Wednesday, December 19, 2012

Growing Older inside the Revolving Door

"I'm superman," the patient told me.  "Do you know how I got to be Superman?"

"No," I slowly shook my head.

"I had sex with Superwoman," he explained.  "Do you want to have sex with me so you can be Superwoman?"

"Sir," I replied, "I am your nurse.  It is not appropriate for you to make sexual offers to the staff."

"You know you want it," he smirked, and then began removing his shirt to reveal a Superman "S" tattooed on his chest.  An attendant stopped him from removing more clothing.

This Superman grandiose delusion is not fleeting.  This is a very sick individual who will probably become clearer on Clozaril.  He is in his early 20s and this is his first admission to the adult psych hospital.  When I meet patients in his situation, I flash to my future at this hospital and see us aging together as they get repeatedly admitted and discharged, each time returning worse and worse.

This patient will return again because he will stop taking Clozaril when he is discharged.  How do I know this?  Pharmacists cannot dispense more than a seven-day supply without blood work results because Clozaril can drastically decrease the absolute neutrophil count, a type of white blood cell.  This patient will leave with seven days of Clozaril pills, may or may not take them, will not go in for blood work, and within two months will be picked up by the police for assault or a botched theft, and be transferred to a local hospital emergency room for psych eval.  Then he will return to me.

Other staff members tell me about the older patients and recall their first admission decades earlier, recounting their fading looks, deteriorating health, the death of their parents, the illnesses and eventual disappearance of their siblings, and other tragedies of life, witnessed by the staff through the years.

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