Friday, August 14, 2009

mad as in crazy or just plain nuts

as anyone who knows even the slightest thing about surgeons could guess, psychiatry was not one of my favourite subjects in medical school. but even i could appreciate a bit of humour in my final practical exam in this cursed subject.

i had to get through it no matter how much i disliked the subject. i would have to 'examine' a psych patient and then present him to the examiners. ideally i'd have to come up with a diagnosis slightly better than 'he's mad!' examine basically meant i had to go through a fairly standardised interview. from that interview, using my amazing powers of deduction i would hopefully be able to label exactly what brand of crazy my patient was. the plan seemed water tight at the time.

they told us there would be translators provided if we needed them. (this is something that is actually often needed in our country, bearing in mind we have eleven official languages. i kid you not.) so when i was allocated my patient, the first thing i asked is what language he spoke. it was zulu. i quickly identified a zulu translator, but before i asked her to accompany me i enquired of the patient if he could hold his own in english or afrikaans (as you will see later in this post, this may not have been the best choice of words on my part). the patient, in a somewhat staccato voice assured me he was fluent in english. ok, i thought. and off we went.

the interview was disastrous. it seemed that the patient was simply under the delusion he was fluent in english. to my shame it took me about ten minutes to figure this out. i just thought he was somewhat stupid. turns out he had no idea what i was asking him and was trying to answer to the best of his english...which he didn't all.

finally i rushed through to get the translator. time was limited. this was after all an exam. i was getting tense.

his zulu was fluent and with the translator we were soon in full flight. the only problem was he was answering each of my questions appropriately. he didn't seem mad at all. i started hoping for a bit crazy, but with each ensuing answer he seemed just like your average joe soap (or whatever detergent of your choice).

great i thought. they have thrown me the wild card. they have actually put a totally sane patient into the exam to catch me out. what sort of sick twisted deranged mind does that sort of thing??
i resigned myself to my fate. all i could do was continue to systematically go through the questions.

the next question was about libido. the translator told me he said he had no libido. it was the closest i had to abnormal so i latched on.
"why doesn't he have a libido?" the zulu equivalent was asked and answered. the translator doubled over in laughter at his answer. there was no forthcoming (or any other form of coming it seems) answer in english. i wanted to jump up and scream at her. i had about 5 minutes left before a bunch of psychiatrists were going to determine if i was going to repeat the year or not and the translator was just laughing?? did she think when she took this job that there wouldn't be the occasional strange answer?? and now with what felt like seconds left to me i had to deal with her sudden delicate sense of embarrassment.

"what did he say?" my voice was not raised but i think there was a noticeable quiver.
"he says he doesn't have a penis." bingo, i thought. then my paranoia about the evil examiners got the better of me. i had to quickly check to make sure there was in fact a penis.
"what's this?" i asked in reference to the member that i could clearly see.
"it's not mine."
"whose is it?"
" it belongs to this tsotsi." he said, pointing to his chest. i was so relieved. he was mad. at that point i didn't even care what sort of crazy he was. the moderator was knocking at the door to tell me to present myself to the examiners. the fact that he was crazy was good enough for me. i could wing it.

p.s i passed but not with flying colours. the examiners also specifically asked me if i had physically checked to see if there was a penis or not.


joegrind said...

Hilarious. I always look forward to your posts. Thank You.

Anonymous said...

I'm starting my intensive psych rotation very soon in nursing. Your story was timed well - too funny! I've been told I excel in this area, but It exhausts me.

SeaSpray said...

Enjoyed the post Bongi. :)

Interesting what you say regarding psyche cases and surgeons.

One of out ED docs was also a surgeon down in a larger hospital in the city.

he was very impatient when psych patients came in to the ED.

One night he blurted out, "I can't stand these psych patients!" (said some other stuff too), after the patient was transported out.

I can appreciate why. You are hands on docs.

11 languages...that is interesting.
Do you speak anything other than English? Afrikaans?

Amanzi Down Under said...

Was he a Joe Soap or a Jabu Omo?

You thought you winged your way through final year Psychiatry? I spend my final Psych rotation snowboarding in Norway (extremely therapuetic btw) then I carefully slipped a completed attendance form into the departments office 2 days before the end of the rotation. No member of faculty staff would ever dare suggest that they had never seen me before when there was perfectly documented evidence of me being there all along. It seems a psychiatrists worse fear is being labeled delusional by your colleagues.

anne said...

Hilarious! But our surgical patients here are often simultaneously psyche patients (or should be seen in the psyche dept at any rate); in fact, just last night I had a very interesting evening with a 19-year-old lady, who I strongly suspect has borderline personality disorder. A little psyche experience sometimes is a worthwhile, though it's not my cup of tea either.

Vijay said...

lq2m x 2, once at your story & once more at the fact that india has 22 official languages which causes numerous such stories during national level medical examinations :)

Unknown said...

I actually found psychiatry interesting.
The thing I remember vividly are the "3 Important Rules" that I discovered (You can be sure that I quote them often):
1. If you talk to yourself, it is OK.
2. If you talk to the chair, it is OK.
3. If the chair talks back to you it is NOT OK.

Unknown said...

Incidently, rules number 2 and 3 apply to all inanimate objects and sometimes to former-animate objects like cadavers. With the latter it is best to confirm that said object really is dead. (In ED parlance: DOAASD - Dead on Arrival and Stayed Dead)

Anonymous said...

Was it delusional disorder, either mixed type, or somatic type with a dash of delusion of grandeur (does speaking English count as grandiose?)

Sid Schwab said...

Well, maybe this explains something, although I don't know what. I actually LIKED my psych rotation in med school; in fact, they told me it was a waste for me to go into surgery, much as I had a knack for it...

Which, I suppose, only goes to show how crazy they were. Or me. I don't know. But I do have a penis.

Bianca Castafiore? said...

bongi -- do you recognize any potential mental illness diagnoses between the states of "mad" and "not mad"?

oops, wait! you do mention "a bit crazy." that's sufficient fine differentiation, i guess.

does south africa hold anti-depressants in as high an esteem as we do in the U.S.? "everybody" takes them...

another wonderful post. thank you so much.