Truthfully, I pick her name off the new patient list because it belongs to a woman, and several of our male patients have already come upstairs flagged for aggression. It is too early in the morning, and late in the week, and I haven’t yet learned that female patients can be just as unpredictable as the men. I am in a hurry this morning, and I make the mistake of not skimming through her chart before I go in to see her. I don’t know any more than the barebones: her name and her chief complaint upon admission.
I find her wandering the contours of her small room, which is set back in a mostly empty hallway. She is brandishing a toothbrush and a tube of toothpaste. Initially, I take this as a promising sign, but the incomprehensible muddle of words that tumbles out in response to my morning salutation dashes those hopes. The term that I will pen into the chart is “word salad.” Taken aback, I pause, one foot bracing the door open. Almost immediately, I realize that there is no possible way I am going to get a meaningful interview this morning. Yet, I feel an obligation to at least give it a good effort. “How did you sleep last night?” The response is a crazy-quilt mish-mash of scenarios involving people who talk underwater, turkeys and flowers.
“…pansies, that’s for thoughts…”
As I plaster my back to the wall behind me, she stands uncomfortably close, swaying inwards as though preparing to ask me a question. But she never quite manages to make the words line up in the correct order. I have never encountered someone so floridly psychotic before, and I am equal parts fascinated and horrified. I am unable to tell if she truly even registers my presence, if she knows where she is, or if I have simply been slotted into the cast of characters populating whatever strange drama is playing out behind her opaque brown eyes.
“..she chanted snatches of old tunes;
As one incapable of her own distress…”
I decide to call her Ophelia.
As is often the case with many of the patients with schizophrenia populating our inpatient ward, the psychiatry team can only assume that Ophelia is in the throes of her psychotic episode because she had stopped taking her medication. However, we will be unable to know for sure until she comes back to herself enough to tell us so. Her parents do not know, although they suspect that she has been neglecting to take her Risperdal. At first it does not appear as though there is going to be much improvement.
Over the course of the last few days of the week I watch her roam the common area, a bar of soap thrust out in front of her as though it is a compass. Perhaps she hopes it will help her map a route back to reality. Sometimes she totes around a rolled up towel, cradling it as though it is an infant. Other times she sidles up and stands on the fringes of our group during rounds, a something almost like a smile on her face. It is as though she thinks we are playing a game, and she is waiting to be picked for someone’s team. I leave for the weekend without much hope. By the start of the next week however, the medication has begun to work its magic.
“…rosemary, that’s for remembrance…”
On Monday, when I greet her with a “good morning,” for the first time her eyes truly focus on mine. Although she is still prone to slipping into nonsensical wanderings, she is now capable of holding the better part of a conversation. There are still cracks in the healing façade of her mind, but the contrast between the two interviews is stunning. Especially since last week she had not even been capable of stringing two words together into a sentence. When I ask her if she has been taking her medications at home she gives me a guilty look, and shakes her head.
“There’s rue for you, and here’s some for me.”
Before I met Ophelia, in a dim corner of my mind that I was always a little ashamed of, I thought of many of the inpatients on the psych ward as simply crazy. I had not yet made the connection between psychiatry and illness, but Ophelia was, perhaps, one of the most desperately ill patients that I have seen in my clinical rotations. She played a crucial role in changing how I thought of psychiatric patients. A sickness of the mind is as concrete and as damaging as any sickness of the body. It was only after this realization that I felt I really began to get the full measure of worth out of my psychiatry rotation. Rather than viewing my psychiatry rotation as an annoyance to be borne, I gained a deep respect for those doctors who stare into the shattered mirror of the human mind.
“…you must wear your rue with a difference…”
Contributing Writer Emeritus
University of Louisville School of Medicine
Erin is a Class of 2016 medical student. She has a B.A. in English. She took a year off before medical school to work as a Emergency Medicine scribe, and to learn how to make cupcakes from scratch. She enjoys discovering the story-telling inherent in every patient encounter.