Naked Medicine

By Robert Lamberts, M.D.

I had a tough situation in the office yesterday.

One of my patients is a 17-year old who went to the ER on Sunday for shortness of breath. They said she had a panic attack and should follow-up with me as soon as possible.

When I saw her, she was clearly distressed, but not to the point of needing to be hospitalized. I asked her what was up and she told me that she had been kicked out of school recently because she stabbed someone with a knife – apparently only after that person grabbed her forcibly. She lives with her mother and her father is a homeless alcoholic. Her mother tells her not to talk to him, but he calls regularly and tells her that she is all he has. He also says that he might kill himself. She knows that he shouldn’t say this kind of thing to her, but it puts her in a hard situation. On one hand, she knows that it tears her apart to talk with him. On the other hand, she fears that if she does not talk to him, he will kill himself.

I asked her if she ever thought of killing herself, and she said she had – especially after talking to her father – but was not at this time suicidal. She had a real good friend with her who was very supportive.

So I am stuck in a dilemma. On one hand, she is clearly depressed and needs both medication and psychological counseling. On the other hand, since there is a black-box warning for using SSRI’s in teens, putting her on one would put me at huge risk for a lawsuit should she follow-through and kill herself. I think she is at very high risk of doing that in the long-run, and don’t really have a longstanding relationship with her as her doctor. I did what I could to tell her to talk with either her friend or me if she should feel she is close to killing herself, but I don’t really know her that well. I am trying to reach one of the local child psychiatrists, but most of them are several months out for new patient visits. Read the rest of this entry »

By Tom Pauken II

“A Personal Perspective of Manic Depression: This reporter gives a first-hand account about the bipolar disorder” reprinted with permission from Mr. Tom Pauken II.

Bipolar disorder, commonly known as manic depression, affects 0.3 percent to 3.7 percent of the world’s population. Fifty percent of them seriously considered or attempted suicide. Forty-five percent of Americans with bipolar disorder believe this sickness made a high negative impact on their lives. Seventy percent of those same respondents assume the public doesn’t understand their condition.

These statistics were compiled by a Global Survey for World Mental Health Day 2005 (Oct. 10) also posted on the upliftprogram.com Web site. Are these statistics important? Do you know somebody afflicted with manic depression? Well, I consider these statistics important because I suffer from this ailment.

I make this revelation not to grab attention for myself. I’m more passionate writing about geo-political issues of the East Asia-Pacific region. I shun diaries and anticipate never using first person voice in future articles.

Nevertheless, I feel an obligation to my readers. I want those suffering from mental illness to feel inspired during their moments of darkness because I might be manic depressive but I’ve taken great strides to overcome my difficulties. Read the rest of this entry »

When I was a graduate student, a senior student teacher (scientist or professor in training?) got up to address the the group of college students and graduate student teachers. The senior student glossed over the usual orientation-related information. At the end, he became very solemn and said, “Please show some decorum around here. Remember that people come here to die. It’s necessary to show decorum.” It wasn’t until months later that I realized what bothered me about the comment. What disturbed me was that no one seemed to be offended at the senior student’s comment – for them it made sense.

Cancer patients do not come to die. They come to fight for their lives.

How many students did the teaching assistant influence with that perspective – those students who didn’t bother to question what he said, or didn’t see there was anything to question?

There is a widespread disconnect in perspectives of those who study cancer and those who live it. I had no clue what living with cancer is about even though I’ve scurried along the same hallways as emaciated, hairless patients who were wheeled around the hospital. I’ve seen children fighting cancer and felt as removed if I was watching a television. How many basic science (preclinical) students go through school wondering whether their project would make a difference at all?

Perspective on cancer matters not only to people living with cancer and to clinicians treating patients, but also to everyone else – graduate students researching on various aspects of cancer, individuals who influence social perspective (teachers, community leaders.) Perspective affects our decisions to to detach and become indifferent, or to increase awareness of and appreciation for individual courage in the fight against cancer.

From a breast cancer patient: “…having cancer has changed me for the better, I wish I could have changed a different way, but I’ll take this way if necessary. Cancer is a disease of LIFE, not just a disease of the body. And though others want you back to normal, normal is different now. It’s not about being strong; it’s about being grateful for every second.”