Friday, March 28, 2014

Psychosis and Living with "The Voices"

   The report came in: "We have a suicidal patient with two large slices running laterally along her wrists. Bleeding controlled and patient cooperative. We will arrive to your facility in five." 
  It always catches my attention when I see a truly suicidal patient. Our healthcare system allows for a lot of "suicidal patients" or people in stressful situations who make passing comments, shoot texts about life being difficult, or maybe they upset the wrong person. When deemed "suicidal" at triage, there is a lengthy series of events that must occur to ensure proper screening and treatment of true suicide. With these patients, we go through the protocols and are prepared in case they were to become a danger to themselves or others. Truly suicidal patients do not exist as often-possibly because they are successful. When they do show up, their attempts often leave us with the double challenge of the physical and the mental to treat.

   This patient was different than the normal, truly suicidal patient. The voices had been telling her all day how worthless and what a burden she was. They had pointed out that she was over fifty, unable to hold down a job, and completely dependent on her eighty-year old parents due to her mental instability. They had pointed to the razor blades in the bathroom and suggested she help society. The voices had only been silenced after she carved the second linear slice through the layers of her skin leaving exposed tendon. She "awoke" to find her wrist bleeding and after an hour of trying to control the bleeding, woke up her father to request a trip to the ER.

  Now pause and rewind thirty years. She was in her early 20's, driving to Reagan National Airport to pick up her father. He was a Marine and flying in to visit. She was a successful TA in a well known college in the area with an incredibly bright future. That day her world changed.

   A driver of another vehicle side-swiped her vehicle at highway speeds. She was unable to regain control of the vehicle. Firefighters using the Jaws of Life pried her limp body out of the pile of metal. She was rushed to the Hospital. She survived the experience, but in many ways several parts of her remained in the wreckage. 

  She spent hours over the next ten years in exploratory surgeries as specialists attempted to repair the damage causing residual symptoms. One of the surgeries she needed was a total jaw reconstruction and a repair of part of her skull. When she awoke from the surgery, it was evident something had gone terribly wrong when she began to seize. She was diagnosed with epilepsy and more medications were added to her already growing list.

   Shortly after the accident, she began to struggle with depression. Raised in a very strong and successful family, she had a wonderful support group including several siblings, but her new-found limitations and dependencies wore her down and made her feel like a burden. She was prescribed medications for depression and assigned counselors. Things seemed to stabilize until the reconstructive surgery. Suddenly she was hearing voices. The voices were loud and unfortunately very much in the foreground of her world. They continuously reminded her of how worthless she was and how much everyone had to accommodate her. These episodes would throw her into acute psychotic medications. Doctors prescribed more intense therapy and stronger medications.

   Back to the present day and the woman that sat before me. Merely the shell of a woman. She drifted into the room and began to change and bag her belongings. The system is well known to her. Her eyes bulge wide as she listens to me. Her obvious analysis of my words and body language are reminiscent of a child on high alert for stranger danger. It is 0300 in the morning and her eighty year-old father sits in the waiting room reading his kindle and prepared for another long hospital visit. 

   As I update him, he explains. She was recently put on a large dose of Lithium-an extremely strong anti-psychotic medication-so that she could be discharged after months from the psych ward. The side effects of the medication caused such intense tremors that she was unable to walk. Doctors cut her dose in half and the voices returned-hence this episode. Not actual suicide, he believed, just a cry for help. His eyes looked to me for answers, "Her mom and I just don't know what to do anymore. She has a PHD from (a well known college) yet she rarely leaves her room. She can sit on her bed doing nothing for hours. She comes to me for permission to have a snack. Her siblings don't believe any of this is real and her mother and I won't be around much longer."


 Her story is duplicated in patients all around the world. I bring it to light because it makes me think about a few things. Most obviously, how many of us have so much to be thankful for-things that we don't even realize? Things like not being hit when that car cut us off last week or not having to take a pile of medications every day?
 The bigger idea her story makes me consider is about the thoughts I entertain daily. How many negative thoughts to I allow to float through my mind? How many of those thoughts do I entertain or explore in more depth instead of chasing them out? How many times do I look in the mirror and dislike what I see? How many times do I see another or  younger person's success and begin to consider how much of a "failure" I have been in that area? I am taking her story to an extreme in many ways but I wonder how much more you and I could accomplish if we removed those negative "voices" in our mind. I am a huge proponent of surrounding myself with positive people who share a mutual desire to challenge and improve both self and one another. While it is great to put yourself in a controlled environment, the larger question is what is inside of you and who or what controls that environment? Do we allow the media and society and the great thinkers of the world to control our thoughts or do we consider their opinions and make our own decisions based on a greater purpose? What makes their human thoughts more valuable than ours? Education? Experience? 

   These are just some things to consider as you wake up and begin another day, perhaps not happy at where you are. Consider what is inside of you and what your internal voices are saying, then consider replacing unnecessary ones with a more positive perspective.

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