Sunday, August 8, 2010

Mind Games

There were only two of them in the past three months that I have worked at the hospital.

They usually come in around 2 or 3 in the morning, complaining about sleepless nights, bothersome thoughts, voices in the night, and well, a bevy of other things that you really can’t point out the source of the physical pain for.

Like the patient who showed up at the hospital while I was on duty the other night…
He was a tall and lanky young man in his twenties. Tanned and seemingly in the prime of his youth, head shorn almost bald, he came in clutching at his lower abdomen, his face in a terrible grimace.

Doctor, please help…” said a petite, middle-aged woman holding onto his arm and looking all flustered. Judging from the way her hair stuck out from under her cap, her ruddy cheeks and long-sleeved shirt belted at the waist, I presumed that they had traveled from quite a while away, on a two-wheeled vehicle.

I had just finished with a patient that time, and wasn’t surprised at all when I saw them come in at around 3AM. Where I work (as with every other hospital around, I’m sure) there are days when people just won’t stay in bed to wait until morning for a consult, OR, that they’d wait for many days, “listening/feeling” their ailments, until of course, their folk remedies won’t work anymore, and that they’d have to seek help at the hospital.
(It’s the irony of life…)

The young man had been apparently well until about 5 days ago when he, according to the lady who stood by him the whole time, started acting…strangely. His father was also there, he stood behind the patient, his hand on the patient’s shoulder while they recounted the events of the past 5 days. The patient himself tried to tell me what it was that he was going through… For some apparent reason, there was a “force” that would seem to squeeze at his insides and shoot up and down his spine.

The blank look. The strange words. The restlessness. Parents who hovered, and were over-involved…

Mental illness.

I’m no expert, and in my 8 months practice in primary care, so far, I’ve only had three such patients who came in with such demeanors. They came few and far in-between, and usually, they brought a considerable amount of stress to their families, whose members almost always came in groups of 5 or more to bring the patient to the hospital.

But you can see how all this was taking a toll on the patients and the people who care for them. 
Grown men have come in tears because they don’t understand what is happening, they can’t stop “the voices” that were punitive and demanding, most times. Their families could not understand the sudden change in the person, or the episodes of violence, or the inner turmoil of confusion that the patients themselves are going through.

This patient’s mother was always within arm’s length, at the slightest grimace, the slightest twitch, the smallest shift in position, she seemed to be rushing to his side, always ready to give a “calming” touch, almost a caress, as if to give comfort. I looked at her face and saw a permanent etch of worry in between her eyebrows (as with the father), and understood that this problem wasn’t new.

As a child, the patient was quiet and withdrawn, the mother said. He was intensely shy, and for a long time would always have her accompany him in school. His premorbid condition surely wasn’t helping any.

I went through the motions of interviewing him and fully examining him, of course. “Doctor, he is not well…” his mother said softly to me, with a look that almost said, “Can’t you see he’s not well in the head?”

“Yes, Ma’am, I know…” I wanted to tell her.

Believe me, I know.

Mental illness is not something I’d wish on anyone. It is a confusing, tumultuous state to be in. I have not had the experience myself, but I’ve seen people who have gone through it, many times.

It is expensive. It is painful. It is oftentimes confusing.

And, in most parts, it is feared.

Sometimes ridiculed.

One percent of the world’s population will be diagnosed with schizophrenia at one point or another, as the books say. Considering the population, that’s a lot of cases, a considerable, significant prevalence of the disease.

Schizophrenia is synonymous with delusions, hallucinations, disorganized speech, behavior that is disorganized. On one end, there is diminished flow and spontaneity of speech, lack of initiative and goals, and on the other end, there is (and I suppose the more common associations) the symptom set of;  ideas of reference (thinking that everything the patient hears on the radio or tv is meant for him/her), grossly disorganized behavior and delusions, and hallucinations.

This disease “has a lifetime prevalence of 1% in the entire population, but only half of those affected will be treated.” It usually sets in when men are 18-25 years of age, and women at 25 to 35 years of age, the prime of their life. Once diagnosed, patients are observed to remain chronically ill and some will have exacerbations and remissions, but there will never be a complete remission. There will be lifelong impairment in 40-60% of patients…and if that’s not enough, 20-40% of schizophrenics will commit suicide.

