“Has anything changed since the treatments began?” I ask the patient, as he lies down on a stretcher in the ECT suite. The anesthesiologist places an IV line in his arm and checks his vital signs. My attending psychiatrist adjusts the machine that delivers the electric stimulus. I’m a psychiatry intern, and this is my electroconvulsive therapy rotation. I’m here to watch and learn.
“My cellphone always has a great charge,” the patient deadpans.
If this were a friend or colleague, I would laugh easily. But this is a patient I barely know. He has bipolar disorder, a previous suicide attempt and a history of bizarre, impulsive behavior. In that context, his joke just feels inappropriate and overly familiar.
I’m taken aback. Is it O.K. to laugh, I wonder? An intern, with years of experience being inexperienced, I quickly glance around to take stock of the room.
The nursing assistant laughs and the anesthesiologist grins broadly. The attending psychiatrist remains stone-faced, and says, “Clearly he’s improving.” As the anesthesiologist injects a sedative, a telephone rings. Everyone’s hands are occupied; the ringing continues. Just as the patient starts to drift off, he looks over at me and says: “Can you get that? It might be the governor calling to stay my execution.”
A moment later, he’s out. The attending hands me the leads, and I feel slightly uncomfortable as I bring them to the patient’s head. The nurses are still laughing as he begins to convulse.
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http://www.nytimes.com/2008/11/18/health/views/18mind.html?pagewanted=print
