The sad Gangsta

The patient appeared just like any other young male I had seen during my residency at an innercity clinic. His hair was kept very short, he wore an excessively baggy red shirt that hung past his elbows and had a matching red handkerchief stuffed in his back jean pocket, but this was different.

Normally the complaint would be some vague pain along with allergies to anything non-opiate, or maybe a new onset diabetic who is having trouble understanding his disease, or someone complaining of a new rash, but this was different.

While looking down at the floor and in a low steady tone he calmly told me how depressed he was, how he has trouble waking up each day, how he can’t bear to think of the future, even if its only a week ahead, and how he  had no interests in drinking, hanging out without friends, or even sex. Before he came to see me he recognized that he was at a desperate time in his life was and had gotten rid of all his firearms at home, but there was one catch. He stated that his job, doing air quotes with his hands, frequently required the use of a firearm. He also had fear about his “coworkers” who may turn on him if they learned how depressed he was. He was afraid because there was no “retirement plan” as he put it, the only way out being death of one sort or another.

I didn’t know what to do as they don’t teach you how to deal with suicidal gang members in medical school. How can I keep someone safe who is a danger to himself, but if he seeks help others become a danger to him? I offered to help him get admitted to a local mental hospital – which he refused out of fear of his coworkers.  I suggested maybe moving away – but he said “they will find me anywhere I go, we have eyes everywhere and in every city.” We ended up deciding on trying an anti-depressant, which he could hide from coworkers, and a return visit in one month to see how he was doing.

But I never saw him again, and I wonder what fate he suffered. Did he take his own life? Did his acquintances turn on him as he feared? Maybe, just maybe, he was able to escape and get the treatment that any human – gangsta or not – has a right to.

Physician suicide part 1

While reading over some articles I found one about physician suicide – which is of course an issue close to my heart. From there I started looking at other articles talking about physician suicide. This is gives me some relief as I am not alone but at the same time scares me as I fit some of the descriptions of a successful physician suicide “to the T”. In a career dedicated to helping others, it seems we fail at helping ourselves as evidenced by “the overall physician suicide rate cited by most studies has been between 28 and 40 per 100,000, compared with the overall rate in the general population of 12.3 per 100,000”  which is 2-3 times the rate of the normal population! In an era of physician shortage, about 400 physicians successfully complete suide each year which “would take the equivalent of 1 to 2 average-sized graduating classes of medical school to replace.”

I wondered if any specialities would be a highest risk – you would think oncology – with so much death and sorrow, or maybe neurosurgery – which are overworked and in constant high stress situations. In my situation, one of my worse clinical rotations was the medical ICU as I started feeling down, thinking very negative and was having trouble with dealing with other people being happy/content. I soon realized that we were averaging a death a day and it was taking a toll on everyone.  The answer suprised me – “there has been multiple studies since the 1960s trying to breakdown this in specialities, and they tend to point to psychiatrists as having the highest suicide risk – although studies done later have found no difference in specialities.” Although maybe dealing with constant mental illness, depression, and anxiety starts to effect oneself.

The risk factors for physician suicide are a lot like the general population – which upset me because I fit so many. For example, rates are found to be “higher among physicians who are divorced, widowed, or never married,” and having been recently divorced…  Another statement describes the personality qualities of a physician who completes suicide “as driven, competitive, compulsive, individualistic, ambitious, and often a graduate of a high-prestige school,” – I don’t think I am too competetive – but of course I am individualist(do autistic people have a choice in this regard?) and driven(which has gotten me to where I am). Another study showed personality factors “including self-destructive tendency, depression, and guilty self-concept” – which basically describe my mindset for the past 20 years – using these attributes psychiatrists were able to review a past medical class and pinpointed the 8 successful suicides without prior knowledge of the class! A 1980s study linked suicides to “having slightly more difficult or emotionally draining patients than other physicians, both throughout their careers and in the final 2 years of their lives” which is not too suprirising.

One of the other reasons possible for such a high success rate in physicians may be our knowledge of drugs and lethality, this has resulted in a “higher completion to attempt ratio”, especially in females. I can appreciate this as I think of my previous attempts when I was a teenager – how unlikely my change of suceeding would be with the methods I had used..

