This was sent to me by a psychiatrist. It just goes to prove that
what you’re taught isn’t always the answer:
“It was a late Fall Monday, during my third year of medical school.
I had just finished a horrifically boring month of Geriatric
Psychiatry at the VA hospital and now was doing a month of Adult
Psychiatry at the local psychiatric hospital. It was a locked ward
and every day, we had to be buzzed in to the unit and buzzed out, at
the end of the day.
There were three medical students working the ward. We each took
turns taking new patients and working them up, when they were
admitted. It was my turn to work up a new patient that had been
brought in on Sunday night.
The senior resident handed me the patient’s chart. It was a thin
chart, suggesting that this was her first stay at the hospital -
generally a good sign.
The resident quickly dashed that hope.
“Mrs. D was brought to the ER last night for severe depression.
There was no suicide attempt; her family was worried, because she
was staying in bed and not willing to move for the past week. Since
being brought to the ward last night, she hasn’t moved at all; she’s
just lying in bed, staring at the ceiling.” She smiled a crooked
smile at me. “Good luck,” she said.
I looked through Mrs. D’s chart and ER notes. There was nothing
particularly alarming, or even interesting. She had been on
outpatient treatment for depression, on and off, for about five
years. No suicide attempts. No significant medical, or family
history. She was divorced, with two teen-aged children.
I walked to her room, the last door on the left, opened it up and
looked in. The room was dark and a large woman was lying, unmoving
on the bed, staring at the ceiling. Her breathing was slow and
steady and she did not seem to be in any kind of distress. I knocked
and entered the room.
“Hello, ma’am. I’m the medical student, Scott. How are you doing
There was no response. Not even a twitch of muscle, or a flicker of
I pulled a chair next to the head of the bed and sat down. I tried
again, “Are you in any discomfort? Is there anything I can do?”
There was no change. She continued lying in bed, staring at the
I pulled out the history form and asked the first question: “How
long have you been feeling depressed?” No answer. No movement. It
was like trying to talk to a brick wall. It was time to try a
“Tell me about your children. How old are they?”
This time there was a brief twitch of the eyes, but no other
“Are you and your children getting ready for Thanksgiving?”
There was another eye twitch, but nothing else.
Clearly, she could hear and probably respond, but was choosing not
“You were brought to the ER last night,” I said, getting no
response. “So you missed Star Trek, then.”
This was Star Trek–The Next Generation’s last season and it was
shown on Sunday nights in St. Louis.
Her eyes opened, and she turned her head my way. “Why? Did I miss
anything important?” she asked.
I laughed, and we spent the next hour talking about Star Trek. Once
up and out of bed, she recovered quickly and was home by the end of
the week. We established a good rapport and had many long talks. I
was glad to see her get to go home, but also sad, because she was
one of the few bright spots in an otherwise dreary rotation.
There was an important lesson to be learned: Where standard dialogue
had failed, where even family concerns were not enough, Star Trek
I’ll be back with my last message of of 2010 tomorrow.
With my best wishes for your optimum health,