Thursday, September 07, 2006

Unexpected poetry

"Simple nails, simple tales" - patient

I took care of a patient recently that was psychotic with thought disorder. Psychotic in general use conjures images of a maniac killer. Actual psychosis is severely impaired thought processes and/or perception. It may manifest as hallucinations, delusions (fixed false belief, "There's a microchip in my brain"), paranoia, thought disorders, and/or lack of insight (unaware that thoughts and behavior are bizarre).

This young woman had profound thought disorder. April* spoke constantly, quickly ("pressure of speech" and yes I know this describes me as well), and without coherence. The syntax of her speech was correct, there was just no meaning. It was just a stream of phrases with constant rhyming. I've been told that rhyming is unusual. Regardless, it's remarkable to witness. It would be unethical to record patients but I wish you could have heard her when she was really going. Further, she would incorporate words she heard around her into her utterances. Fascinating, and awfully sad. It's like she had something terribly important to tell you, but couldn't pull it together.

“Suddenly, suddenly this sickness”

In the midst of a stream of nonsense, April said that phrase. It stuck out. Was this a coherent statement? An awareness of what was occuring? Or is that just me imposing order on a virtual white noise of words? I suspect the latter and hope against the former. It would be kinder if she was consciously unaware of what was going on with her and wouldn't have memories of it, particularly given one facet of her behavior.

“Come here so I can taste it. I promise I won’t waste it.”

The staff joked that April had a crush on me. That's putting it lightly. She was very sexually inappropriate, mostly with me. I quickly became very good at flinching away from her grabs at my crotch and eschewing her offers of sexual favors. Sometimes she'd just lean against the wall or straddle a chair, stick out her butt, and somewhat wearily suggest we get started. It wasn't embarrassing for me - she's clearly out of it and I strive to be professional - but it was a tad frustrating.

During shift change when I was giving report to a staffperson coming on, April tried to sit on a table. I gently dissuaded her, "Let's not sit on the table. It's not stable." My co-worker and I shared a rueful laugh, apparently April was a powerful influence.

I think about April's stream of words often. Is it at all connected to the bursts of inspiration that artists experience when they write a great song in 10 minutes? The way freestyle rappers flow? How can we "unhinge" ourselves temporarily while maintaining self-awareness?

* Fake name. As always, I often change details of patients' sex, age, etc. to protect their identity.


  1. Delurking to ask, do you think this patient's use of the 'taste/don't waste' phrase could be echoes of William Shatner's "You'll Have Time"? Or maybe it's Shatner that is echoing some common phrase that I don't know.

    I have no idea how I got here - it's that link-to-link-to-link thing again. But your stories are a look at a different Austin.


  2. Interesting, but I doubt it. She said it during a lengthy period of sexually inappropriate words and behaviors. Makes more sense as that.