Patients

Over the last few weeks, I've met quite a few patients with neurologic and psychiatric problems. It's been really fascinating for me. For some reason, the symptoms and signs associated with disorders of the mind captivate me more than those associated with other systems; diagnosing sciatica, while important and interesting in its own way, just doesn't compare to trying to understand florid hallucinations. Patients with mental illnesses have not only distorted perceptions of the world, but also distorted perceptions of their own illness; you can't always take what they say at face value.

Two weeks ago, we saw a patient who had previously been sick with a psychiatric disease. She heard voices, had hallucinations and delusions, and attempted suicide once. Her story really made an impression on me, but I'm struggling to explain why. I think it's because I'd never really heard what a person with delusions sees, hears, and feels. It's something I couldn't understand until I placed myself in her shoes. From the outside, it seems ridiculous to think that someone would believe things that aren't real. But when you hear the patient talk, you find their story spooky, compelling, and intriguing.

For FPC, we saw a patient last week who had her right occipital lobe removed because of intractable epilepsy; as a result, she has no vision in her right visual field. However, as I walked with her, I could not tell she couldn't see half the world. Over 30 years, she'd learned to adapt without a significant portion of her cerebral cortex. At preceptorship, I met a patient who was experiencing hallucinations, but did not realize it. Her daughter came in to tell me about the hallucinations; the patient thought they were undeniably real. In taking a mini mental status exam, she told me the year was 1907.

I guess the patient presentations of a lot of disorders of the brain and mind make this block incredibly fascinating. A lot of it is trying to understand a patient's subjective experience from an objective point of view.