Wednesday, September 3, 2014

A Year of Diaphoresis

Medical terms aren't meant to be mysterious. They're intended to quickly communicate to other medicos the current status of a patient but anyone not in the healthcare field finds it so much gibberish. It's not for we uneducated to understand, we rationalize, and that's okay as long as they know what they're doing, but that's not always the case.

There are so many patients that I can recall at the many places I've worked that it's like reading a familiar book of short stories, only O'Henry didn't write these. These tales were lived and carefully nudged into whatever chemical structure comprises our memories, but they live, nevertheless, and so it is today. Occasionally, one boobs to the surface like a swimmer asking to be noticed and maybe that's what memory is; the reliving of moments not to be forgotten and jogged by some small thing in our present lives. I'll resist the temptation to become philosophical here.

The day started out like so many with morning meetings, patient groups, walks to other buildings for yet more meetings, chart reviews, informal hallway chats and admissions. The admissions one was where I first saw him from afar.

A young man, probably in his middle 20s or so, long oily hair in tangles, dirty, torn clothing and totally incoherent in his speech. It was not unusual except for one thing, he was diaphoretic and that was a bit unusual. Patients admitted to psychiatric hospitals aren't usually in any medical distress and it appeared this young man was or was he? Not being an MD, I dismissed it as something to be evaluated by the physicians on the unit. No, it wasn't a mind-body thing and, therefore, not in my province of expertise.

The next day, I learned that he had been transferred from the Admissions unit (quite unusual quick transfer) to a unit for the severely disturbed, not the Hospital unit. Again, somewhat of an unusual move for a patient who appeared to be in some type of medical distress. I happened to be on that unit that day and saw him seated in a chair where a muscular male nurse was carefully combing and cutting his hair. I never knew shampoo was such a good medium for cutting hair, but that's what the nurse was using.

He sat just staring ahead and once in awhile he would blurt something out, but it was totally indistinguishable. No one knew what he was saying, but he was docile and allowed the cutting to continue, so no restraints required here.  I did notice, however, that he was still diaphoretic and the nurse remarked that they'd already changed his clothes twice that day because he was sweating so much. Why was he sweating? The ward physician had looked at him, but didn't have him transferred to the Hospital unit. Why? No answer. That was the way it was and no one questioned it.

Weeks later, I inquired about the patient and was told that they couldn't figure out his diagnosis. He was still sweating profusely, had been pulling his teeth out and no one could get through to him. Not violent, but seriously agitated.  Can you think for just a moment how you'd feel if you were feeling awful, probably psychotic and couldn't get anyone to understand your needs? It must have been incredibly mentally painful.

The months went on and I worked at other units at the vast hospital where I was transferred to the Hospital unit at one point. It had been a year since that patient had been brought in and I questioned one of the physicians. I was told that they just couldn't figure out the problem and he was still sweating as before. If I said I was shocked, that wouldn't even come close to my disbelief about the way this young man was being treated. Why hadn't he been transferred to an outside medical facility? No one seemed to know or cared to ask about it. Life went on and they just did their jobs as before as though he never existed.

A few years later, I was talking to a colleague and I mentioned this patient. I wondered what had happened to him. The colleague vaguely remembered him and said he'd died. They thought he might have had AIDS-related dementia. Yes, yes, I know what you must be thinking. How could this happen and if it were AIDS, didn't anyone consider the contagion factor? Well, in a hospital where they didn't know sodium bicarbonate from sodium pentothal, it wasn't surprising. And where the psychiatric nurses didn't know what they were seeing with some patients was called akathisia and not "the Mellaril shuffle," it shouldn't have surprised me.

I got out alive and healthy. The young man never made it.