CHAPTER 1: Appointment Slips
For a person who spent more than half of his life out of touch with reality, there is a window by which another can glimpse his soul. It's not always through the eyes, as the famous dictum goes. Most of the time, it's less obvious. Sometimes, they're like puzzle pieces or clues and you have to be keen and intuitive to spot them. And then keen and intuitive to try and figure out what they mean.
Windows.
A portal into another person's mind.
For this one patient, it was his appointment slips.
I've been seeing him for almost 3 years now. He was endorsed as a case of chronic schizophrenia with irrefutable delusions of being perpetually targeted by two big business companies. He could not get over it. And when he's at his most paranoid, he became religiously preoccupied. For him, all his life's problems are because these two companies are preventing him from happiness and success.
I could't break through the delusions. Even without the hallucinations, he held on to these delusions like a life boat. I was never sure if he was getting better on not.
Until I started noticing his appointment slips.
This is how our OPD appointment slips look like.
The following are some of this patient's appointment slips since 2011.
August 21, 2011
October 12, 2011
January 4, 2012
April 18, 2012
August 23, 2012
November 15, 2012
January 17, 2013
April 10, 2013
Pretty tough two years, I know. But despite these persistent delusions, this patient has been fairly functional. He works for his church with a zeal that actually drives others to becoming better. His chronic illness became his legacy of courage and faith despite the perpetual battle against the voices that even Jehovah would not hush.
Then one day he came to follow up with a clean appointment slip.
Then again...
And again...
... and these clean appointment slips coincided with reports of improved functionality, improved mood, good continuous and restful sleep, and the prospect of a good paying job. All I did was change his first generation antipsychotic medications to a second generation SDA (and stuffed his arms chock-full of free samples). But his previous doctors have been doing that in the past 10-15 years, only so he could end up unable to maintain compliance due to dire financial difficulties.
I have discovered a window by which I could glimpse some parts of his inner world, but what to make of it is a completely different matter.
I honestly don't know what I did that made him better, so in one of our sessions, I asked him how he thinks our sessions helped.
And his answer astounded me. It went something like this:
"Alam ko naman doc na hindi mo kaya gamutin ang isang sakit na wala naman talagang lunas. Alam ko naman na ang gamot na meron tayo pansamantalang pinapawala lang ang mga boses. Pero sa totoo lang, naging bahagi na nga sila ng buhay ko, hindi ko alam kung anong gagawin ko pag nawala na sila. Tanggap ko naman na talagang naririyan sila. Kung nasa plano ng Diyos na samahan nila ako habang buhay, tanggap ko na po. Nakakaluwag lang po talaga sa dibdib ang may nakakausap ka tungkol sa mga boses na hindi ka nahuhusgahan. Dito ko lang po nararamdaman na may kumakausap sa akin na para akong normal."
I spent the rest of that afternoon in the call room, in our Ling-bed, in fetal position wondering why that was such an unsettling experience for me. We talk about empathy and putting ourselves in another person's shoes, but the truth is, I could never know what it's truly like to wake up to these voices everyday of my life and learn to greet them like friends.
CHAPTER 2: Drawing Pads
This next patient doesn't even talk to me. When he talks, he only echoes my own words. He's one of those persons who seem like they're trapped in childhood.
There is a lovely book by Alan Lightman entitled Einstein's Dreams. It's one of my favourites. It fictionalises Albert Einstein as a young man dreaming about his theory of relativity and every chapter depicts time in a very picturesque way. One chapter talks about the odd characters who are afraid to move or cause any form of change in the universe so they end up trapped in themselves, fearful of making eye contact, or causing so much as a breeze in the air.
He pretty much described my patient.
Except of course that Alan Lightman also describes them as characters lost in time. People misplaced in the fabric of time and space that they are afraid to change anything in perpetual fear that if their breath causes as much as a ripple in the air that would change the course of history, they would vanish in an instant. :)
I do that. Yes. I add colour to the people I meet that way. :) And mind you, some the people I have met in the past 3 years are like characters that have popped out of a book.
But anyway, I was going to tell you about this patient's drawing pads. He brings me little works of art usually copied from a grade school work book. Sometimes I miss a session for some reason and I know that he's mad at me when he doesn't bring me anything. They're like love letters in cuneiform. Mostly birds and flowers in a neat line. I have more drawings than chart entries in his records.
I asked him to draw a tree, a house and a family one time and this is what he gave me.
"How old is that child?" asked Nanay Ring when she saw me studying it one night.
I had to smile.
"He's forty two."
CHAPTER 3: Saying Goodbye to My Box of Patients' Charts
I'm not done yet. I've been writing and writing endorsement notes for days now and I'm still not done. In fact, parang hindi nababawasan ang kailangan kong isulat.
Perhaps because I keep getting all sentimental going through three years of chart entries, mostly with side notes in post-its to myself like: "this patient just made me cry inside" or "this patient can be very annoying when you forget that he has no one else to talk to other than you" and my personal favourite "patient looks hungry, next time bring food from call room: patient looks like he hasn't eaten for a week."
I worked in a government hospital, catering to the mentally ill of Metro Manila and most of them come from the lowest socio-economic class that even their travel fare is equivalent to a day's meal. I have one patient who has to start walking from his little shanty at 5am just to get to my cubicle at 9. In fact, I think I'm supersaturated with cases like these that I get short tempered when I come across a patient who complains of "the world ending" when they lose one of their properties in say, Forbes. They slash their wrists for it or swallow a dose of silver jewellery cleaner and that's serious too. But sometimes I wonder if God made a mistake giving all that wealth to someone who put too much or too little value in it while another person from the slums can afford to be grateful for the little that they have but still manage to shrug their shoulders at the losses they have to deal with everyday.
It's a short-coming of mine and I've been working on it. I am in no position to judge. In fact, my job is to be non-judgemental because everyone has a story that deserves to be listened to. The social injustice just screams at you when you're working for a government institution. It's pretty hard to ignore.
So anyway, as I was going through my charts, I realised that these people whose life stories are in my hands have become a very significant part of my own growth. Perhaps the reason why I'm taking so long writing these endorsement notes is because going through all these stories of people who have become a significant part of my life for the past three years just feels so much like going through a stack of old photo albums. You can't help but get a little sentimental and sentimentality takes time.
I suppose the most meaningful lesson I'll be taking home with me is that the mentally ill are just as capable of changing another human being's view of the world in ways you least expect. They're just as human and just as capable of touching your heart, of showing you courage, of teaching you faith and humility, and some of them could blow you away with their ability for simple acceptance.
I've seen two patients fall in love and walk away from the emergency room hand in hand knowing full well the battles they have to face together. I've witnessed patients becoming mothers and battling their inner demons for the ability to actually be mothers. I've seen an old man getting his "Cinderfella" story despite his debilitating OCD.
There are a lot of dreadful stories too, of course, but even those carry with them an opportunity for insight and introspection.
In a way, I've been their chronicler.
I hope I was more than just a chronicler to them though. I was their doctor, and I sincerely hope I was able to make their lives just a little bit better.
