The Psychotic who predicted her death

This is the story of a dear patient. Sne was a cauc. Female in her early forties who was found orthe floor of her home in feces and filth. She was malnourished.when we interviewed her,she was actively hallucinating. She saw bugs, heard voices. In got to do the complete psychiatric interview on her. She was very interesting. A few days ago, in the early morning, she was found pulseless and not breathing. A code blue was called. PEA was identified and the appropriate procedure initiated. Forty minutes later, a pulse and respiration was re- established. We do not know how long she was down for. since the last person to see her active was a phleblotomist who came to draw blood @ 4:10am in the morning.

She was intubated and transferred to the icu as I write this. Will she make it? She told a nurse yesterday that today she would die. Depending on how long she was down, her brain has been deprived of O2 for a good while. Did she attempt suicide? If so, how? She told another med student yesterday that there were 2 people in the roomM with her (hallucinations). Did 'they' kill her?

Iain writing this update a few days later. The pt. is dead. She died in the evening after we all left the hospital. From the time she wss transferred to the lCU she never regained consciousness. We determined that she was breathing a little on her own, but otherwise there wss minimal brain function. We had her on 8 ug of dopamine to keep he BP up. Towards the end of last week, it was agreed upon by family and her attending doctors that she was never going to regain consc. Her pupils were fixed and dilated and she showed only primitive reflexes. Her relatives asked that we disconnect all machines. Her attending physician felt that this would be too aggressive and active a move. Instead, heopted to keepthe ventilator on. Towards yesterday evening the pt. began to develop a climbing fever. Nothing was given for it. This was the acute Cause of her demise.

This case was interesting because of the rapid turn of events, the psychosis and in the end, our inability to elicit a favorable outcome for her. It was a tragic story. I believe that everyone acted appropriately. However, none of us who participated in the case came away happy. We lose some battles in spite of everything.