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Can't stop smiling when I think of this one--despite all the crap I've put up from other patients this week.
Two weeks ago on call I picked up what looked like your basic drug-induced psychosis. 28 y/o, acting weird at the Mission, talking nonsense...then becoming unresponsive (though VSs stable) after admission. I'm thinking "this looks like catatonia", but he didn't respond to benzo challenges. No idea what, if any, past history he had. Clean urine toxicology. The next day he's posturing with absolutely classic waxy flexibility. Two days with not eating or drinking, starting to look dehydrated, we placed an NG tube (which he didn't resist in the least) for hydration and nutrition. Got a neuro consult for an LP which was of course negative.
Finally located some parents and got some history--had bad meth use two years ago, but they were sure he was clean. Had been very depressed, isolated, but he'd been avoiding any suggestion that he see someone and was on no meds. They were resistant to the idea of ECT, but after some research on their own they decided it was the right treatment for him in his current state, and didn't oppose us when we went to get a court order (since he couldn't consent).
All last week we're waiting to go to court. Everyday I see the guy and say hello, get nothing more than maybe a brief turn of the head. He finally decided after 4 days that he'd had enough of the NG, and pulled it out, but was at least chewing on some bread and taking enough fluids on his own to stay alive. Thursday I got pulled out to testify (courtroom is in our hospital, but it's still pretty rare that they expect us in person) and we were able to convince the judge that ECT was the best option. Of course I believed it--had plenty of literature, a tiny bit of experience--but when a judge and two attorneys are grilling you, with concerned parents looking on, well, you just cross your fingers! So we got the order, gave the first treatment Friday--not much change.
Monday am he had the second treatment. I pop in to see him on rounds--he's sitting up on the bed feeding himself Cheetos from a styrofoam cup. Ask him how he's feeling, as usual. "I can't remember a damn thing!", he says. My jaw just about hits the floor, and the NA is laughing at me. I tell him that it's great to hear him talk, since he hasn't said anything in two weeks--and now his eyes get big. "Two weeks? You've got to be kidding me!". Ask him what the date is--no idea. I tell him it's July 13. "You're s--tting me!"
Today he's reading the paper, trying to figure out what he missed. Still has no idea how he got there, but lucid as heck, smiling, talking to other patients, eating his full tray. My social worker said that his father broke down sobbing on the phone when he heard. What a Great Day. Seriously--I can't think of another thing I've seen in the last five years that's been so dramatic. Everyone on the unit is just delighted. Even the other patients were overheard talking to each other yesterday--"Did you see J__? He's talking!" One day to sit back and enjoy a little bit of success.
(BTW--thank you Max Fink and Michael Taylor for this Most Excellent Book. I was SO glad I read it before having to testify in the court hearing to get an order to administer ECT.)
Two weeks ago on call I picked up what looked like your basic drug-induced psychosis. 28 y/o, acting weird at the Mission, talking nonsense...then becoming unresponsive (though VSs stable) after admission. I'm thinking "this looks like catatonia", but he didn't respond to benzo challenges. No idea what, if any, past history he had. Clean urine toxicology. The next day he's posturing with absolutely classic waxy flexibility. Two days with not eating or drinking, starting to look dehydrated, we placed an NG tube (which he didn't resist in the least) for hydration and nutrition. Got a neuro consult for an LP which was of course negative.
Finally located some parents and got some history--had bad meth use two years ago, but they were sure he was clean. Had been very depressed, isolated, but he'd been avoiding any suggestion that he see someone and was on no meds. They were resistant to the idea of ECT, but after some research on their own they decided it was the right treatment for him in his current state, and didn't oppose us when we went to get a court order (since he couldn't consent).
All last week we're waiting to go to court. Everyday I see the guy and say hello, get nothing more than maybe a brief turn of the head. He finally decided after 4 days that he'd had enough of the NG, and pulled it out, but was at least chewing on some bread and taking enough fluids on his own to stay alive. Thursday I got pulled out to testify (courtroom is in our hospital, but it's still pretty rare that they expect us in person) and we were able to convince the judge that ECT was the best option. Of course I believed it--had plenty of literature, a tiny bit of experience--but when a judge and two attorneys are grilling you, with concerned parents looking on, well, you just cross your fingers! So we got the order, gave the first treatment Friday--not much change.
Monday am he had the second treatment. I pop in to see him on rounds--he's sitting up on the bed feeding himself Cheetos from a styrofoam cup. Ask him how he's feeling, as usual. "I can't remember a damn thing!", he says. My jaw just about hits the floor, and the NA is laughing at me. I tell him that it's great to hear him talk, since he hasn't said anything in two weeks--and now his eyes get big. "Two weeks? You've got to be kidding me!". Ask him what the date is--no idea. I tell him it's July 13. "You're s--tting me!"
Today he's reading the paper, trying to figure out what he missed. Still has no idea how he got there, but lucid as heck, smiling, talking to other patients, eating his full tray. My social worker said that his father broke down sobbing on the phone when he heard. What a Great Day. Seriously--I can't think of another thing I've seen in the last five years that's been so dramatic. Everyone on the unit is just delighted. Even the other patients were overheard talking to each other yesterday--"Did you see J__? He's talking!" One day to sit back and enjoy a little bit of success.
(BTW--thank you Max Fink and Michael Taylor for this Most Excellent Book. I was SO glad I read it before having to testify in the court hearing to get an order to administer ECT.)
