Exercise In Humility

by S. R. Panda

Hasrat, a third-year medical student going through his six-week psychiatric rotation, confidently strode through the corridors of the Methodist Hospital to interview his first patient in the Emergency Room. He grabbed the chart from the desk and perused it long enough to get the name of the patient and his personal history before proceeding with the interview. Hasrat saw himself as a cut-and-sew man, not one to sit and twist someone’s mind.

The presentation of the case to Dr. Brown, the consulting psychiatrist, was already formulating in his mind. This was how he would begin: patient is a sixty-five year old male, married, a retired pipefitter. He lives with his wife and one daughter; four other children are married and live on their own.

Hasrat tried to have a spot diagnosis from the patient’s demeanor: short and stocky, with muscles bulked up on his chest like those in his upper arms, consistent with his occupation. The downcast eyes, stooped posture, and unkempt appearance pointed to depression.

“John, is it? What brings you here today, John?” Hasrat had memorized the interview outline over the weekend, and kept a copy of the print-out in his pocket, just in case.

John’s words sputtered out in a hurry. “My wife, she has turned my children against me, all five of them. They don’t come to see me anymore. She hates me. She is trying to poison me.”

Hasrat sat up straight and listened intently. “Misunderstandings happen in marriages. If it’s that bad, why didn’t you leave?”

“So she can marry another man? That’s what she’s been waiting for. Five kids, probably the last two aren’t even mine.” The furrows in his face deepened. Tears rolled down his cheeks unchecked. He doubled over in the chair weeping. “Can’t sleep, have no taste for food, feel worthless. Dogs are whores, but a wife should be better.”

Hasrat wondered if he had heard the last part right and was too embarrassed to ask John to repeat what he had said. He imagined the man’s perhaps younger wife flaunting her body to stir the wrath of an older husband.

Hasrat asked the patient more questions about his education (“seventh grade”), about friends (“none; she stole all mine”), and about his hobbies (“worked from seven in the morning to seven at night to keep those ingrates fed”).

The Social Worker knocked on the door and peeked inside, asking, “The police want to know if they could leave.”

“Police?”

“The seventy-two hour hold, it’s in the chart.”

An awkward smile hovered on Hasrat’s lips. He flipped through the chart and read the police report:

At midnight, we were contacted by John’s neighbor who told us that John was huddled close to the skylight holding a knife. We had to call the Fire Department to assist us in bringing him down safely. John admitted he was spying on his wife. He believed his wife was hiding her lover inside and he wanted to kill them both. We searched the house and found no one except John’s wife and daughter. He is a danger to self and others.

“Please tell them to stay until Dr. Brown comes in. Meanwhile, can you send in the family, please?”

The case was making Hasrat nervous. What he thought would be a cinch was making him look like a quack. He groaned.

Hasrat did some quick calculations; there was no doubt the man was depressed and delusional. Before he could finish his thought, a diminutive woman wearing a faded dress entered the room leaning on a walker. Her hair was mostly white and her face was a map of wrinkles radiating from the corners of her puckered mouth, circling the eyes, crossing the forehead, and lining the sides. During the introductions, her glance darted from the ceiling to the chair and rested on her daughter, who unlike her parents, was taller, with attractive chiseled features. A faint sense of unease churned in Hasrat’s stomach.

After the introductions, the daughter sat close to the father leaning in to give him a peck on his cheek. Then she curled her fingers around his and squeezed. “Papa, did you tell them why you’re here?” she asked.

“To see the priest, of course. What kind of a question is that, Lily?”

“I’m not Lily, Papa. I’m Ruth. Tell the doctor what day it is today.”

John hesitated as if she were asking him a trick question. Hasrat saw an appeal for help lurking in his eyes. John stretched his arms, rubbed his hands and said, “This is December 1934, isn’t it? Tomorrow is my birthday.”

“Papa this is 2010. We’re still in April.”

“I know that. That’s what I meant to say.” John’s earlier feistiness disappeared and in its place was a surprising meekness in his daughter’s presence.

Hasrat was aghast. God, he thought, Dr. Brown would have creamed me for this lapse.

“The first rule of thumb is to consider all your patients suicidal and homicidal until you’re able to rule out both,” Dr. Brown had said repeatedly in classroom lectures. “Enough of them talk their way out of our grip and make our lives miserable.”

Dr. Brown hadn’t said, “Always check an elderly person’s memory before proceeding with the interview.” Or had he?