Tuesday, March 17, 2009

Diagnosis - Mysterious Psychosis - NYTimes.com

The patient lay on the bed, her eyes wide with fear as she struggled for breath. The nurse at the bedside looked almost as scared. She turned as Dr. Kennedy Cosgrove entered the hospital room and said, "I can't get a blood pressure, doctor — her pressure is too high for me to measure." Cosgrove felt his own blood pressure soar. Most patients in this psychiatric ward of Stevens Hospital in Edmonds, Wash., were physically healthy, and Cosgrove, a psychiatrist, hadn't managed this type of emergency since his internship. He ordered an EKG and quickly phoned the internal-medicine doctor on call.

Ten days earlier, the patient was taken to the hospital's emergency room by the police. According to their report, she phoned her teenage son to say goodbye — she was going to take her life. He and the police found her at home, shouting, incoherent, weeping.

When Cosgrove met her later that day, his first thought was that despite her erratic behavior — which wasn't unusual in this ward — she looked different from his other patients. Her hair was well cut. Her nails were clean and manicured. She looked tired and disheveled, but she didn't look chronically mentally ill.

After introducing himself, Cosgrove asked the patient if she knew why she was there. Tears filled her eyes. She couldn't take the disappointment of life anymore, she told him. He nodded sympathetically. She shifted restlessly on the bed. "I've had seven death attempts on me — by the police!" she shouted, suddenly angry. Her eyes narrowed suspiciously. "Have you heard this?" There was a conspiracy against her — organized by the state of Washington and the Boeing Company. Sometimes she could even hear them talking to her — their voices coming from inside her own brain. She laughed giddily and then became angry again. "Get out! Get out! Get out!"

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http://www.nytimes.com/2009/03/15/magazine/15wwln-diagnosis-t.html?ref=magazine