by The Naked Lady Who Stood on Her Head: A Psychiatrist's Stories of His Most Bizarre Cases
Although most schizophrenics tend to be so disorganized that they are unable to hold down jobs and relationships, there are exceptions. When schizophrenics are highly intelligent, their superior cognitive abilities help them control their psychotic thoughts so they can maintain seemingly normal lives, at least most of the time. One of the most well-known examples is the mathematician John Nash, portrayed by Russell Crowe in the film A Beautiful Mind. Nash’s extraordinary intelligence allowed him to excel at MIT and other top academic institutions, and he won the Nobel Prize in 1994. However, he spent many periods of his life in mental hospitals, succumbing to his paranoid schizophrenia and intermittent depressions.
Like Nash, Steve Ackerman excelled in his legal practice, yet suffered from depression and psychosis. Many patients with both mood and psychotic symptoms fall into a diagnostic category known as schizoaffective disorder. Patients with this diagnosis usually have a better prognosis than schizophrenics without mood symptoms. Regardless of what I called his condition, I realized he needed both antipsychotic and antidepressant medications. Also, he would benefit from his own psychotherapy in addition to the sessions with his wife.
A few days later, Steve returned to my office. The higher dose of Haldol was the right way to go—he seemed more organized, less spaced out, and less obsessed about his penis. I also prescribed the antidepressant doxepin, which helped him sleep at night as well.
For the next few months, I continued to see Steve alone every week, while seeing Sharon and Steve together every other week. As his medications continued to kick in, things got better between them. Pete Carter helped Steve give up his steroid-cream habit and the rash cleared up, along with Steve’s delusions about his shrinking penis. As Steve’s psychotic symptoms diminished, Sharon calmed down. Although I would still classify her as a fast talker, she became bearable. They even began having sex again.
Steve eventually did make partner, and not long after that, his firm transferred him to their Chicago branch, and the family had to move. Knowing that schizophrenic symptoms tend to recur, I gave him a list of several good psychiatrists he could contact there.
I never heard from Steve again, but Sharon called me every couple of months for a while to give me updates. Steve was taking his meds and seeing one of the psychiatrists from my list. Sharon had hired a nanny and gone back to work part-time. I also noticed that her speech had slowed to a normal pace. I felt that my couples therapy with them had been a success. At least I had helped them with the two symptoms that seemed most disruptive to their marriage—her fast talking and his shrinking penis.
CHAPTER EIGHT
Worried Sick
Spring 1988
IT HAD BEEN ABOUT SEVEN YEARS since I had begun working at UCLA. I was just starting to get on track to become an associate professor with tenure, but I still had a way to go. First I’d have to convince an ad hoc review committee that my research was innovative and had a logical trajectory. I’d also have to demonstrate that I had become independent from my mentors. It was becoming clear to me that academic advancement wasn’t just about science—politics came into play. I had to consider who would be writing my support letters and make sure that I impressed them with my scholarly accomplishments. At the same time, my practice was growing, colleagues were gaining confidence in my clinical abilities, and I was getting steady referrals.
It was a warm Sunday afternoon and I was lounging by my pool, relaxing. Life was good. I had all my weekend accessories outside with me—iced tea, crossword puzzle, and cordless phone—very high-tech back then. I dialed the number of a girl named Gigi whom I’d met at a Memorial Day party, and again got an answering service for some talent agency. I left a second message and hung up. It was frustrating—she still hadn’t returned my message from a week earlier. I wanted to connect with her—she was attractive, funny, and smart, and best of all, she had seemed interested in me.
But Gigi wasn’t calling me back. Maybe she wasn’t that interested after all, or maybe I’d gotten the wrong number from my sister, who had called her friend who threw the party, who had called her friend who had brought Gigi to the party, who had then called Gigi to see if it was okay to give out her number. It had been a lot of freaking calls to set up a date.
