Listen To The Patient...

I worked the inpatient psych/addiction scene for close to fourteen years before re-entering the detox and day treatment scene. This story is from those inpatient days.

Phil was a guy that would come in a couple of times a year. He would go off his anti-psychotic medication (stelazine) and then go on a two, three day bender drinking; which would cause him to lapse back into a state of paranoid schizophrenia.

This last time I worked with him was no different. It had been a beautiful summer and Phil thought it was too nice not to have a couple of beers. Well, this couple of beers escalated in a day or so, to drinking around the clock. We are talking a case a day plus. Per usual he had stopped his medication from day one of this episode.

By the time he came in he was in an ever increasing state of paranoia. He was convinced that the F.B.I. was watching him and they had tapped his phone; that is what the voices were telling him anyway. As was typical with a patient in this state of mind they cannot be convinced otherwise. I would acknowledge to him that I believed he was hearing voices; but that I was not.

I had built a good rapport with him over the years and he would seek me out on the unit when in the throes of another extreme episode of feeling paranoid.

Phil had been assigned to one of the new psychiatrists on the unit at the time. One that had been schooled in all the “new” anti-psychotic medications; hence he started Phil on one of these newer medications. When that first one did not work he tried another and after several days with no effect, a third.

In the meantime, Phil’s state of paranoia was ever increasing without relief. I could sense his agony going through this process. He had asked the doctor several times to go back on stelazine and the doctor kept putting him off on that being an option.

Finally after a week or so of this ‘experimentation,’ Phil was ready to explode.

I went to the doctor with this info and his response was, ‘if we need to, we will have a ‘show of force,’ and then restrain him if necessary.’ After this compassionate statement I let him know that those of us working the unit referred to a ‘show of force,’ as a ‘show of support,’ rather the arcane, negative, ‘show of force.’ He seemed put-off by my remark, too bad I thought. I am there for the patient, not for some pompous ass, using Phil as a guinea pig.

The next day Phil came to me, ‘please Willy tell him just to put me back on stelazine.’

So once again I went to the doctor to tell him of Phil’s desire to be started back on stelazine. He responded to my statement by saying, ‘stelazine had a lot of possible side-effects.’ Side effects doc, he has been on stelazine for ten years now, don’t you think he would have experienced them by now?

His first remark back to me was, ‘my name is Doctor XYZ, which I would appreciate if you would use in the future when addressing me. I made no comment back. The rest of the “doc’s” except this one wanted us to call them by their first names; they respected our observations, counselors and nurses alike. We were a ‘team’ that looked out for each other on the unit; we watched each other’s backs.

He went on to say that “he” knew what was best for Phil.

I had had enough. O.k. “Doctor XYZ,” let me tell you what is going to happen. Phil is riding the edge right now and it is only a matter of time before he goes off. I’m pretty sure you have noticed that he is quite a large man. Say, what, about six-foot four, roughly two hundred and sixty pounds. I’m fairly certain that when I go back and inform him that you do not plan on putting him back on stelazine, he is going to go after you…and you know, by the time we can get the Code team together…

“All right,” he said, “I will talk with him now about the ‘possibility’ of going back on stelazine.” He was perturbed at me; I didn’t care.

Well, he put Phil back on stelazine and he stabilized enough in three days to return home.

Listen to the patient…