Monday, December 22, 2008

Voices of No Reason

I was asked to see a patient because he was HIV positive.

"Is it a new diagnosis?", I asked the intern who called me.

"No, he said he had it for 20 years, or 22, not sure, he keeps changing his story. He doesn't have any documentation with him but he has some bottles with HIV drugs. He was admitted last night for gastroenteritis. He's also schizophrenic, big time schizo, and he just came from Phoenix to Tucson and is not saying why. This guy's crazy, so if you can just tell us what HIV meds should we keep him on and if we need to check a CD4 count or other labs as well. Appreciate it."

I went to see that patient at the end of the day. It was around 6 pm. I intoduced myself to this 40-something dude, brought a chair and started chatting. I looked at him: he had a very abnormal face, which could tell his had some congenital disease. I tried to guess what it was but couldn't come up with something. If I had paid more attention in the genetics class in med school I might have been able to tell ( damn those Khateeb lectures were so boring).

Although I love talking to psych patients, I didn't feel very comfortable then. This guy had no facial expressions. I would ask him a question and he'd answer like a robot. No smile, no frown, no emotions in his voice. No emotions in his face.

I was done asking him about what I needed to about his HIV, then decided to go a little bit over the schizophrenia.

"So you have schizophrenia?"
"For how long have you had it"
"Two years"
"Do you hear voices"
"What do they tell you"
"They tell me to ........." and I couldn't hear well
"They tell me to hurt people"
"What do you do when you hear them?"
"I obey them"

(I was impressed by the word obey)
"So have you tried to hurt people"
"What else do they tell you"
"They tell me to kill people"
"And what do you?"
"I obey them"
"Have you tried to kill people?"
"With a gun, I have a gun"
"Do you have a gun with you now?"
"No, I left it in Phoenix"
"Why did you leave Phoenix?"
"Because I had a court order"
"Order for what?"
"Court order to take my schizophrenia medications"
"So you don't want to take medication?"
"Why not?"
"I don't like these medications"
"So for how long haven't you taken these medications"
"Long time"
"Do you hear voices when you take the medications?"
"So are you hearing voices now?"
He paused as if he was listening to someone else
"At this moment, are you hearing voices"?
"What are they telling you?"
Closing his eyes he answered, "lotsa things, lotsa things"
"Are they telling you to hurt someone?"

He paused again and looked straight at me, again without any facial expression. I started the process of crapping on myself, and wished I had stopped at the HIV part and left the room. It was dark, the room's door was closed and because it was the night shift there were only very few nurses around. I was 1-on-1 against this man. He was well-built, with a sign "6th street gangster" tattooed over his back, and quite a few scars on his face. I thought to myself if this dude jumps on me now and rests his big hands over my neck he can send me to floor minus two (the morgue) in 20 seconds and I will end up being a headline on the local newspaper.

Instead, he answered, "No" and kept listening to the voices and added, "they're not telling me to hurt people"

I left the room, as I opened the door I turned back and said, "Ok, nice to meet you sir"
I was not expecting a reply but he said, "Nice to meet you too"

I called his intern.
Intern: "So does he need HIV meds?"
"Yes, he also needs a psychiatry consult and you need to call the cops"

This guy may end up in jail for violating a court order, but they won't admit him to a hospital unless he was actively contemplating suicide or homocide. If he had thought of it a few weeks back they would still let him go back to the street.

Here's the equation: in our city of nearly one million, there are only 2 hospitals with very few beds reserved for psychiatry patients. Each night costs 500 dollars. Meanwhile there is much more room in jail, and a night there costs 10% of what a night in a psych hospital costs.
There's a reason why I don't like walking alone in the street and why I make sure doors are well-locked at night.


Whisper said...

Thank God that the voices liked u or were sleeping
Otherwise he has to obey them !!

I don't know why I remembered my mom now
if i told her Ur story she will start crying and feel sorry for u and for my brothers in UAE and for every one away from his mom :"(

Anonymous said...

HAHAHA, I bet you dreamt about him paying you a visit last night :D

I find people like him very interesting, until they start to obey orders.

mab3oos said...

you should have gone behind the curtains and starting making "voices"

Goooo baaack to Phoeeeeenix

KJ said...

As a psycho myself I would have loved to have a convo with this person. The human mind is marvelous!

Of course I would have done it with people watching from another room in case something happens.

Just know that since this person is a schizo, he really is not intent on hurting you. He just believes he has to - he doesn't really want to otherwise he would have killed you when he had the chance.

I hope he finds solace in the ward. It's best to see the relationship between this person and the "voice".

Anyway, glad you're out and safe, and hopefully never would have to run into potential danger again!

maroo said...

i felt that im watching "ER" and u were like DR. green talking 2 one of his strange patients :)

Ali Dahmash said...

Oh my Gosh, that must have been so crazy man. I think it's much easier to have HIV thesedays than being schizophrenic, hamdella ala salamtak ;)

Anonymous said...

HAHAHAHA that would have been fun watching you freaking out.
To think people call me a freak I should show them this post

The Observer said...

:(, poor guy! Isn't there anyway that you can help him? Does his medications really work? I mean his shizo medications?

I felt like watching an episode of grey's anatomy while reading this! :)

Anonymous said...

lool @ mab3oos' comment

what you did is brave Dr. Good Job :)

a different perspective said...

I had a roommate/landlord who was shizo, so I understand how difficult it is. He sometimes didn't want to take his medication because he thought he was being someone else when he does. He never said anything about voices in his head, he just acted strange at times and said weird things. We (the roommates who lived there) never felt in danger, he never tried to harm anyone, but he ended up killing himself by hanging. It was very sad. It was unexpected because he seemed to be leading a somewhat normal life with a job.

Hareega said...

Whisper, yep, maybe the voices where just "whispering"

nizar, yeah they're interestinf for a few minutes only

maf3oos, I don't think I can deceive him, he's got real experience with voices and can tell the real from fake voices

KJ, many schizos end up killing people who are very close to them in ugly ways because of their voices! they can really be dangerous

maroo, no i'm not dr. green, those med shows are a load of crap (but i like them!)

Hareega said...

Ali, Alla ysalmak

Suha, the point about freaking out is that you have to hide, just like if you come face to face with a bear in front of you, you'll be dead scared but pretend to be calm so you wont get hurt, thats what I did

Observer, medicatiosn do work for many schizos, but the problem is to let them take their meds, most of them do not have insight, they don't know that they are abnormal so they don't like taking meds

Steve, thanks

A different persepective, sorry to hear about your friend, schizos can break into an attack all of sudden. Less than 30% of schizophrenics recover completely from their illness

Anonymous said...

hehehe shall i say 7amdellah 3al salameh? :P

Unknown said...

i love the pic, thats how i feel, like there's a "mini me" hiding inside my head.. it speaks to me too, but it never tells me to hurt ppl, though i wouldnt mind if it did, would make a good excue, "the voices told me to"
i guess the bright side is, he never feels lonely, the voices are always there to keep him company..

Matt said...

hehehe shall i say 7amdellah 3al salameh? :P