My promising patient tormented by disease and drugs

When I first met Jason, I was a third-year medical student halfway through my psychiatry rotation, and he was a newly admitted patient halfway through a nasty comedown from crystal meth.

He sat slumped in his chair scowling with his face hidden by a baseball cap and black hooded sweatshirt and growling responses to my interview questions.

“Why do I have to do this? I hate this crap. I’ve answered these bullshit questions a million times. I’ve been in the psych ward a million times, and it’s never done anything for me.”

Reading his records, I realized that “a million times” wasn’t such an exaggeration. At only twenty-five, he’d been admitted to most of the local psychiatric hospitals. For several years, he hadn’t been out of the hospital more than a few months at a time.

His diagnosis was either schizophrenia or methamphetamine-induced psychosis. He’d started having psychotic symptoms at 19, but he’d also started doing meth around then, so no one could figure out which came first.

This time, the police had brought him in. His mother found him hacking at his shoulder with a knife, saying, “Die, die, die!”

Getting to know Jason over the next few days, I found him polite, even charming — which, in my experience, was unusual for someone with schizophrenia. He had an open, friendly smile and strikingly bright blue eyes, and he was funny and smart.

One evening, I noticed him standing in a common area, drawing on a whiteboard. Using only a few fading dry-erase markers, he’d drawn an elaborate, surreal cityscape, and its buildings were interspersed with intricate geometric designs.

“That looks awesome,” I said with admiration.

“Thanks!” he answered cheerfully. “I just started doodling, for something to do, but I ended up getting really into it.”

“Do you draw a lot?”

“Used to,” he said. “Took some art classes in high school, they were pretty fun.”

“Was art your favorite subject?”

“Either that or math,” he replied. “I was good at math. I used to think it would be cool to study, like, architecture, since it kind of combines the two.”

“That would be cool,” I agreed, surprised to feel a lump rising in my throat.

These moments of connection with Jason were the reason he made me sadder than any of the other psych patients. I felt for all of them, but most had been so ill for so long that it was difficult to imagine them without their diseases. Jason, when lucid, was no different from my male friends and classmates.

He was only a year younger than me — if things had been different, we might have gone to the same college. Maybe he’d have majored in architecture or engineering. We might have taken physics or calculus together. Now he would be in graduate school or working.

I pictured him meeting up with friends for happy hour, his blue eyes flashing enthusiastically as he talked about his new work project or his Ph.D. I found it so easy to imagine who this guy might have become if his brain cells had been wired slightly differently, or if he’d never started doing drugs. So easy, and so heartbreaking.

It quickly became clear that, despite almost Oscar-worthy efforts to impersonate an improving patient, Jason was simply too sick to be discharged.

Asked about hearing voices, he’d give a bemused shrug and reply, “The medications are working great. I think they’re really helping me. Thank you so much, doctors.”

But he’d also stand in the shower for hours, fully clothed, or pace the unit with his headphones’ volume cranked up, trying to drown out things that no one else could hear.

Once, at morning rounds, I saw that he’d drawn colorful stripes all over his face with Sharpie markers.

“Can you tell me about the stripes on your face?” I asked.

“It’s just a thing I do to keep people from messing with me. It confuses them, you know? I can wash it off if it’s a problem.”

Although he gave the “right” answers in that morning’s interview, his tone was clipped and snappish.

“Do you have any questions?” I concluded.

“Yeah,” he said. “Why am I still here?”

“Because we want to make sure you’ll be well enough when you leave, that you don’t have to come right back. And we want you to feel better.”

He gave a short, sarcastic laugh. “You can’t make me feel better.”

“Why not?”

“You just can’t!” he snapped. “You’d have to cut people out of my body to do that!”

“What do you mean?”

“They come up to me and mess with me and get inside me and they eat my organs, and they destroy my brain, and the only way to get rid of them is to cut them out!” he said, his blue eyes blazing with anger and fear.

“Is that what you were doing the night your mom called the police?”

He started to yell and swear at us — and, it seemed, at his invisible tormentors, too. My attending took over the interview.

By phone, Jason’s mother confirmed his psychiatric history, but also told me what Jason had been like as a kid — sometimes rambunctious, but very sweet and affectionate, never embarrassed to hug or hold her hand in public.

“Now he screams at me all the time,” she said hollowly. “He calls me names constantly. He’s threatened to kill me so often. I don’t think it’s safe for him to live with me anymore.”

I realized that I was talking to a mother who’d lost her son in a way that didn’t even provide the dignity and closure of a death certificate and a funeral. She’d watched him deteriorate before her eyes into someone just recognizable enough to break her heart.

On my last day on the unit, I went to say goodbye to Jason. I wasn’t sure what to say. But I wanted to find some way to tell him that I could still see the bright, kind person he might have been and that I was rooting for him to get better — to take his medicine and stay off drugs so that he could realize his potential.

I found him pacing the unit. There was no marker on his face, but he wore a surgical mask from one of the nursing stations and a heavy winter jacket.

I waved to get his attention, and he walked over.

“Today’s my last day here, and I wanted to say goodbye,” I said, reaching out to shake his hand. “It was a pleasure getting to know you, and I wish you all the best.”

“Thank you, Ma’am,” he said woodenly. His eyes above the mask showed no recognition. With a polite nod, he turned away and resumed pacing.

Watching him disappear around the corner, I wondered what frightening creation of his brain he was trying to avoid.

It’s been more than a year since then, but I still think of Jason often. Sometimes I wonder if I’ll see him on one of my emergency-department shifts. Maybe the police will bring him in screaming and swearing, high as a kite on meth. Or maybe he’ll actually try to cut out the people inside of him and come in as a trauma code.

If I don’t see him, though, I will hold out hope that by some miracle he’s getting better — that some combination of medication, psychotherapy and sobriety has saved him while he still has a chance at becoming the person he should have been, before disease and drugs burn the light out of his blue eyes.

Beatrice Leverett is a medical student. This piece was originally published in Pulse — voices from the heart of medicine

Image credit: Shutterstock.com

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