You Can’t Pick And Choose Which Medicines You Want

It does not matter what country they were from. The father got into the system when his 19 year old son went stark raving looney bonkers and started destroying the homestead. Luckily it was an apartment in an urban setting, or I don’t think anyone else would have known about it. There was one older child who had already flown the coop, one wife who had died because the strain of leaving the old country had been too much. I had a feeling she had also gotten raped or something, but that was father’s post-traumatic stress disorder if anything. I told him to come back for himself, but I never saw him again. He swore on a stack of bibles that his son did not use drugs.  He said nobody had ever explained to him what was wrong with his son. At least no way he could understand and explain back to me.

For an American the solution would have been a support group, like the Alliance for the Mentally Ill. They lived in a rural area, though, and I did not know if the local chapter had anybody who spoke his language.  There is no way the patient could have handled that – and probably not the father, either.

They had made it to the states from a similarly isolated village in a distant land — I don’t even know how — but I did find out that neither had seen a physician in his lifetime.  That is until recently when the neighbors called the cops and brought the young man into the hospital – on two separate occasions. The first time — I understand — nobody knew what was going on. The second time, several medications were prescribed. The father, understandably, had very little money, so he only bought the cheaper ones. Unfortunately, those happened to be benzodiazepines.  If you’ve ever read this blog before, you’ve heard me rant about this class of drugs (which includes Xanax, Valium, Klonopin). They are anti-anxiety medicines, not unlike alcohol in their effect on a patient, and I avoid using them like the plague. In fact, a large part of my private practice is getting people OFF of these drugs, since they are horribly addictive and an overdose can be fatal.

Unfortunately, many doctors (and almost all emergency room docs) dish these things out like they were Halloween candy.

So the patient was getting a terrible drug (which wasn’t effective in treating his condition anyway) and not getting anti-psychotics and mood stabilizers — which would have stopped the symptoms and the violent trashing of his apartment. The patient was catatonic. He occasionally ate some chicken soup but generally sat around unresponsive, somewhere between a statue and an automaton, moving little but in inappropriate ways. A touch of his hand told me was dehydrated. I lined up an interpreter and made sure the patient’s father, to whom he had signed a release understood what was going on. I knew father and son were somewhat religious, as religious services had been really their only contact in town. I had to tread gently, yet it was abundantly clear to me that son’s medical care just had not been done right.

I told dad the following:
1. His son was ill, and this was a serious illness. It was schizophrenia of the catatonic type. We wrote this down and gave it to him on a piece of paper.
2. The illness was not his fault. He did not have the power to cause nor to cure it. It is a brain chemistry problem. It does seem to be at least a little bit genetic. Someone in his family probably had something somewhat like this before. He nodded. Mom had.
3. I know this makes things very hard for families. I grew up with at least one person (my brother, but I did not want to go into my story in too much depth). This is pretty much why I ended up doing this sort of thing for a living. If he desired, we would make every effort to put him in contact with families that had a member with similar illness. He could learn from them how they dealt with it, if he liked — more than from me.
4. Under no circumstances should his son be permitted to go without the medications prescribed. If he could not afford medications, he should come to the facility where free medication would be made available to him. If not, his son was going to have to keep going back to the hospital.
5. I would answer any questions that arose by phone or they could come back to the clinic and we would provide the interpreter

But the important thing was — his son needed the medicine. With women, I can touch or hug sometimes, but this man was dressed formally, and seemed a bit afraid, so I extended my hand for a shake. I received a surprisingly hearty one, accompanied by rapid speech that I didn’t understand.  However the interpreter told me I had been profusely thanked in the most glowing terms. The next to the last thing I told him was that our country, the great president John F. Kennedy enacted a law in the 60’s that every locality must provide services for his son and others like him.  Because of this, it was reasonable to expect his quality of life to improve when the treatment could be followed. I smiled when I shook his hand again and said “Welcome to the United States of America.”

And at that moment, I realized how proud I felt to be an American. With all the problems and all the bad news that bombards us each day, this is a great thing to remember.

I was glad to share the experience with this family.