WORKS CITED

Miller, et al. The Painful Truth: Physicians Are Not Invincible, http://www.medscape.com/viewarticle/410643_2 “Southern Medical Journal”, 2000

Facts About Physician Depression and Suicide, American Foundation for Suicide Prevention

Andrew, L, et al. Physician Suicide, http://emedicine.medscape.com/article/806779-overview#a1, 2012

Colic and Probiotics

For anyone who hasn’t had a child, one of the things that be very stressful is colic, aka “Cry fuss behavior”. Colic is a poorly understood constellation of symptoms which there is no effective treatment, yet it puts the caretakers under great stress and is a common reason for ER and primary care visits.

To start off, there are different definitions of colic depending on what criteria you use but they all rely on a certain amount of time (usually over 3 hours a day on a frequent basis) and an infant who is healthy (meaning ruling out other causes) for a colic diagnosis. Examples of this include the “Rome III criteria” and the “Wessel Criteria”.

There is no one accepted theory that explains colic, and it is most likely a combination of social and physical causes, but most theories focus on the GI system (specifically around milk digestion), biological factors (like smoke exposure), and psychosocial (the babies tempermant).

The history and physical focus on ruling out diseases that CAN be treated, such as metabolic disease and GI disease, and the workup would be dependent on if you think one of the other disorders exist (this includes labs, radiology studies).

The usual recommended treatment of colic focuses on supportive therapy (soothing the baby) and with adjusting feeding techniques. Other treatments include removing lactose from the diet (for suspected lactose intolerance) to herbal remedies.

One of the secondary treatments that has been gaining some interest is treating with probiotics. A review of RCT(randomized control studies) in 2013 found inconclusive results regarding probiotics. Multiple other reviews occured in 2013, which showed confilicting results (some positive, some showing no effect)

A new paper, by Indrio, et al. “Prophylactic Use of a Probiotic in the Prevention of Colic, Regurgitation, and Functional Constipation: A Randomized Clinical Trial”, published 2014 in JAMA pediatrics adds to this existing knowledge.

This is a somewhat small study (n=238 in the treatment group) for a short peiod (90 days), but it is structued as a “double blind” study. The secondary outcomes used include the number of medical visits, ER visits, and the number of parent work days lost, were much less in the treatment group. This makes both a difference to the parents along with reduced healthcare costs. The authors mention that longer studies are needed, as are ones comparing the different probiotic formulations – which would be interesting if they were designed in a similar way.

This provides an interesting alternative if the methods of feeding adjustment and soothing do not work and you are left with a very frustrated parent.

SOURCES

Uptodate – uptodate.com

Indrio F, Di Mauro A, Riezzo G, et al. Prophylactic Use of a Probiotic in the Prevention of Colic, Regurgitation, and Functional Constipation: A Randomized Clinical Trial, JAMA Pediatrics. 2014;168:228-233

A renovation

A lot has gone on since I started this.. I have finished my family medicine residency, I have moved, and I am going thru a divorce..

I think I may continue the use I originally intended this for (life thru the eyes of high functioning austism) and in addition include articles/research studies I find interesting.

I am very open to people asking questions or having me talk about certain effect of HFA on medicine/life.

Repeat

This is a very similar post to my previous post about Ritalin, but this issue dominates my life.

Also, I originally thought this would be a space about my experiences in medicine and how autism effects my views but I seem to be on a mental illness kick. Considering not many people read this and it helps me a little to get things in physical writing, I will continue to write whatever I feel at that time.

I am laying in bed alone, I feel hopeless and overwhelmed. A vast empty abyss is growing in me. During the day I am having trouble returning the small talk normal people require because my focus is set inward. Doesn’t inward focus sound good? Well for me it’s a toxin. I turn my intelligence and ability to spot weakness on myself. I tear myself up over little things, I don’t let anything slip by. My emotions are very fragile during this, for example, I almost cried when someone wouldn’t sit with me.

It’s only been a week since I stopped taking ritalin because I was feeling stable. This quite a quick decline, sometimes I can last a month. I am at the bottom, I fall asleep planning little details of my suicide. I plan item lists, locations, and imagine how it would feel. This relaxes me enough to sleep.

Sleep..all I want to do is sleep. If I allow myself I’d sleep 18 hours a day. Dreams are so much better than reality, I get to feel the rush of serotonin in my dreams. I actually get to have good feelings in them as to opposed to the negativity that dominates my life.

I suppose I will take a Ritalin this morning as I feel my interpersonal relationships at work crumble. I am purposely distancing myself and reducing how much I talk. I lack the urge to “mirror” their facial expressions.

I just dread that high, speedy feeling. I am not looking forward to feeling my thoughts race and feeling anxious. It’s so much more comfortable for me to be slowed down and depressed.

