Station 17 · Seizure

Persona and manner

• Pleasant, evasive, keys in hand; tenses when driving is raised; anger flares once, then honesty.
• He has decided it was a one-off caused by heat and beer, and has been driving for work for two weeks.

Opening line — say this verbatim

• "Thanks for seeing me — I'm fine now, the hospital said the scan was clear. I just wanted to check there's nothing else I need to do before the clinic."

Volunteer freely if given the space

• 'One-off'; 'probably the heat and I'd had a few beers the night before'; back at work 'the next week'.

Only if asked

• No further seizures. Earlier events: 'a couple of moments where I lose a few seconds — everyone does that' — blank spells over the past year, once while stationary in the van; no myoclonic jerks he has noticed; sleep poor; alcohol 15–20 units; no drugs; no head injury; no family history.
• He is driving — 'I've got to, it's my job'. The hospital 'mentioned the DVLA but I didn't think it applied to a one-off'. He has not told the DVLA or his employer.
• Two months' savings; mortgage; wife works part-time; grown-up children; 'I've driven all my life'; his manager 'would let me go'.
• If asked about safety at work beyond driving: loads at height sometimes.

Ideas, concerns and expectations

• Idea: 'a one-off from beer and heat'.
• Concern: losing the job; 'being labelled epileptic'.
• Expectation: reassurance and no restrictions.

Cues to deliver, timed

• Minute 1: keys; 'I'm fine now'.
• Minute 3: 'I didn't think it applied.'
• Minute 5: 'my manager would let me go.'

How to respond to the doctor's plan

• If the doctor elicits the picture including the blank spells, explains clearly and kindly that after a first seizure he must not drive and must notify the DVLA (six months off with normal investigations and no recurrence for a car or a van up to 3.5 tonnes; longer if higher risk), explains the doctor's own duty if he continues to drive as a fact not a threat, explores the financial reality and offers practical help (fit note / 'may be fit' for non-driving duties, an employer letter with consent, benefits and Access to Work signposting), addresses alcohol, offers to write to the clinic about the blank spells, checks understanding and agreement, documents the advice, and follows up in two weeks: he is angry — 'you're joking' — then quiet — 'and if I keep driving?' — and when answered honestly: 'OK. Can you write something for work?'
• If the doctor says 'it's your decision' or accepts 'one-off': relief — and he leaves; the examiner will not.
• If the doctor threatens without support ('I'll have to report you'): 'do what you like' — and disengages unless the doctor recovers.

Examination findings if requested

• BP 144/88; neurological examination normal; no tongue injury now; looks well.

Background you can draw on if asked

• The seizure: his wife found him on the kitchen floor, shaking, bitten tongue, incontinent; confused for twenty minutes. He remembers nothing.
• The blank spells: his wife has said 'you went off again' three or four times this year; a colleague once had to repeat a delivery address twice.
• Alcohol: a few pints most evenings, more at weekends; 'never at work'.
• Work: fifteen years with the same courier firm; a company van; a 'points system' for lateness; he believes the manager 'has it in for the older drivers'.

Do not

• Volunteer the blank spells or that he is driving unless asked directly.
• Agree to stop driving without honesty about both the law and the consequences; agree once both are given with practical help.