Psychosocial

The hospital is a unique place. There are few places in America where problems are so densely concentrated or where one can find the best characteristics of humanity and the worst characteristics of humanity separated often by a single curtain. As a medical student navigating these treacherous waters, a taut rigging over thoughts and emotions is critical. If the ropes pull too hard in opposite directions, the heart is subject to tears.

I saw a patient today in crisis who had a profound effect on me (name and details are altered to protect confidentiality). On first meeting Carl, he reminded me of Louie Anderson. Fat, baby-faced, nasally voice with a wit that seemed like it could have pierced the iron curtain. But what started as a jovial conversation about the Boston Red Sox, quickly disintegrated as details from a much darker past emerged. Carl was a 21 year-old, homeless, unemployed white male with a history of PTSD and depressive symptoms. By that age, he had already been homeless for 3 years. At a young age, he had found his mother lying senseless in the bathroom after an attempted suicide. His father later beat his mother before calling an ambulance. As a teenager, Carl had once locked himself in his room after an altercation with his father. His father then proceeded to break the door down with a large hammer. Once inside the room, his father managed to hit Carl on the side of the head with the hammer. Carl managed to prevent further blows by wrestling his father to the ground and choking him.

Before the age of 18, Carl had already been to rehab once for significant drug and alcohol abuse. At that age he ran away from home, his family ostensibly not wanting anything to do with him anymore. Carl resorted to trying almost any drug available. If you named a drug, he had tried it. He came to the hospital after managing to get himself clean and sober for 7 months. He had found a shelter and was working hard to stay afloat, but had reached his wit's end.

Society seemed to already have written him off, and he knew it. Tearing up, he told me that that morning, he had sat down, thought about his life and just started crying uncontrollably. "It hurts" he said pointing to his chest, "you have no idea how much it hurts."

Given his history of drug and alcohol use, I don't think Carl had gotten a lot of sympathy in the past. Indeed despite being abused as a child, he took a lot of the blame upon himself. His ego was on the verge of shattering if not in pieces already.

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Post TBFAS (to be finished after shelf!)