6/16/09: “I’m turning into a pot plant”

“I am getting telepathic messages. I am hallucinating. I have arachnophobia. I am losing my memory. I am turning into a pot plant. I am numb to feelings. I keep having nightmares where someone is trying to kill me; someone chopped off my arms and my head in a dream.”

This soliloquy was delivered to the panel of 4 of us sitting across the table in response to the simple question of, “how are you doing today Mr. Smith.”

He continues: “I have visions of being in an electric chair. I have visions of someone raping my mom. I have visions of raping a nurse.”

The psychologist redirects him at this point and reminds Mr. Smith that he has never raped a nurse and these are visions that are not real. This 33 year old man sitting in front of me is obviously dealing with some intense thoughts and can’t distinguish between dreams, visions, and reality. His thoughts are on a different plane than you or I think. He is clearly in turmoil. I am glad there is a psychiatrist sitting next to me who knows what to do in this kind of situation. Right?!? What do you do in this situation?

The psychiatrist mostly sat, listened, and after taking in this truckload of loaded statements, says that we should increase the Risperidone dosage. WHAT!! NO crisis counseling? NO intervention? NO resetting the framework this person is using to think about things? I don’t have any experience with someone who is this deeply affected by Schizophrenia, but I have to believe that there is more that can be done in the acute setting such as this one; I just don’t know what!

This was the 6th or 7th patient we had seen today. We were a formidable bunch the inmates walked into. We were in a standard conference room with 1 large wooden desk in the middle of the room with several chairs around the table. The inmate would be escorted in by the nurse and take a seat in the middle of the table closest to the door. Directly opposite the inmate was the psychiatrist; he was an older gentleman with a friendly face and a brightly colored Hawaiian shirt depicting images of Caribbean islands, airplanes, and vacation get-aways. “Are you serious,” is my internal reaction; thinking about vacation get-aways is the farthest thing from the daily routine for these inmates.

I am sitting on the left flank of the psychiatrist wearing my white coat helping to create a foreboding wall with the nurse who is on the right flank wearing his duty uniform including a white shirt. The psychologist is sitting next to the inmate and directly across the table from me. He has disheveled hair, crooked and bent glasses, and a slouching posture that I imagine is from the weight of being responsible for 2000 inmates.

We are a wall of authority and far outweigh the power of an individual inmate. Most of the encounters were about 5 minutes and consisted of, “how are you doing today Mr. so-and-so?” “Feeling more depressed? Lets increase/decrease/change/or otherwise alter your medications.” Next. “How are you doing today Mr. so-and-so?” “Feeling more depressed? Lets increase/decrease/change/or otherwise alter your medications.” Next… and so on. How can we expect an inmate to come in and within 5 minutes reveal his deep dark thoughts and help identify what the best treatment might be for him? I don’t think I could get in touch with my personal feelings within 5 minutes, let alone talk coherently about them to a bunch of strangers (and they haven’t diagnosed me with a psych disorder… yet!)