The Charles Manson Fan Club of 1

I just had to talk about this session this afternoon. The patient is a 20-something caucasian female, slightly obese, dressed in a T-shirt and jeans. She sat with a grimace on her face and pulled at her shirt sleeves, looking somewhat uncomfortable, somewhat anxious, somewhat depressed. The session blew my mind away. She talked about being a fan of Charles Manson. She sent death threats to another psychiatrist who hospitalized her over Christmas for suicidal ideation. She said to relieve stress she was thinking of doing something different... like smashing someone's head with a sledgehammer. Her therapist recommended she try smashing a watermelon first -- you know, just for practise and to see what she would have to deal with afterwords. She did. She set up the watermelon in her kitchen and smashed it with a sledgehammer. Somehow, this convinced her to abandon her plan because she says she's been cleaning out watermelon seeds and pieces from all over her kitchen for weeks now. Instead, she thought she might try jumping from a high point. I thought she meant bungee jumping, but further elaboration revealed she meant without a cord or a parachute. I surmised this when she said "the jump would be fun, but hitting the ground would hurt." Incidently, she brought in something she had sketched. It was a pencil sketch potrait of herself, drawn as Mona Lisa sitting in a bathrobe on a torn sofa. The Mona Lisa looked liked a photograph. I thought she must have been drawing it from a picture. She casually mentioned she had drawn this from memory. Of course, how much of this was shock value and how much of this was psychosis? Apparently, her body is like railroad tracks from the self-mutilation. Laugh if you will, but look behind you when you're walking home alone at night...

In the morning, I got a wish I had for some time. I was really interested in seeing dementia -- vascular, Alzheimer's infectious disease-induced... Well, I spent the morning in the geriatric psych ward. Fortunately (or unfortunately), I had been on call with my attending covering all the patients there both Saturday and Sunday, so this morning when I went to see them again, but this time with an internal medicine doc, I felt like I was meeting old friends. One of them -- a troubled 60-something year old female of mixed caucasian-indian descent came up to me and hugged me and woulnd't let me go. This, in the middle of the lunch room at lunch time. Whether from the meds she was on or from previous activities, her voice was heavily slurred and words came out agonizingly slowly. As she held me close, she announced to me and to all present, "Doctor, will you kill me please?" Then in a little louder voice, "Please doctor, kill me!" Finally, screaming while hugging me tighter, "Kill me, Doctor!" Okay. So I think I've seen enough dementia. There was one really cool thing though. Over the weekend we had seen this sweet little old lady with crippling parkinson's. Today when I saw her, she kept sticking her tongue out at me in a tic-like fashion. It took me a few seconds when I realized what I was looking at...tardive dyskinesia. And finally, there was the retired psychiatric Charge Nurse who over the course of her 40 years of service has probably trained half the psychiatrists in the state we're in. My attending spoke respectfully to her and told me later that she taught him and helped him a lot when he was an intern 20-odd years ago. Her memory has gone to pieces, but as is often the case in such dementia, when he quizzed her on some old psychiatric drug pharmacology, she spit out the answer even before I could hazard a guess. I'm enjoying the psych rotation... in a strange kind of way. Now when I walk in the mall, I see people differently...

More later...