Thursday, June 17, 2010

No Miracles Here

A box of Risperdal tablets

I saw him masturbating through the eight-inch square, reinforced window in the door to his room while doing 15 minute patient checks. He was in seclusion because, despite the tempering effect of antipsychotic medication, he wasn't convinced we weren't phantoms. Sweet sixteen and muscular, when he was admitted days earlier, he was four-point restraints, tied as securely, we hoped, as a calf in a rodeo roping event. Now off restraints, he was still unpredictable and a swing of the fist was one way to find out if we were real or not.

He'd been at a rave party and someone gave him a hit of ecstasy -- MDMA or 3,4-Methylenedioxy-N-Methylamphetamine (one of those fifty dollar words we pretend to memorize in medical school). It's not uncommon for ecstasy to contain a mixture of chemicals and someone theorized his included ketamine, an anesthetic agent that may cause severe hallucinations. All we knew was, we had a psychotic kid with an uncertain prognosis on our hands.

His repetitive masturbation had become an expression of his mental state. Perseveration is the tendency to focus on a thought, word, or behavior, and repeat it over and over, almost like an obsession. In this case, most of the time he seemed scarcely conscious of what he was doing, though on one occasion, when I cracked his door open to verify he was okay, he came off his bed quickly, angrily demanding his privacy. I gladly gave it to him.

When his friends came to visit, he seemed almost normal and that was about the only time. I'd like to tell you his story had a happy ending, that he responded well to the medications, eventually was able to talk about his experience and express hope for the future. The truth is, after six weeks, he was transferred to a long-term care facility and I never heard from him again.

This is one of those situations you hear about but have to see to believe. Sixteen, popular, athletic -- he had a beautiful girlfriend -- his entire life was ahead of him. Whether the drug triggered an underlying schizophrenia or did irreparable brain damage, no one could say. He'd gotten better but he hadn't gotten well, and it wasn't clear he ever would. There should be a sign on the door of every psychiatrist, "Miracles are not performed here."

Even though we'd like them to be.

(Creative Common Image via Wikipedia)
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