Find The Time

Jim was 57 years old….he was not my patient - but maybe he was. I cared for Jim’s father, Richard. After a lifetime of great professional success and now at the age of 90, Richard’s memory had started to slip. First it was names, then dates, then breakfast. He initially had some awareness of his failings - and so frustration creeped in.

Then, as time moved on, even that awareness disappeared. Dementia. Soon Richard couldn’t even tell you what day it was. And he didn’t recognize his own son, Jim. ‘Time it was and what a time it was, it was A time of innocence, a time of confidences. Long ago, it must be, I have a photograph; Preserve your memories, there all that’s left you’. (Simon and Garfunkel) Sadly, Richard no longer had any memories. And sadly, his son Jim was feeling desperate; crying. Wanting his father back, if even for a few minutes. Jim pleaded with me, even yelled at me, as if I had some magic to bring his father back. But, except in rare cases, dementia is not reversible. There was nothing I could do. And so I sat with Jim as he wept. Jim shared that he and his father had a falling out years before; a stupid argument. And then pride got in the way. No efforts made to reconcile. And years of estrangement. Jim now wanted to tell his father how sorry he was, how much he loved him - but Richard’s eyes simply did not register. And Jim was left alone. In my work, I have witnessed this all too many times. Life is short; life is precious. Mistakes are made. No parent and no child is perfect. Don’t wait too long, because you may never have the chance to ask for or to give forgiveness. ‘I’ve long since retired, my son’s moved away I called him up just the other day I said “I’d love to see you if you don’t mind.” He said “I’d love to Dad if I can find the time.” (Harry Chapin) That last phrase, ‘if I can find the time’, resonated as I tried to comfort a 57 year old son.

Ramblings...

Every day, as I ramble about the psych ward from room to room, the goal is to help, to do no damage. Working in a psychiatric hospital is an awesome responsibility because we have peoples’ lives in our hands. We need to listen, truly listen, to do the best we can to put ourselves in our patients’ shoes and mindsets.

We try our best to give words of counsel and, when necessary, to medicate judiciously.

Most of our patients are receptive to our efforts, and get profound relief from dark palpable depressions, intense manic episodes, excruciating panic attacks, and paranoid delusions.

But sometimes we psychiatrists are in the awkward position of needing to force treatment to those who are aggressive or floridly psychotic. In this way, hospital psychiatry can be an ugly job. Those patients, in their deep frustration, threaten us, make verbal and physical gestures of violence. It is up to us to keep our cool. We have to be aware that they are in pain, pain that expresses itself in all sorts of way.

Psychiatric work in a hospital can be an amazing opportunity to turn a person’s life around. Watershed moments. I have seen so much suffering over the years: orphans, widows, poverty stricken. People whose DNA destined them for psychosis, mania, addictions. People who simply never learned , were never taught, how to push the pause button, never conditioned about self control. People who suffered horrific abuse, who didn’t have good parenting, or no parenting at all.

People who are utterly alone. Think Eleanor Rigby. People who are the forgotten of the world.

The world of hospital psychiatry is a universe unto itself. Spend one day and night there and it will change your life. Every day I am witness to life’s journey in its rawest of forms. A challenge and an honor to see each person’s dignity, to try the best I can to never diminish their passion or spirit.

I am blessed to have been touched by so many.

His friends called him Tommy....

In high school, Tommy was Mr. Everything: handsome as anything, top 5% academically, football quarterback, led the basketball team in scoring, great sense of humor. How the girls flocked to him. He was living the dream, a future with endless possibilities and promise.

I first met Tommy when he was 47 years old, room 314 in the psychiatric hospital. He told me he wanted to die. Jump off a bridge, just end this whole damn nightmare: “The voices, Doc, the voices, I can’t stop them.”

Life has a strange way of moving forward. We cannot know what awaits us, nor should we. We make our plans, but sometimes things just seem to happen, and everything turns upside down.

Two years after his stellar high school journey, when Tommy was 20, something happened. Slowly, subtly at first, Tommy started believing that his friends were taking his things. Then he started commenting how the government was poisoning everyone’s food as a form of mind control. Soon Tommy was missing his college classes, too tired to go. His grades plummeted. He forgot to take showers. His inner world had changed, but his friends still adored him.

Sadly, tragically, Tommy’s journey started heading down a road of no return. Schizophrenia. His life became psychiatric hospitalization after hospitalization. His mind was plagued by voices telling him that he’s no good, that the world would be better off without him, that no one loves or cares about him. He didn’t want to live this way. Suicidal. And he hated taking meds which made him gain all too much weight.

“Here’s a picture of me in high school," Tommy showed me - and there he was in his basketball uniform, tall and strapping and confident. I asked if he had any more pictures - and we looked at some family photos in days gone by. He started to cry, then caught himself. Then, in a flash, things shifted and he wanted to warn me about the mafia: “they already got my Mom, Doc, but soon they’re coming after you…”

Tommy and I developed a wonderful relationship during his two week stay on the psych ward. Having no filter for communication, he liked telling me about his high school girlfriends. He would carry around a Bible and want to discuss certain passages. He told me about his Uncle Bill and his dog Charlie and the mob and conspiracies and the haunting voices - and then please doc, can you get me more snacks. He never stayed with one topic for very long. Over time, the intensity of the voices and the paranoid delusions decreased. He reluctantly took his medications, which did help, but he continuously complained about them.

I grew so fond of Tommy, and learned so much from his pure refreshing soul. His spirit always put a smile on my face. Yes, maybe he was a star in his younger days - but, as a 47 year old with Schizophrenia, in his earnest innocence, he still had the ability to touch people, to make the world a better place. And so, feeling better, he finally left the hospital and headed back to his group home and mental health clinic.

Sadly, I never saw Tommy again. I read about him in the paper. Six months after he left the hospital, he stopped taking his meds once again. The voices intensified. A tortured soul, Tommy had taken his life.

I went, quietly, to his funeral. Hundreds of people were there. Family and friends. Feelings of love and adoration.

Celebrating Tommy.

I have since often thought about this beautiful young man. From high school star to a suffering and yet engaging adult, his life clearly was not in vain. Maybe I could have, should have, helped him more. It’s hard to know.

One day recently, for some reason, I suddenly remembered that when I first met him, I had addressed him as ‘Thomas’, the legal name that was on his chart. But after a week of good talks, he said with a big smile, “Doc, you can call me Tommy, like all my friends do.”

And Tommy remains with me - both then, now, and forever.