Drug addicts are best part 1

It is the third year of my medical school and I am in a psychiatric ER, against my will, and on the phone with my course director who states the dean promises that they will treat this incident just like any other acute illness requiring hospitalization.

How did I get there? I think it was a perfect storm. Sure, almost every month I have times where I am actively planning every little detail of my death, but this time was different. It was Ramadan thus I was fasting from food/liquid and because of this I had not taken my Ritalin for 2 weeks or so. At first it wasn’t going so bad but suddenly, or so it seems to me, I started crying at the slightest thing. People would make tiny criticisms and I’d just fall apart.

It was also the anniversary of my grandmothers death, who you know was very close to me. I could feel the fear and apprehension of actually having to face it start to mount.

My wife was also pregnant and in her last weeks. I did not feel prepared, I did not feel like I should be a father.

Ritalin my enemy

My heart is pounding against my chest, I feel the tremendous force of its impact against me and it’s uncomfortable. My mouth is dry and tacky reminding me of when I fast from liquids. My eyes are darting around and it’s hard to focus on anything for too long.

My mind follows this pattern, skipping thoughts and subjects at a rapid pace. I barely can keep with the speed of my thoughts, I wonder If this is what mania or ADHD feels like? It’s hard for me to talk to people as my mind wants to go faster and faster.

I have a deep pit in the bottom of my stomach. My body and mind are telling me I did something really horrible, like run someone over, and I’ll be caught. I try to review my life, and I can’t find a real event that causes this.

This is why I have a love/hate relationship with Ritalin. Whereas it helps reduce my suicidal thoughts and helps give me emotional stability it comes at a cost.

I also hate how it works. I hate how I can be planning my “end”, take the medication, and an hour later I am hopping all over the place. But of course it works, it’s based on amphetamine. Wouldn’t even a normal happy person feel better with such a stimulant? SSRIs, like prozac, take 4-6 weeks to take effect, so isn’t it wrong to have my mood elevated in 30 minutes?

It feels dirty, like an illegal high. Like I am doing something wrong that I shouldn’t be doing.

Can’t I get thru this by my intelligence alone? I have gotten in and completed an ivy league education and medical school with moderate effort, so can’t I overcome this problem with my mind alone? If I am so smart why can’t I apply it to this situation and overcome it?

“Compare it to a diabetic who needs insulin, are they weak for needing medicine?” is what I’d tell a patient who thinks antidepressants are for the weak. But this is different. Ritalin is an instant up with a noticeable downslope. It comes out of the system in hours. It’s abused so that people will feel better. No one takes Prozac without prescription for fun!

Saving a life?

This story begins with me in a rotation in the medical ICU as an intern, which is the first year of residency. I feel more prepared than others because I have experience as an EMT on a 911 ambulance service and I also have had quite a few rotations before this one, including pediatrics, 2 family medicine hospital rotations, and a rotation in the cardiac ICU.

As settle myself in I see the fast paced action going around and I decide in about the second week to tell the senior residents that I want to “run” the next code. Running a code basically means you tell when to give the drugs, when to stop CPR to check the EKG rhythm, and when to stop the “rescue effort” all together. As fate would have it, the next patient who “coded”, aka whose heart stops mechanically pumping, is one of the patients I have been managing.

She is an african american in her 50s who looks like she’s in her 80s because of her severe blood infection (sepsis). I have never interacted with her when she was awake, as all my visits have been while she was in this coma like state. Despite our efforts to save her, including tons of IV fluids, which are making her swell like a marshmallow, and 10 drugs hanging from IV poles, she is still dying. Even though everyone sees what is happening, her health care proxy, her son, wants us to do everything possible.

The blue light begins flashing, “CODE BLUE MICU, CODE BLUE MICU”, indicating a patient in cardiac arrest. I run to my patients room knowing that it is probably her. I am one of the first ones there and begin assuming command of the code. As I am keeping track of time and the drugs that have been given, I am disgusted as I watch the medical staff slip off her chest as they do CPR. Sadly, she is so far into sepsis that any contact with her is literally tearing off her skin. The area where chest compressions are done is just bare raw flesh, even her wrist where the nurse is checking for a pulse has turned into red flesh absent of any skin. The staff put a towel on her chest so their hands stop sliding while doing CPR. We continue the code….5 minutes…10 minutes… I call out “2 more minutes and I am calling the end of the code!” 1 minute passes… Then a nurse yells out “I have a pulse!”, I reply in a monotone voice “Confirm”, which another nurse does.  We end the code and I have “saved” a person. A person who is twice their normal weight from all the fluids that are needed to keep her blood pressure up, a body that’s skin falls off at the slightest of touch, a person who has no interactions with the outside world.

