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    The true power of medicine

     



    I stepped back into the room. “How long has she been catatonic?” I asked the nurse warily.

    “91 days. She doesn’t even eat or drink anything. We’ve had to put her on total parenteral nutrition just to prevent her from dying. Her condition has deteriorated. And she shows no sign of improving.”

    I had prepared a study guide of questions I was to ask in my interview. A check-list for bowel movements, diet, suicidality, homicidal ideation, auditory and visual hallucinations. I stuffed the sheet back in my pocket. I looked at Amanda and caught her gaze. She stared at me, past me —through me—with the most sunken, sullen eyes. At that very moment, I knew what the gaze of true hopelessness looked like. I asked her how she had slept. I asked her what she was reading. Nothing. She was completely motionless, unresponsive, rigid, inflexible, gaunt—frozen.

     

    IN CASE YOU MISSED IT: We need to continue progress in primary care



    I stepped out. I rushed to my attending physician in utter disbelief. “There MUST be something we can do for Amanda. She’s hypoglycemic, hypotensive, she refuses all meals and drinks, she is literally wasting away before our eyes. Why? There must be some medication to help her.” My attending gave me a stern yet understanding expression. Amanda suffered from catatonia of unknown cause, he told me.

    B12 deficiency, infection, trauma, schizophrenia, mood disorders—all ruled out. We literally had no idea why this poor woman ate nothing, drank nothing and moved not an inch. My attending had tried various antidepressants and benzodiazepines—a sedating class of medications that ironically helps in catatonia—to no avail. Amanda had been hospitalized for three months, currently weighed 79 pounds and was refused to be admitted by the Medicine Department because they did not view “catatonia” as a legitimate medical ailment. I was utterly enraged. How could the docs in internal medicine not accept someone dying right before our eyes? The psychiatry team would constantly consult Medicine as a way to pressure them to continue being involved in Amanda’s care. This was the best they could do.

    My attending placed his hand on my shoulder. There was still hope, he said: Electroconvulsive Therapy (ECT). According to the literature, ECT—a targeted shock to the brain, under general anesthesia—provides 80-100 percent relief in catatonic patients, even in those whom pharmacotherapy with benzodiazepines has failed. A wave of relief overcame me at once. She won’t waste away after all, I thought. I asked why ECT hadn’t been carried out already. My attending, with a drawn-out sigh, explained that because she is completely mute, she did not have the capacity to provide legal consent for the procedure.

    Next: The best physicians heal patients and themselves

    Ramin Rajaii
    Ramin Rajaii is a medical student at the University of California, Irvine School of Medicine and MBA candidate at the Indiana University ...

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      Mr Rajali might consider an alternative career as an author or journalist. Best medical writing that I can recall.

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