In our psych rotation, we have the option of getting out of a weekend call by engaging in a quick book club. We read a book chosen by the clerkship director, then get together with a handful of psych interns to discuss it over pizza. I don’t know the details, but the book club was started shortly after an intern at Penn committed suicide for unknown reasons. This collective reading and discussion serves many purposes: it sheds light on mental illness, something that we as a society are painfully poor at acknowledging; it gives that illness a face, not so unlike you or me, or those we hold dear; it allows us to appreciate what we learn on the wards in a different forum, thereby deepening our understanding; it recognizes those, like the young intern, who perhaps wasn’t fortunate enough to find comfort and aid, to receive treatment, and calls for us to do better, to not let other colleagues slip through the cracks.
My cohort read Brain on Fire: My Month of Madness by Susannah Cahalan. Cahalan was in her mid-twenties, an up-and-coming reporter for the New York Post when she developed hallucinations, seizures, behavioral changes, and delusions before entering a catatonic state. She had been seen by a number of physicians in a variety of specialties, spent weeks in different inpatient units, and when she woke up, strapped to a bed, her head covered in electrodes, she had little memory of any of it. Through the use of hospital records, a journal kept by her father, and other first-hand accounts, Cahalan pieced together her story.
My colleagues were most disparaging about the last third of so of the book, which Cahalan devotes to describing her recovery. Many of her critics hold the same complaint: the puzzle had been solved, and she had been “cured”; she spent too many pages going on about her painful and frustrating recovery. I admit, it wasn’t as gripping, but in many respects I think it was the most important part for me, as a med student, to read. We’re all health twenty- or thirty-somethings. Very few of us have had to endure a long recovery, let alone one that involves your mind. The exciting part of patient care is the diagnosis and finding a treatment that works, not managing side effects and trudging through the long road that we can’t expedite. It’s important for me to be reminded that the patient’s journey is many times just starting when she’s discharged from the hospital. And Susannah was one of the lucky ones. Many don’t fully recover from this kind of brain insult, and some die, even after treatment.
By no means one of her most traumatic moment, but a time that sticks out in my head during her recovery is when she attended a wedding, several months out. It was to be her big comeback. She, Susannah, had returned to being the person she once was. She and her boyfriend would be that cool hipster couple with whom others want to talk. Sure, she was bloated and swollen from the steroids, her speech and movements weren’t fully back, or even fluid. But she bought a great new, pink I believe, dress, and got a new haircut. Only months later, looking at video and photographs, did she realize that she actually looked like a deranged robot, with her mechanical, broken movements on the dance floor.