What a cop-out…

A person loses the best years of the prime of his life just because his brain chemicals have gone awry, or, as they say (but is not 100% proven) that he has bad genes, or that his environment was messed up…that, for me, is a rip-off.

What is a bigger annoyance is that these patients get an unfair persecution from the general public most times. People stay away from “crazy people”. It isn’t generally the patient’s fault, as is in schizophrenia, that the brain chooses at that opportune time to… well, fail, so to speak.
It is generally unfair.


Anyway, lest I get too emotional, I have to say the real reason why I’m writing this entry. J

Just recently, I’ve decided to take a leave from my “paid vacation” of a job at the hospital I’m working in currently, so I could try to apply for residency training in Psychiatry in one hospital, and Neurology in another.

The brain, and the mind have always fascinated me.  Before, I always used to say that I was after “the stories” of patients in psychiatry, and wanted to be involved in the humanities more, but now, I’ve realized that mental illness in itself is a fascinating study.

The brain-mind marriage which is Neurology and Psychiatry was very attractive, and I thought I’d give it a go. Giving it “a go” seems so childish a way to undertake something so daunting, so I would have to recant that and say that I’m exploring my options and deciding to see if I want to make it my life’s work, my career path. My contribution to the world. My effort to make the world a better place to live in…


As I was telling a friend, I thought my top three list of things to do residency training in would be:

1.       Psychiatry – for aforementioned reasons
2.       Pediatrics – because, as a mentor would say, “Children are God’s most precious gifts… - Dr. O., who is writing me a recommendation letter, by the way, thank you very much! J), and because babies are simply adorable, and
3.       Obstetrics – because the “miracle of life” just can’t be beat… J  

One of my favorite residents keeps telling me that next to Psychiatry, all the other specialties would be second best, which is of course, understandable, because she is a Psychiatry resident herself… :-p

When I tell people about this Psychiatry thing, they always ask me why so. I reckon, later in life, it alone wouldn’t get my children through International School, but then who knows, right?
I’m always up for a new adventure.


Good morning!

~ S.

 P.S. I used Case Files: Psychiatry, 3rd edition by Eugene Toy and Debra Klamen, 2009, for some info i put here.


  1. The mind is indeed baffling... love this story you wrote. And good luck on your shift to Psychiatry and Neurology. xoxo

  2. Psychiatry! You'll never get me off your couch. =)

    I see a fair number of people in DC who must have some form of mental disorder. Most are not a problem, but there are some who seem unstable to the point of being dnagerous. It is a sad situation. There was one lady I used to see every day outside the subway station. She was there every day reading from the Bible, with signs denouncing the Pope as the anti-Christ. I greeted her every day, but she was pretty focused. The only reaction I ever got from her was one small, brief smile. I haven't seen her for a long time now.

  3. the mind always fascinated me. and i guess it really got interesting when i started to pick my own mind apart. but then that wasn't the result of a curios mind for purely scientific reasons. None the less i had done that. but recently i have decided to stop doing it for a while. and just let my mind take control and stop the analysis.

    I know what you mean by the whole thing about people looking at psy patients as though they got some kind of weird disease or dangerous and incurable condition. I know what i got when i said im seeing a shrink for my depression. its another thing i didn't get much out of it beyond a point. but then it did help get things started.

    I guess in the end of the day . we are all chemically imbalanced blobs of neurons firing away at random hoping to or not hoping to colliding into each other and crash and burn.

    the very definition of a chemically balanced mind simply does not exist.

    All the very best for it.

  4. Reminded me of my fascination for psychiatry. But psych rotation during internship scared the wits out of me..

    yes, confusing. Takes a lot of adventurous mind to dwell on it!

    Good luck!

  5. bilib ako sa'yo. i used to have the energy to write this passionately about the things that i experience in my work. i don't anymore.

    but you, you write them beautifully. and passionately :) when i read your posts it's as if i can almost experience what you felt when you were writing it.



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