Wednesday, October 05, 2005


Crazy people really are crazy. Yesterday I was called to see someone who also has what appears to be a severe case of psychosis. He tells me that all of his problems are due to the "spirit that moves me," and then refused all treatment - don't want to get rid of the spirits!

This, of course, reminded me of other cases I've seen (I can almost not enter buses because the people will send me back to my internship and I'll feel all depressed and sleepy). The one in particular that struck me was when a delusional patient was talking to an attending. I was just watching as a medical student. The delusional patient is exactly like a religious zealot, who, in Churchill's words, won't change his mind and won't change the subject. So the guy is telling the attending that people are trying to steal his organs to run experiments on them.

This actually has some basis in fact, because almost every morning we check labs on patients, and blood can be considered an organ (it is a tissue), and they do run it for cell counts and salt levels, which constitutes a very boring experiment.

In any case, the attending was a young man, and very practically minded. He insisted again and again that no-one is going to run experiments on his organs. He ran through some reasons why this made no sense, and had about as much progress as I would have convincing Tom DeLay there is no god. Eventually the attending asked if the patient thought he was missing any of his organs.

To this the patient looked up at him and gave him a gapped tooth smile, "I'm missing my mind man. My mind."

True enough.

And thus I realized that the right answer can be ascertained in a variety of ways, some don't even have to be proper. I think that's probably one of the most important things I learned in medical school, all due to a wild haired, gapped toothed, psychotic person. I'm referring, of course, to the attending.


Blogger echrai said...

I love this. Absolutely priceless. There's no doubt that the insane once in a long while say things that seem completely and utterly lucid. It's enough to almost make you wonder what's going on up there. But this particular example is also a good lesson. Even for us non-doctors.

5:26 AM  
Blogger acumamakiki said...

I love this story. I also love how lucid crazy people can sometimes appear to be.

9:38 AM  
Blogger Doc NOS said...

It's famously the case that insanity frees people to say the truth and act in more normal ways.

I have to admit, when that guy said it, he got a huge laugh out of all of us. The attending, however, was less amused.

Makes me think that medicine is a cool job.

11:58 AM  
Blogger acumamakiki said...

Medicine is THE COOLEST job. I might have tried conventional medicine but can't stand seeing guts and gore. I start thinking about my own guts and gore and I get all faint.

5:21 PM  
Blogger Doc NOS said...

Before I put so many various types of needles into people, I thought that was the worst aspect of medicine: the stick. Somehow both the idea and practice of opening up the body didn't bother me. But seeing steel going into/comming out of the human body - especially if you're going deep - is troubling to me.

I just got blood drawn btw, and it makes me nearly puke with nervousness and anxiety. I can give, but cannot take.

2:50 PM  
Blogger marybishop said...

"If you wait by the river long enough, eventually you will see the bodies of all your enemies float by."
- Sun Tzu (attrib)

I guess the insane also can be sane once in a while. And the opposite can also be true.

I commend all medical people because of the natural "icky" feeling they have to overcome to help others.

Thanks one an all!

6:42 AM  
Blogger Doc NOS said...

For all my ick, its obviously the patients who suffer. Man. Do they ever. Word to the wise: do not shoot H into your legs. You are not above gas gangrene. It appears anaerobic bugs do not care that you went to an Ivy league school.

That was gross.

12:28 AM  
Blogger laurenbove said...

this was a cool albeit gross post. I loved my short-lived internship at the norwich mental hospital. Yes. that's what it was called. i'll never forget the personalities. I should post them.

the old dude who told me: " you're on fire honey, you're on fire", the young black druggie with the shakes, who ended up giving me the shakes as I tried talking to him...the dude who spoke not a word but doodled mendel's periodic table of elements out to four or five decimal places... AH, good times...good times.

they were like little kids all waiting at the door of the hospital for the college kids to get off the bus and visit with them each week. so cute. so odd. so medicated.

12:58 PM  
Blogger Doc NOS said...

One thing that hits me each time I go into a locked psych ward is how utterly real mental illness is. Tom Cruise in his wisdom doesn't think depression is real? Dude, come take a look. All he has to do is walk into any locked psych ward and open his eyes (he'll blame the meds though). The depression that these people have is as palpable as cancer. The psychotics are so clearly psychotic.

9:54 AM  
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