At the end of the code, when everyone else has left , I straightly stand over the “living” person. I stare down at her corpse-like body thinking “What have I done?” Have I really “saved” a person to experience more suffering and hardship? Tears begin forming in my eyes as I am having trouble accepting if I have done as what Hippocrates said, “Do no harm”.

I go off to lunch for about 10 minutes, when I come back a bedsheet is over her body. Her heart stopped again during the short period I was gone and the staff made the son watch the resuscitation process. He last only few minutes before he pleaded for the workers to stop and let his mother go.

Thus ended one of the most horrible experiences I have had when I did what is medically right, but felt so wrong inside.

 

When we touch

One of the aspects of autism is a problem with personal space and affection. Either the person avoids touch and has a large personal space or the complete opposite, guess which one defines me?

I hate being touched, hugged, tapped on the shoulder, or having someone put their hand on me. It brings up a feeling of anxiety and a need to escape that overwhelms my consciousness. For example, if someone is talking to me and puts their hand on my shoulder I can’t think straight. I lose track of the conversation and all I can think about that feeling of something foreign invading my sense of comfort.

The closest I can describe the feeling is “pain like”. Bolts of electricity are sent to my brain as the physical contact continues. It’s like a molten red piece of metal pressing on my skin. The feeling demands to be acknowledged and requires to be on the forefront. It does not fade but instead stays present.

I have learned on some level how to lessen my visible repulsion to touch. The reason neurotypicals do this came to me as a teenager. I realized that they are actually comforted by such motions and are hurt/offended when I do not seem to return the same response. This is why I started to limit my response and I have come a long way.

When I was a teenager and people hugged me I stood straight like a piece of lumber. I kept my arms and hands flat against my sides and did not move them during the interaction. I could tell by the way people reacted that they found my response very uncomfortable. Then in my early twenties I started moving my hands, giving the other personal taps on the back in a very mechanical way.

Now as a physician I have advanced even further. I will initiate contact such as a touch on the shoulder or even in certain situations a hug. They seem more fluid and almost natural but they are still painful for me and overwhelm my senses. To help deal with this I count to 5 and release, this helps me deflect some of the pain and gives me and endpoint to look to.

In the end physical contact still brings on that burning feeling but I have learned to push thru it to achieve the objective, comforting the other.

The abyss

I sit on the couch, all of my muscles feel exhausted even though I have over slept by 4 hours. My thoughts form slowly, my mind working at sluggish speeds. Even though it is just the beginning of the day I feel like I have run a marathon and then had to take a 2 hours calculus test. It is almost like I am drugged, dragging myself thru a fog.

In addition to this exhaustion I am have no interest in common things. I can’t find myself caring about anything, I am not drawn to music or hobbies. Thinking about playing guitar, or even going outside seem like unobtainable goals.

But worst of all is the feeling of being alone. I feel unattached to anyone. No connections to the outside world. I float along thru the mass of humans with no attachment to the masses. It feels like a dark abyss, large and empty. Surrounded by a gulf of darkness. My body remains untouched, my skin isolated from the electricity of humanity.

My mind tells me to escape. To do anything possible to leave my current situation. I am like an animal who is caught in a cage, my vision is narrow and I can only think of the immediate present. I am unable to visualize the future and the consequences.

Death and autism- part 2

I stand in the hallway with my dress shirt and pants accompanied by an oddly matched tie wearing a long white coat which is slightly dirty and has pockets overflowing with papers and notes.  Next to me is a small red-haired medical student, this is her first rotation but she is a former hospice volunteer so she is use to these emotionally stressful situations.

Across from me is a young black woman with tears in her eyes even before I say a word. But her eyes speak of something else, they speak of an intense need for someone to give them hope, but I am about to do the opposite. I am very blunt with her, I use the word “Death” and “Dead” repeatedly. Odd thing is, I feel myself when speaking like this, I drop all my filters which parallel tact and just “Shoot from the hip”. I crush her hopes, re-affirm again and again that palliative is not curative, and her loved one is in the hospital to die, not be treated.

