It’s very difficult to summarize psychiatry. Prior to medical school, the world of psychiatry was rather murky to me. In fact, prior to starting the rotation I assumed that psychiatry issues were something you could parse-out, dissect, compartmentalize, and separate. They are not. Instead when speaking about the mind, psychiatry is like a baked-in ingredient – in a similar fashion, you’d be hard pressed to separate yolk from a finished cheesecake. About the body, well, I’ve spent over three years (plus) working on figure that little bit out.
The Case of Mr. Gibson
The phone rang, it was another order psychiatry consult put in. This time, to see Mr. Gibson, we were requested to check on a elderly war vet who had kicked a nurse that morning. On the psychiatry team, we lived in the locked unit. However, we were regularly consulted by different teams: medicine, hospice, and substance abuse units amongst others.
On the hospice care, Mr. Gibson had long ago heart disease and declining neural function had long ago robbed him of his independence. We made our way to his room and we solemnly approached his bed. In his prime, Mr. Gibson was a large man towering above others. But, in his bed, he appeared diminutive and a fragile in comparison to the gravitas he once held. I saw his personal affects surround his bed, an alter and praise from the people he loved. While maintaining the standard issue wards “listless face”, I internally grinned as I imagined him on his happier days. Helpless, we watched him fluctuate between deep hyperventilating breaths, shallow breathing, bouts of not breathing at all, his breathing accompanied by an intermittent rattle – proof that his central nervous system was struggling to regulate to handle his carbon dioxide – evidence that he was likely dying very soon.
The dialogue of the consult was always the same: build quick rapport, inquiry about mood, investigate consult concerns, determine the patients orientation, and figure out if the patient has been hallucinating, and most importantly determine suicidal or homicidal ideation. We gently woke Mr. Gibson for our consult.
The team: How are you Mr. Gibson?
Mr. Gibson: “I want to die…I have no regrets”, after another minute or two, I want to die…no regrets”
From his photos, he had lived a full life, he experienced love and marriage, the excitement and meaning of having children, probably the pain and growth of losing friends and family, at some point in his life the horrors of war, and the fortunate experience to come home after war. I thought of all of this, perhaps mainly to appease my own conscious, how else could I reconcile hoping that a patient soon passed away – some would say, “Go in peace.” Death itself is ambivalent, but the methodology can be cruel or benevolent. Seldom we get a choice of how we’ll go, but I was hoping his would be painless and on his time schedule.
Mr. Gibson died that very day.