 Speaking of transitions, it
occurs to us that we've already been running a series of articles describing
a kind of transition -- that of the first few years in one's chosen profession.
(Maybe we have stumbled onto a theme for this issue, after all...) We
received this article not long before the Boston Worldcon, which not only allowed
us to find out for ourselves that she still has lots of entertaining stories left
about the medical profession, it shows you how long this issue of Mimosa has
been in transition between the Post Office and the mimeograph. The seasons really
do speed by here in the Washington area...
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Tales of Adventure and
Medical Life (Part III) by Sharon Farber Take him to Bliss.Say it like Sidney Greenstreet,
and it's threatening -- send him to his ultimate reward! Say it like Peter Lorre,
it's not quite as threatening -- give him some obscure oriental drug that will
disarrange his thinking. Perhaps permanently? Pity...When a doctor in St. Louis says
take him to Bliss, it means "take him to the local public mental hospital,
and lock him up."Malcolm Bliss Mental Health Center
was one block away from City Hospital, but not a block you'd particularly want to
walk, let alone at night. A tunnel connected the two hospitals, but I'm told that
was even worse. A drunk is supposed to have wandered into the tunnel system a few
years ago, and was eventually found dead. In any event, the roaches in the
basement were as big as a respectable mouse, and I had no desire to meet the
mice.Medical students spent a month at
Bliss, and then two weeks in the more refined private psychiatric pavilions at the
university, with an entirely different patient population. At the university, the
patients were still functional enough to have insurance, or relatives with
insurance. Some did not even need to be hospitalized -- they just wanted a
vacation from responsibility. I once heard my attending have a long conversation
with one of his patients, explaining that it would be at least two weeks before
she could get a reservation.Patients at Bliss, on the other
hand, were usually dragged in kicking and screaming by families or police, or
(in the case of the chronic patients) shuffled in on their own when life got too
tough. You knew this was going to happen when there was a "positive suitcase
sign". (It is difficult to persuade someone who has brought his suitcase that he
doesn't really need to be in hospital. A friend once saw two people with
suitcases out in the waiting room. He was quite upset, knowing this meant two
admissions. But it turned out the patients knew each other, and by the time my
friend decided he could no longer put off speaking with them, they'd gone off
together to have fun.)Most of the patients were
schizophrenics of all variety, maniacs, and depressives, though you had to be
incredibly depressed to get into Bliss. It helped to be catatonic. There were
also a fair number of violent and unsavory individuals in for forensic evaluation.
I was warned to never go into the wards alone; on the other hand, the orderlies
would never accompany me, so I did anyway.
Another class of patients that
frequented the hospital were down and outs -- drunks, sociopaths, the mildly
psychotic -- who had learned to abuse the system. They would present on a cold
night, recite the proper litany of symptoms to earn admission, sleep in a warm bed,
enjoy a couple of meals (Bliss had the best hospital food in town) and then check
out. Hotel Bliss we called it.Naturally, this made us furious.
Not only did an admission entail an extraordinary amount of work -- complete
history, physical, review of prior charts, paperwork galore -- but this usually
occurred in the dead of the night, when you'd rather he sleeping. And it took
up beds that might have been occupied by those actually ill. Many times, real
patients were turned away for lack of room.One of my housemates enjoyed a brief
reputation for heroic tough-mindedness when she got rid of one such patient. He was
an alcoholic with a long history of checking in overnight. It was impossible to
summarily dismiss him as he had, through trial and error, hit upon the exact words
that were guaranteed to gain him admission. "I'm going to kill myself," he would
say.It's very hard to get rid of someone
threatening suicide. (Just a hint to those of our readers who may someday be
destitute and looking for a free room and board. If you don't mind being held
against your will and given drugs and perhaps shock therapy in return.) Of course,
a phenomenal proportion of those who threaten or attempt suicide (usually in fairly
benign ways -- many people who succeed in suicide are quite surprised) are hysterics
and sociopaths just doing it to manipulate others.Anyway, my housemate asked this
drunk: "How do you plan to kill yourself?" The man -- taken a bit aback, he thought
he'd be cozy in bed by this point -- said, "Well, I'll jump off a bridge.""Which one?" asked my friend. There
are several in St. Louis, not counting overpasses."I don't know"" the man replied,
rather annoyed.No suicidal plans, she wrote and
booted him.#My first trip to the wards at Bliss was
illuminating. I unlocked the door, walked in, and was promptly surrounded by a half
dozen schizophrenic, disheveled, expressionless, shambling persons of various races
and sexes. "Doctor, I want a pass." "Doctor, I need cigarettes." I quickly took
refuge inside the nurses station, which was surrounded on three sides by huge glass
windows, lined with patients demanding cigarettes. It was a lot like a fishbowl, or
feeding time at the zoo.Eventually, I learned the proper way
to enter the ward. You unlocked the door and headed in with enough momentum to plunge
you through the wall of supplicants and into the conference room, whose door you kicked
shut behind you. I learned to juggle in that room.Soon after my arrival, I was assigned
to do an admission physical on a paranoid schizophrenic who had bounced back into the
hospital. It went rather uneventfully until I decided to check his Babinski reflex.
This entailed removing his stockings. I stared in amazement as the putrid hole-ridden
socks peeled off his feet but maintained a foot shape. They were stiff with dirt.