I dove into the pool and swam a few laps, plopped back down on the lounge chair, and let the sun dry me off. I was almost asleep when the phone rang. It wasn’t Gigi; oddly, it was my ex-analyst, Charles Reidel. I wondered why he was calling me, especially at home on a Sunday. I had completed my psychoanalysis years ago. Was he having issues letting go?
It turned out that Reidel had taken over a mental health program for doctors in training and wanted to refer a patient to me—the mother of a first-year medical student. He had evaluated the student for insomnia and anxiety and thought the young man’s symptoms were complicated by his overbearing, intrusive mother.
“I’ve spoken to her and she’s already willing to come in and talk to you,” Reidel said. “In fact, she seems eager.”
“Sure. Have her call me next week. I have some openings,” I replied.
After an uncomfortable silence he asked, “So how are you, Gary?”
That simple question transported me back to his office couch during the years when I was in psychoanalysis, preparing for my career as a psychiatrist. A major part of any insight-oriented therapy, particularly psychoanalysis, involves developing transference to the therapist, then coming to understand it and eventually resolving it. In other words, the patient learns how he transfers feelings he’s had about people earlier in life—often his parents—to the therapist. Ideally when therapy ends, the patient moves on. However, transference feelings are powerful and can linger for a lifetime. After analysis, if one bumps into his ex-therapist, it can be just as uncomfortable as when those chance encounters occur during treatment.
My reaction to Reidel’s question probably stemmed from some unresolved issues. At an unconscious level, I must have still experienced him as powerful and all-knowing, and now he was asking me to see one of his patients. How cool was that?
I pulled myself together and responded to his question with a simple answer, “I’m terrific, thanks. I appreciate the referral.”
Later in the week my assistant, Jackie, buzzed me and said I had a call from a Mrs. Carol Wilson, referred by Dr. Reidel. I was just about to start a conference call, so I asked Jackie to get her number. She told me Mrs. Wilson was calling from inside the hospital, room 632.
“Really,” I said. “I’ll call her back, but please get me the name of her internist and find out why she’s in the hospital.”
Jackie had learned that Dr. Lisa Chung had admitted Mrs. Wilson the day before for evaluation of back pain. After my appointments, I headed up to room 632.
I stood at the open door of the four-bed ward and observed a woman with bright red hair holding court as three other female patients listened. I checked the list of names on the side of the door to figure out which was Mrs. Wilson’s bed, then hesitated in order to eavesdrop for a few moments.
Carol Wilson, the redhead, continued with her lecture. “Shirley,” she said to the woman across from her, “I know you think your doctor is right, but I’m telling you, your symptoms suggest it’s more than simple arthritis. You could very well have lupus, too. Has anyone thought to get a sed rate?” She was referring to the erythrocyte sedimentation rate, a nonspecific screening test that quantifies inflammation in the body and can be useful in detecting and monitoring a variety of diseases causing vague symptoms, ranging from tuberculosis to autoimmune disorders.
Shirley looked dumbfounded, and I made my entrance. “Good morning, ladies. Sorry to interrupt. I’m Dr. Small, and I’m here to see Carol Wilson.”
Carol chirped, “That’s me, Doctor. I called you.”
I pushed a chair up to Carol’s bed and pulled the curtain around us to create a semblance of privacy.
“I’m so glad you came up to see me, Dr. Small,” she said. “You’re much youn
ger than I expected. You know, you remind me of my son, Michael. He’s a medical student here at UCLA.” She raised both hands as if to stave off my congratulatory remarks. “I know, I know, I’m very proud of my little genius. He’s my whole life.”
She paused to take a sip of water and groaned in a spasm of pain. She leaned forward and grimaced, pushing her palms into her back. “Please, call for the nurse. I need something for pain.”
She struck me as histrionic, so I wasn’t sure how much pain she was really feeling and how much she was just performing for me. Maybe she was addicted to pain medications and putting on a show to get the doctor to prescribe them. I rang for the nurse and urged Carol to breathe deeply and slowly. After the nurse gave her a shot in the hip, Carol calmed down and seemed comfortable again.
