working with miracles

I've been working. I love my work. I run up and down the hallways and stairways of my hospital talking to patients about the crises that have brought them to my care, usually on an involuntary basis. I spend a lot of time talking to team members about how we can best help each patient. My job is to select and manage medications and to somewhat lead the team when I'm covering for a vacationing psychiatrist.

I think I work with miracles. Biological miracles, at least. I'm astounded weekly by what disturbed brain chemistry can make folks do, whether disturbed by natural causes, or a foreign substance like methamphetamine, crystal, or heroin. It is nothing short of a miracle.

I wish I could tell you what the brain chemistry can make folks do, but an actual story might make my patients recognizable, and violate HIPAA laws. My patients are admitted to the hospital in extreme states of vulnerability, unable to care for themselves, or control their own behavior to the degree that someone is in danger--my patient or other persons. This is the definition of grave disability, danger to self, and danger to others. Danger to property falls into the commitment criteria as well. My patients occasionally make the news before they come to my hospital.

Psychosis and mania are so stereotypical that the stories all run in similar form:

"I thought I was god...I had the cure for AIDS if I could just remember...I'm working with the FBI and I can't tell you any more...someone is trying to kill me, but they can't get into the hospital, so it's safe here..."

Such statements are the bread and butter of the assessment process of the psychopharmacotherapist. We assess behavior as well, and make inferences when patients can't talk to us coherently. Patients take their clothes off and stand on their heads, or wear many layers of clothing, perhaps with pajamas or underwear on the outside. Others wrap articles of clothing around their heads, and may wear a denim turban with a Levi's tag over their 3rd eye for a few days. Others are so fearful due to their biologically distorted perceptions that they are assaultive to staff or other patients. They may integrate us into their delusions sometimes, and all we can do is medicate, and wait for the next miracle.

The next miracle starts when I select the right medicine for the patient. If the patient will take the medicine, the chaotic brain chemistry slowly begins to stabilize, and the real person behind the biologically driven behavioral chaos emerges. I never tire of watching this process--the return of the patient to the consensus tract that more of us share.

The next miracle is when the real person with the stabilizing brain chemistry emerges, and starts asking questions, piecing together what happened. Or not. Some do not want to talk about it. Some want to know what they can do to prevent it from happening again. Some already know. They remember exactly what happened, what they were thinking as they were engaged in their respective dangerous behaviors, their fire-setting, car wrecking, self immolation, etc.. Some set out to change their lives. Some set out to change their lives many times.

I used to try to interpret all this behavior through various psych* theories and paradigms. Now I just think of all as miraculous and consider myself blessed to be present and be of service.