Less than 24 hours and one psychiatric consult: the time it took me to question my books, to question all given facts and statistics, to question the obvious.
The boy was our sixth patient of the day. He walked into our room and immediately diverted his eyes when I introduced myself as the medical student. He sat with his legs turned away from my attending and me, his eyes fixated on the cellphone in his mother’s lap. He nodded and shook his head to our conversations. His speech — though he barely talked at all — was slow and careful. His fingers twitched incessantly.
My attending suggested he had autism, and offered diagnostic tests so the boy could be started on the right medications. He also recommended considering special learning classes for the patient at school. The boy’s mother dropped a blunt no. “I was like him when I was young,” her thick Arabic accent echoed through the walls. “But look at me now, I am fine. He is just shy.”
Shy. Being shy is not talking, but wanting to. Being shy is needing the extra push; it is realizing the world is a tunnel with a light at the end … something to reach for. The young boy, however, couldn’t get to that light. He was not shy. He was distant and disconnected and detached. The world as we saw it was not the way he imagined it. New people were strangers, another species who didn’t understand, who couldn’t understand. To him the world was spinning colors, a kaleidoscope of different.
The mother, however, refused to entertain our suggestions about diagnostic testing or social therapy. So, we proceeded with the interview. We asked the boy how he was doing. If he was sleeping well. Eating okay. We received nods. If we were lucky, maybe a rapid eye glance towards the ticking clock above our heads. Nothing more.
The mother requested to speak with us in private and had her child sit outside for a while. As the nurse took the boy away, the mother started crying. “How can he have autism?” she said. “What did I do wrong?”
As my attending consoled her, I couldn’t understand why the mother was so upset. Her child was healthy and alive. He could walk, talk and eat. He didn’t have a life threatening malignancy. His blood counts were normal. I handed her a Kleenex as she finally agreed to sign the paperwork for the diagnostic tests and therapy. I was still confused, I still didn’t get it. Why was this woman so miserable?
It wasn’t until the mother left the room and I talked to my attending that I finally understood the significance and impact of the mental illness. This kid — with an IQ most likely lower than average — would not be able to get a decent job. His social isolation would prevent him from forming long-term relationships. His mother was upset for this very reason. Her son’s possibilities and opportunities — his whole life — took a whole new turn and it took hard words from my physician to finally grasp the concept, severity and danger of mental illness.
This is not only true for autism, but for post-traumatic stress disorder, bipolar disorder, anxiety, depression and all other mental illnesses. Although these diseases do not necessarily have physical manifestations, they are so robust as to completely change our every day life. The way we talk, interact, see the world, the way we live: that all changes.
As physicians, it is our responsibility to understand these serious implications and to help these patients live as fully as possible. A patient is not just his or her numbers — their vitals or their lab values. A patient is not just an MRI reading or a CT scan finding. Every individual has a mind, and we must take into account mental health when treating these patients because if left untreated, they can have dire consequences. More importantly as people — as humans of society — we must not stigmatize these illnesses.
Our books tell us the most common causes of human death are cardiovascular disease and carcinomas. Magazines, research articles, media, friends, family and physicians target these illnesses because that’s what the statistics tell us to do. However, it took me less than 24 hours and one psychiatric consult to realize that we have failed. We are missing the hidden pieces — the mental illnesses that creep into our lives and infiltrate our society: these are the silent killers, that are just as (if not more) deadly.