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Encountering a patient who hears voices

My classmate and I were walking back to the residents' workroom when we realized one of the psychiatry patients was trailing along behind us.

My classmate and I were walking back to the residents' workroom when we realized one of the psychiatry patients was trailing along behind us. I glanced over my shoulder and found a very short gentleman in a patient gown walking just a little too close to me.

“Serena,” he said, smiling at me.

I looked at my classmate. We were on inpatient psychiatry and he looked as nervous as I was. Our attending had just talked to us about staying safe and keeping patients safe in this bizarre world where patients might be simultaneously having a conversation with us as well as with the voices only they could hear.

“My name is Natalia,” I said as gently as I could. The patient was holding a pencil up so that it hovered at shoulder height and he was still a little too close to me.

“What’s your name?”

By now my classmate and I had reached the workroom. The patient kept his eyes on me.

A nurse walked by.

“I love you,” the patient said to me and smiled all the way up to his eyes.

I glanced at the pencil in his hands. He was within arms reach. I glanced at my classmate. Then I looked back at my patient, who was now checking out my chest.

“We’ve never met before. It would be hard to love me,” I said finally.

“You’re my best friend,” he said happily.

“What’s your name? I don’t know you,” I said.

The patient stopped moving. His face went slack and he looked right through me to another point I couldn’t see. Standing too close to me, holding a pencil less than a foot from my chest, the patient was receiving orders from a voice I couldn’t hear.

“We have to go now,” I said. I reached for the door.

“Wait, I love you,” the patient said.

“You don’t know me,” I said as kindly as I could. “Do I look like someone you know?”

“Yes,” he said and relief washed over his face. He stepped back.

My classmate and I hurried to punch the key code as casually as we could and shut the door to the workroom behind us. He looked as shaken as I felt. It was 3 p.m. and it was our first day of inpatient psychiatry. I had never been as unnerved as I was in that moment. On previous rotations, I had been awed, devastated, and inspired but I had never felt like I was in a scene from the beginning of a scary movie.

There is something animal within us that can sense when a person is preoccupied with things that don’t exist in the real world, with voices or visions that happen only in their brain. And it’s unnerving to sense this without being able to consciously identify why or how we know something is off. It has been a few days now and the patient has stabilized; he never did anything dangerous while in the ward.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

Natalia Birgisson is a fourth-year medical student at Stanford. She is in her second year off and writing her first novel, which is described on her site

Photo by Wikimedia Commons

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