“That really came on suddenly, Mrs. Wilson,” I said.
“Yes, I know. It’s a kidney stone,” she said, “but Dr. Chung seems skeptical. I don’t know why. I’ve had trace red cells in my urine, and the mid-back location of the pain is consistent with my diagnosis.”
“You know a lot about medicine,” I said. “Are you a physician?”
She laughed. “No, but aren’t you sweet. I do have a Ph.D. in languages, and I’m an avid reader. In fact, did you catch that recent JAMA article linking Epstein-Barr virus and chronic fatigue syndrome? Or maybe I read that in the New Yorker. I read so much that sometimes I forget where I’ve seen things.”
I barely had the time to read the abstracts in my medical journals, and I couldn’t remember the last time I’d picked up a New Yorker. “No, I didn’t catch that article. But let’s talk about you. Dr. Reidel thought I might be able to help.”
“I hope so, Doctor,” she said quietly. “It’s my son. I’m worried that he’s overwhelmed with all the studying and competition in medical school. Sure, he’s brilliant, but he’s so sensitive and not willing to talk to me about what’s going on.”
“Did he used to talk to you?” I asked.
“We were best friends. His father died when he was five, and I became his confidante. I could always sense when something was bothering him, and I would advise him. But now he’s so busy, I hardly ever see him.”
“The first year of medical school can be hectic,” I said.
“I know, but now he’s getting these headaches—they’re so bad that he gets nauseous, and he can’t even come over on weekends. I’m really worried about him.”
Dr. Reidel’s suspicions about a doting and overbearing mother seemed accurate. Carol was sharp and articulate, but I suspected she might be missing the message her son appeared to be sending—that he needed some space. This could be a classic enmeshed mother-son relationship. Carol just said he was her whole life, but maybe Michael wanted his own life.
One of the challenges of consultation psychiatry is the lack of privacy in hospital settings. I didn’t want to delve too much into Carol’s personal issues while her roommates listened in. And she seemed more comfortable talking about her son than about herself, so I went with that.
“So what worries you about Michael’s headaches?” I asked.
She lowered her voice. “I don’t think he’s telling me the whole story. I’m sure he’s playing down his symptoms, and I believe his vision may be affected too. Lately, every time I see him, he’s wearing dark sunglasses.” She paused and looked down.
“What is it?” I asked.
“I haven’t told this to his doctor yet, but I suspect a brain tumor.” She leaned forward, “Malignant.”
I barely kept from laughing. Since when had sunglasses and a headache become the diagnostic criteria for brain cancer? “Really? What makes you think he has a malignant tumor?”
“God willing I’m wrong, but all his symptoms point to it.”
“Carol,” I said, “lots of people get headaches and wear sunglasses.”
“But this is new for Michael. Light sensitivity, headaches—both could be indications of cerebral edema from a tumor. In fact, for all I know, he could have a glioblastoma impinging on his optic nerve.”
Boy, this woman knew her medical jargon and liked to throw it around. You’d think she was the one in medical school. Before I could reassure her that gliobastomas were almost never found in people under age thirty-five, Michael walked in wearing black jeans, a gray T-shirt, and dark sunglasses.
“Michael!” Carol exclaimed. “I’m so glad you stopped by. This is Dr. Small, the one you told me about.” She patted the bed beside her for him to sit down.
“Nice to meet you, Dr. Small. I liked that lecture you gave on geriatrics a couple of weeks ago,” he said as he pushed his sunglasses to the top of his head. “I see you’ve met Mother.”
“Yes,” I answered. “We were just getting to know each—”
Carol interrupted, “It’s so nice to see you, sweetheart. I was just telling Dr. Small what a genius you are.”
Michael looked annoyed and stood up. “Look, Mother, I just stopped by to say hello, but I can’t stay. I have a study group.” I figured this was my chance to get a few minutes alone with Michael.
“You know, I have to head out too,” I said. “I’ll be back later to talk some more, Carol. Michael, I’ll walk downstairs with you.”
