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The Art of Medicine

Sifting for truth

Katers, Laura A. MS, MCHS, PA-C

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Journal of the American Academy of Physician Assistants: September 2018 - Volume 31 - Issue 9 - p 58
doi: 10.1097/01.JAA.0000544308.40363.94
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What I know is this: a body in motion tends to stay in motion, unless acted on by an outside force. Tweaking Newton's First Law of Motion, I surmised a person who is unstable tends to stay unstable, unless there is an intervention, or outside force. In medical-speak we call such interventions Haldol IM. We call this involuntary commitment. In community-speak, we more than often call this intervention jail.

Richard arrived because there was nowhere else to go. A disheveled and slim 60ish-year-old man with vibrant blue eyes and a sun-riddled face, his legs were mere shadows under his worn green hospital gown. He wore another gown in reverse, like a jacket, “To keep all the bits in,” he said with a chuckle. The chuckle melted his face for a moment; then it was once again masklike and stern.

Richard called 911 to report abuse of homeless women in wheelchairs. His goal: to get attention. When the police didn't respond to his offhand and confusing statements that the “women on scooters are being terrorized,” his story changed. “I'll blow my brains out,” he then said to the responding officer. “I have the means.” Attention, he got.

When I met him he looked like every other patient in the psychiatric holding wing of a large state hospital. Even if he wanted to, he couldn't leave. Even if he could somehow vanish all the alarming things he had already shared, things that allowed us to temporarily suspend his rights, he had nowhere to go. There was no independence with only a sheet as protection from a world of prying eyes and medications. There was no identity, no necklaces or bracelets or tee shirt with a favorite band splashed across the front.

And anyway, Richard had more interesting things to say. Over the course of days, he told me extravagant tales of living for many years as one of the very wealthy 1%, owning large properties in an affluent city, enjoying high respect and regard in his community. He was a mountaineer and taught others how to scale peaks over 14,000 ft. At one point, he also worked extensively with the local police in search and rescue. In Vietnam, at 20 years old, his job was to carry bodies that arrived from the field to boxes that would carry them home. Something happened, he told me, after carrying all those bodies. He met Nixon. Wasn't right in the head. Was honorably discharged. As I listened, I sifted for truth. We didn't have a last name or a medical history aside from what I was collecting in the moment. A student at the time, I also knew the hallmarks of delusion, which is to say, a delusion cannot be reasoned away. Was Richard delusional? Was he a military vet with an honorable discharge and a life of hard-earned privilege, or a man who followed women in wheelchairs professing to protect them but perhaps instead causing them harm? As a medical team, we needed to know so that we could treat.

Of course, treating and healing are not one and the same.

I went home that night and asked my roommate to role-play with me. I'd borrowed a gown from the hospital, put it on, tied it loosely in the back, and sat myself in a chair in the front room. She walked in and laughed, but I was stern. I went through my own history, not knowing what my end game was, until I offered that I played college soccer against Mia Hamm (at the time the most famous female soccer player in the world), and my roommate (off-script) stated, “No way!” And it was there. Buried in her eyes. A mirror back to me where I saw myself in this horrid role of trying to convince another human that I was whole and sound, that I was me. I tallied off other tales: winning a trip to Alaska with Backpacker magazine, publishing photographs and essays, interviewing Temple Grandin before she became so famous. All true. Only now I felt unsure because the smirk on the face of my roommate—a psychology student—said she thought I was still playing along.

As if the gown itself rendered anything but only potential pathology obsolete.

I googled Richard to find information about him or family we might legally be able to contact. And there, parts of his life unfolded as so many of our lives have become intertwined with the Internet. I found his wealth, and his properties, and other parts of his life I didn't believe when he narrated them. I felt shame for allowing the gown to get in the way of listening to this extraordinary man who, in nearly every way, was just like me. We eventually found Richard's doctor, who told us about the brain mass that began to cause disorientation years earlier, and Richard was put back on the medications and treatment that would let him eventually leave the hospital, and the gown, behind.

A body in motion tends to stay in motion. Unless.

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