Their color was an ill-defined shade somewhere between filth and Kelly green."Well," I said. "They're
certainly...green.""Yes," said the man. Up to now he'd
been perfectly quiet. "They're green. I'm the Green Hornet."I allowed that I was pleased to make
his acquaintance."I'm an architect," he continued. "I
design skyscrapers. Batman does too. He's my archfoe. We have a grudge match." It
turned out he wasn't really the Green Hornet -- he stared at me blankly when I asked
about Kato -- but I decided that maybe Bliss would have its interesting moments.#We had not been long at Bliss when my
classmate (the Robot) and I were taken to witness a court hearing. One of our quieter
schizophrenics wanted to leave the hospital, and his family wanted him to stay. He
was a bit violent, but for some reason I never understood, the psychiatrist was not
allowed to testify to that effect. The testimony had to come from family.We got to court, and waited. The
family didn't show. Finally, the judge declared the case closed, and instructed us
to release the patient. At that moment, the family straggled in, reeking of liquor.
"Too late," they were told, and this bad news made them belligerent. As we left,
they were beginning a shoving match under the watchful eyes of the bailiffs.#I suppose, in the good old days,
seriously crazy people did think they were saints, or Satan, or Napoleon. You still
see an amazing amount of religious delusions in the insane, which can lead to problems
in diagnosis. For instance, how do you determine insanity in someone who says she
converses with angels, when everyone else in her church also gets personal advice from
higher powers and speaks in tongues? It turns out that what you do is to go to the
other people in the church, who have the same totally bizarre beliefs, and ask, "Hey,
is she nuts, or what?"A surprising number of the delusions I
encountered at Bliss were science-fictional. People with thought-control devices
imbedded in their head; people who were convinced they were robots; strange visitors
from other planets. We even had a Vulcan on our ward, though he did not act in the
least Vulcanish. (When I learned that there was a Vulcan on another ward downstairs,
I suggested we put them together and see what happened. No one was amused.)One teenaged manic, after we all had
been enjoying hearing how he'd impressed all the Cardinals with his baseball skills,
went on to tell us that he'd constructed a working rocket ship in his backyard."You must've needed some help on a
project that big," said the attending. "Who worked on it with you?"The kid shrugged. "Oh, me and God and
some other guys."A few years later, a friend of mine
had a patient who claimed to have a rocket ship inside his brain. My friend did the
logical thing. He called a neurosurgery consult. It took the neurosurgeon -- a
rather nasty gentleman, in the habit of terrorizing his subordinates -- a long time
to comprehend that someone was playing a joke on him.#After I'd been at Bliss about a week,
it was time to take call in the emergency room. The resident flipped through the stack
of charts, then tossed me one. "Suicidal ideation. Should be easy," he said. "Just
ask him all the questions about depression, then come tell me the history."I went into the examining room, mentally
rehearsing the symptoms of depression (insomnia, anorexia, anhedonia, dysphoria) and
sat down at the desk beside the patient. The man was huge. He looked like a Green
Bay Packer. A sullen Green Bay Packer."So," I said, "you want to kill yourself.
How were you going to do it?" First, let's make sure he's sincere.
"I'm going to drive my car at eighty miles
an hour into another car," he replied, with a total lack of expression."Gee," I said. "Won't that kill someone
else, too?" That was unusual for a depressive.The Hulk stared at me. "My voices tell
me to kill people."Oops. Voices. I had the wrong diagnostic
category entirely. This guy wasn't depressed, he was psychotic."Uh, any people in particular?"He continued to stare at me very
intensely. "My voices tell me to kill women."I began to wish I hadn't sat so far from
the door. "Uh, do you do what your voices tell you?""I go down to the Stroll and I hurt
women."Great. I very casually rose from my
chair and inched towards the door. I needed another couple questions to fill up the
time it would take me to escape. Quick, what were other symptoms of schizophrenia?
Hearing voices, thought insertion, personal messages from the radio or TV...."Do you get messages from the TV?""It tells me to kill women."Great. I was almost to the
door. "Any shows in particular?""Starsky and Hutch."I zoomed out the door, into the
resident's office, and said, "He likes to kill women!""Fine," said my resident. A few
minutes later, he sent me back to do the physical examination. I decided to pass on
the rectal exam.#After Bliss, I did two weeks at the
much classier but also much duller psych ward at a private hospital. One day, as
I was standing at the nurses station on the locked ward, a patient got up from a
game, shuffled over, and placed a stack of playing cards onto the counter."Nurse," he said, "we need new cards.
We aren't playing with a full deck."#The strangest thing about medical
education is how it changes you into someone who thinks and does things that you
never would dream yourself capable of.I remember, back around '71, when
Thomas Eagleton had to give up running for Vice President because of the revelation
that he'd been hospitalized for depression and received shock therapy. I had a
typically Californian response to shock therapy. "What sort of barbarians would do
that to a person?"Well, it turns out that Washington
University at St. Louis was the hotbed of electroconvulsive therapy (ECT). And so,
thirteen years after deploring Eagleton's ECT, I found myself, in probably the same
ward where he received it, as the resident administering shock therapy.However, I was probably the only
neurology resident in the history of the hospital to deliver shock while shouting,
"Fire phaser, Scotty!"Some people are crazy on the psych
ward, and I'm not just talking about the patients. All illustrations by Charlie Williams |
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