Carol replied, “Lovely. You two boys get to know each other. Ta-ta!” As we headed out the door, Carol went back to holding court with the ladies, “Now Shirley, lupus is nothing to screw around with…”
We took the stairs down to the sunny courtyard below. Michael confessed, “I don’t really have a study group, Dr. Small, I just wasn’t in the mood to spend an hour with my mother while she diagnoses every move I make.” He took off his sunglasses to clean them and continued, “She never stops with the questions—How did you sleep? What did you eat for breakfast? Are you still dating that Mia?”
“So she really gets under your skin,” I said.
He laughed. “That’s the understatement of the year.”
“Your mother seems to be a very intelligent but intense woman. It must be exhausting being the center of her life,” I said.
“She has way too much time on her hands, and she focuses it on me,” Michael said. “If I ask for a sandwich, she makes a Thanksgiving dinner. If I cough, she’s convinced I’ve got pneumonia. And it’s getting worse.”
We bought coffees and grabbed a table in the courtyard. “What do you think is making it worse?” I asked.
“She can’t handle my moving in with my girlfriend. I lived at home all through college, but when I started med school, Mia and I finally got our own place. At first Mom acted like she was happy for me, but then things got a little weird. She sold our family house in Encino and bought herself a condo around the corner from UCLA. She claimed the house was too big for her alone, but I know she just wanted to be closer to me.”
“Sounds like she’s having a hard time separating,” I said.
“You think? Mia keeps telling me that I need to set limits with Mom, but it’s tough. She can’t stand Mia, even though she’s never really given her a chance. I mean, no girl will ever be good enough for her little genius. Mia’s fantastic, and I want to make it work, but it’s difficult for me to upset my mother.” I could see that as much as Carol was struggling with Michael’s perceived abandonment, Michael was having his own issues separating from his mother.
“You’ve met with Dr. Reidel,” I said. “Are you going to continue seeing him?”
“We’ve got an appointment next week, and believe me, I can use it. I can’t deal with all my mother’s guilt trips—I never stay long enough, I don’t call her enough, I’m too thin…It’s keeping me up at night.”
“I’m sure Dr. Reidel can help you with that, but I think your mother could use some help too,” I said.
“That’s where he thought you might come in.”
As I headed back to my office, I thought about Michael’s attempts to extricate himself from his mother’s clutches. I speculated that Carol had never resolved her grief over the loss of
her husband and held tightly to her son to fill that void. An emotionally mature, nurturing mother would be able to express her love for her son by allowing him to grow, make his own mistakes, and eventually become independent. Carol appeared to love her son and seemed to want the best for him, but she was having difficulty letting him live his own life.
The next day I went back up to Carol’s four-bed ward to see her, but her bed was empty. The nurse told me she had been transferred to a private room. I paged Dr. Lisa Chung to find out what was going on, and she met me at the nurses’ station.
Lisa smiled when she saw me. “Hey, Gary. Nice to see you.”
“You look good, Lisa,” I said. “I guess internal medicine agrees with you.” After completing a psychiatry residency, Lisa had switched to internal medicine, and now she was chief resident.
“Thanks, I’m really enjoying it. Instead of having to listen to patients whine for fifty minutes, I only have to deal with them for ten minutes at a time.”
“So what about this patient Mrs. Wilson? What’s up with her?” I asked.
“She presented with acute mid-back pain, insisting it was a kidney stone about to pass,” Lisa said. “We did find some red cells in her urine, but she also had a urinary tract infection, which explains that.”
“What about an IVP?” I asked. An intravenous pylogram is an X-ray test that allows the doctor to see kidney stones after injecting an iodine-based contrast dye.
“Negative,” Lisa said, “but I have a hunch about what’s really going on with her—at least physically.”
“What’s that?” I wondered aloud.
“Whenever she swallows, it exacerbates her back pain. I think the pain is coming from her upper GI tract. She’s been taking eight hundred milligrams of Motrin for pain, without food, for several months. She probably has gastritis or an ulcer from the antiinflammatory.”