A Pulse

My patient had been refusing his medications for several weeks.  His schizophrenic delusions became more vivid by the day.  Upon receiving a court order to medicate him against his will, the staff found it necessary to restrain him forcefully to give him the haldol injection he needed.  I was not there, but I spoke with him the day after, and a few days later, and a few days later…

He became withdrawn.  Before the treatment, he had been talkative, indulging me with details about his family, his education, and most importantly, his delusions.  Now he stared more into the distance, choosing not to look me in the eyes.  When he spoke, it was only to give direct answers to my questions; he no longer volunteered information.  His body had begun to shake.  It was most likely a side effect from the medication, but when I saw how it worsened when he spoke about his most pressing concerns, I realized that it could also have been from anxiety.  He was suffering.

A week after the treatment, I spent nearly 90 minutes with him.  The only substance of our conversation was his desire to go to “the hospital,” since he did not believe that he was currently in one.  He was concerned about the shaking but also about his heart.  For the past few weeks, he had become convinced that his heart was not working; he thought that it sometimes stopped.  I asked him if he had ever tried taking his pulse.  He awoke from his trance, looked me in the eyes, and said that he did not know how.  He quickly took me up on my offer to teach him, his eyes widening with wonder when he felt the beating of the radial artery under his fingertips.  I told him that he could try to check it when he felt that his heart was not working.

He withdrew again, telling me that the pulse was not connected to the heart, unconvinced of my explanations of how the circulatory system works.  I gave him the option, several times, to leave if he no longer felt like talking, but he always chose to stay.  Even though I felt as if I was doing nothing for him, I could tell that simply being there together was somehow comforting.  I am the only person he talks to; he doesn’t talk to the other patients, the nurses, the social workers, or anyone.  Just me.  I think of that moment when he felt his pulse for the first time ever, and I hope that I am helping him – and I choose not to think of what will happen to him when I leave for good.  I don’t want to imagine the pain.