He was 35 and tall and thin, with beige hair and a rare grin he claimed only I could elicit.  He enjoyed seeing me. He always came with a knapsack, because he didn’t really trust the other people in the residence where he lived.  He probably had reason to feel that way, for things had been stolen from him before.  Things like medications.  He reported these things to the pharmacy involved.  Both they and I believed him.  After all, these things happen.  He had not abused anything known to us.  Besides, medications are frequently stolen.

The diagnosis was schizophrenia, that too-often debilitating disease that hits at least about 1% of the population and that is still generally considered manageable but incurable.  He was actually doing pretty well, living in a residence and “stable” after countless hospitalizations.  I asked him about his plans for the future.  He told me he had been attending information sessions about an interesting course at a local college.  Now I knew that local colleges, this one in particular, were famous for providing “practical” education.  I had even heard of a bachelor’s degree in auto body work. He told me he wanted to learn to make guns.  I tried not to appear nervous here, but I was impressed that he could read my emotions well enough to tell I was worried.

“Don’t worry, Dr. G.  I am not going to hurt anybody and I don’t want to kill myself.  You must worry a lot about that because you ask me every time.” Good — he was smart about that.  But what could happen if his medicines were stolen before I could replace them?  In his distant past, he had some real troubles with “false beliefs,” worrying that criminals were out to get him.  What if he believed that, and tried to shoot someone?  I could not ask him that, I knew he would tell me it would never happen – but I knew it could.  “I really like hunting animals.  Little ones, not bears or anything.  Squirrels, but that was a long time ago.  There are lots of squirrels and things like that around here.”  He went on.  He was exhibiting more insight and understanding than I had ever heard from him.

“I like the insides of the gun and how it works and I want to learn how to make them.  I did like the feeling of shooting a little animal, because it meant I was smarter than he was.”

(more…)

I remember when I was very tiny, getting a TB (tuberculosis) skin test as part of some public school campaign.  It was negative.  My parents were pleased with me, but they never had any doubts that I would be “clean.”  They said something about poor people with poor hygiene being at risk, but not nice middle class folks like us.  No problem.

Fast forward to a far more vivid memory.  I had to get another TB test in France when I attended medical school there.  It was a hassle, as I had to get someone to take class notes for me while I went to a cavernous and overwhelming public health office.

I was in line with all the rest of the “aliens” as the laws required me to be.  There were people who looked more terrified than I — young mothers from North Africa with four or five young children orbiting around them like out-of-control satellites.  Unlike this frightened young lady, at least I knew what they were going to do to me — even though I was only a first year med student.  They called it a “scarification.”

There was a very petite nurse who had to reach up to give me some scratched parallel lines on my left shoulder.  It was the BCG, the “Bacille de Calmette et Guerin.”  They told me that it was a strain of tuberculosis that had been developed in Lille, a few miles to the north of Amiens where I was, and that it was a gift to the world.  It was a benign form of tuberculosis that would give me immunity. (more…)