While I am explaining this I am burning a lot of energy actively scanning for non-verbal communication. This of course is a problem with people with autism, we lack the ability (severity varies) to read non-verbal signs. To overcome this I run what I call “computer scripts”. I watch water from eyes forming tears, I look at the angles of the mouth to see if they change from resting state, I look at the facial muscles to see if they twitch, and I watch the hands to see if they jitter about or make fists.

The worst part for me, and sometimes most telling, is eye contact. Making eye contact, especially prolonged, causes what feels like physical pain to me. A searing feeling in my head that causes my mind to shout at me “LOOK DOWN LOOK DOWN”, I start to feel anxiety flood my body and my muscles tense, then I break eye contact and start again. But the problem is I know normal people thrive off eye contact. They NEED the ‘other’ to look at them in the eye and maintain eye contact in such a very stressful situation. So I run another script, I stare at their pupils for 20 seconds, break eye contact and look down for 1-2 seconds, re-engage. During this I examine their own eye contact, do they avoid my eyes? Do they burn with intensity and anger? Do they look beyond me? Are they dim-witted, like they aren’t absorbing the information I am giving?

It’s amazing how comfortable I am in these encounters, it almost feels like I am in “the zone” despite my lack of natural communication skills. I have an objective and multiple strategies to get to achieve that. I adjust my plan based on my scanning of non-verbal communication. And when the patient has a peaceful passing that is void of suffering, when I have reduced whatever mental suffering and questions the family has, that is when I feel a sense of accomplishment.

Its kind of funny though, if you asked me in undergrad or medical school if I was interested at all in palliative/hospice care I would’ve given a definite no. But this year I have had many, many encounters with it and it is one of the most satisfying interactions I have hd. Even when I spend a large amount of time fighting with a family on the behalf of a patient suffering horrible pain, when that patient passes in no pain because of me, I feel like I made a difference.

Shock therapy – literally

Shock therapy, aka electro convulsive therapy (ECT) is much more humane now then it was in the 1950-1960s and very different from how they portray it on TV. Although the objective of causing a generalized tonic-clonic seizure remains,  a combination of general anaesthesia and a muscle paralytic agent makes the procedure painless and reduces fractures to basically zero. So here is my “one flys over the cuckoos nest”

It’s a day off from my crappy minimum wage job and I am being driven to the hospital by my parents, as you are not supposed to drive after general anaesthesia. I wait in line outside the “therapy room” with others like me, lots of them much older or on the surface much more disabled. Finally, the wait is over and it is my turn.  I am led to the therapy room by an older nurse, one who still wears the old nursing hat with the matching folded cap. The ECT machine is imposing in the room, large, antique looking, steely gray with a bunch of dials and gauges. I lay down on the cold OR table still wearing my street clothes and look up at the sterile white ceiling. I feel the fear and apprehension building even though I have done this many times before, but I try to ignore it. I try to concentrate on the patterns on the ceiling and ignore the screaming anxiety in my head. The IV is started, my head is strapped with an old leather belt-like device (bipolar ECT), my body strapped down by much thicker leather straps, and the drugs are pushed.

“Count back from 100…”, the anesthesiologist says. I start to feel drowsy but then right before I nod off the paralytic agent takes effect.  I feel my legs go numb then limp, then the worst happens. I feel my diaphragm start to slowly give up and this causes me intense panic. It feels like the worst asthma attack I have ever had, I can’t move enough air, my eyes become wide with fear. I begin a losing fight against the medication’s effect, using every ounce of strength and determination I have to keep my diaphragm moving up and down… And then…. I black out.

I wake up with three large leather straps across my body. I have no idea what is going on, where I am, or who I am. I feel intense fear, an overwhelming urge to escape to a safe place to figure things out. I start fighting against the straps, trying to tear myself out, but I am secured tightly.  A nurse I have never seen before comes over and asks “Whats your name? Where are you? What just happened?” I am unable to answer any of these questions and I become very angry. She tells me my name, and when she does all I feel is a twinge of deja-vu, like “I swear I’ve heard that name before”. This process, asking me the 3 questions then telling me the answers occurs every set period of time until I am able to answer all three without her prompting me. I have no idea how long this takes as my sense of time is destroyed.

They lead me to the cafeteria and offer me juice and crackers. The anaesthesia has made me very nauseous, or maybe it was the grand-mal seizure? Either way I have no urge to eat. I feel…flat…nothing..a blank slate and my face reflects the same emptiness. I have no negative thoughts or positive thoughts, I am just..level. My parents meet me and start talking about random life topics. I am unable to keep up with the pace of the conversation, my brain feels like its going thru a thick fog.. On the drive home the feeling of deja-vu occurs over and over again.. “oh I think I’ve seen that car before” “Oh I think I’ve seen that house before..”

