠Mnemonics in rheumatology

🎯 Location of auto-antigens in inflammatory myositis
#sullysrounds
#rheumatology
#MedTwitter
#Mnemonics https://t.co/uZ0bDUbOQ5

Ashish_Matt retweeted

almost 3 years ago

Several GRAPPA members are involved at IRACON 2023 this week. 🎉

934

Ashish_Matt retweeted

Manouk de Hooge @MdH42715285

almost 3 years ago

Very happy with the publication of these BEPAS data 😀 @TissueHomandDis @KurtdeVlam

600

Ashish_Matt retweeted

almost 3 years ago

Mimickers of plaque psoriasis Great talk @amitgarg2009 @Iracon2023 @GrappaO

624

almost 3 years ago

@IlliasulK @Iracon2023 Well done Illias!!!

Ashish_Matt retweeted

Ruby Taparia @ruby_taparia

almost 3 years ago

Anticipation builds for tomorrow's grappa workshop! 🦴🤌 Join us for an immersive exploration into the world of psoriasis. 📅 Date: 23/11/2023 ⏰ Time: 4-8 pm 🌟 Objectives: - Updates on psoriatic disease. - Hands-on training for the assessment of psoriatic disease.

IlliasulK's tweet photo. Anticipation builds for tomorrow's grappa workshop! 🦴🤌 Join us for an immersive exploration into the world of psoriasis.

📅 Date: 23/11/2023
⏰ Time: 4-8 pm

🌟 Objectives:
- Updates on psoriatic disease.
- Hands-on training for the assessment of psoriatic disease. https://t.co/h63GUgpAKK

738

Ashish_Matt retweeted

almost 3 years ago

Get beneath the surface at our MRI workship at #IRACON23. Gain invaluable insights and discuss with experts in the field. This practical session provides need-to-know MRI physics, protocols, and image interpretation! 🧲👀 Let's explore the unseen! 🦴🔍 🔗https://t.co/CpIxgMUNNZ

ruby_taparia's tweet photo. Get beneath the surface at our MRI workship at #IRACON23. Gain invaluable insights and discuss with experts in the field. This practical session provides need-to-know MRI physics, protocols, and image interpretation! 🧲👀
Let's explore the unseen! 🦴🔍
🔗https://t.co/CpIxgMUNNZ https://t.co/sS6Se3n0Vv

757

Ashish_Matt retweeted

almost 3 years ago

Don’t miss the GRAPPA workshop at #IRACON2023, where we’ll be learning from the best about psoriasis and psoriatic arthritis. It’s a unique opportunity to gain insights from legends in the field. #IRACON2023 #LearnAndGrow

IlliasulK's tweet photo. Don’t miss the GRAPPA workshop at #IRACON2023, where we’ll be learning from the best about psoriasis and psoriatic arthritis. It’s a unique opportunity to gain insights from legends in the field.
#IRACON2023 #LearnAndGrow https://t.co/rPFOqaQctd

698

Ashish_Matt retweeted