I underwent over 100 of these procedures, and only stopped because I had a heart arrhythmia under anaesthesia. They did not make me happy, nor did they make me “normal”. They do not end a behavior because of “pain” (as there is none) or negative reinforcement (again, as there is none) but it did help reduce my intense urge to kill myself. If one was suicidal, and 10 was perfectly happy, it made me a 5 with the inability to go to a 4 or even a 6. Others around me say I became very forgetful, that during this period I was not as sharp or as quick as I normally was. One person told me I was a “zombie version” of my former self. Also, the 1.5 year period I was receiving these is completely wiped from my mind still.. My memories from this time are purely people telling me later what I did or what happened. Yet, despite these side effects I feel that ECT helped save my life. It helped me get thru one of my roughest depression phases and hence able to go on with life and for that I am thankful.

Autism- the beginning

For years I was told by members of my family, my wife, and a few friends that I had aspergers or high-functioning autism but I brushed them off because I thought they were just too eager to fit me into a nice explained box. My odd behaviors and “special” way of communicating with people felt like a bunch of quirks that bundled together made my personality

This all changed one day in medical school during a psychiatry lecture on some non-specific topic. I was sitting there bored so I started randomly reading articles that were stuck in our notes and landed on one from a NY times author about how he discovered he had high functioning autism (HFA) by the time he was an adult. Much to my surprise, the article made me very upset, so much so that there were tears coming down my face because of how much I identified with the writer. I was upset that all these features that I once thought were unique ended fitting nicely into a diagnosis. It wasn’t the typical medical student neurosis of “OH NO I’M COUGHING I HAVE PNEUMOCYSTIS PNEUMONIA”, it was more than that. All these quirks, not just one but ALL, fit nicely into a little autistic box. My great ability with numbers/computers, my severe speech delay, my clumsiness, lack of tact, and my social ineptness all lined up with this diagnosis.

To help sort things out I made an appointment to talk to one of our psychiatrist professors. After a talk of why I thought I may be autistic and my troubled past she agreed that I had a form of aspergers or high functioning autism. This was a little surprising as I have seen psychiatrists for 18 years pretty much constantly, been diagnosed as Major depression(duh), OCD, Bipolar(oh come on-wheres the manic part in my life?), schizotypal(not even close) but never autism. There is a footnote to this though: As mentioned in a previous post a “case report” was written on me when I was younger, could that have labeled me as autism? No one remembers, so it is lost in the past.

After months of struggling to come to term with it (I thought I was unique?) I accepted the diagnosis and allowed myself to be at peace with this one part of my life.  I have even become comfortable to the point that on a whim I tell people I have aspergers. Because of my pretty much non-selective way of sharing this information I have had a very wide range of reactions, from good: “ooh that’s why you act like that/said that” to bad: from a med school evaluation “Cannot keep a professional distance from clinical staff”. I have also had different experiences from my fellow classmates and have been shaped in different ways
because of my mind structure. It seems because of my outside experience of the “group conscious” that I escape many of the unspoken social pressures that change many neurotypicals.

Oddly enough, this same psychiatrist ended up involuntarily committing me to the hospital and later  suggested I write an article about Aspergers and medical school. But, sadly, my writing skills don’t really trap and interest readers as you have most likely experienced here.

Death and an autistic’s response

Does grief affect someone with autism differently than neurotypicals (those without autism)?

I went to assess a pt who was in end of life and met the pt’s daughter in the hall. She was shaking and saying her mother hadn’t breathed in over a minute. While the nurse tried to calm her down I listened for breath and lung sounds, which there were none. I informed the daughter and she started crying. I started feeling the strong sense of composure and cold detached logic, which I pride myself on, collapse. The wall around my emotions I had been building since my grandmother’s death 3 years ago just gave way and I felt the daughter’s grief affect me on a personal level. As I saw the daughter cry I began identifying with her pain and knowing how deep it runs which tore me apart inside. I felt tears start to well up in my eyes, I tried to say my condolences, hugged her (which I did even though it causes me physical pain because I know neurotypicals need it in times of grief) and quickly escaped the room.

It all seems odd to end up this way as I have spent countless hours focusing on my death, planning it, trying to predict it’s after effects. I looked at death in a logical way, as in an event that is expected end point of any life. Yet I was not prepared for my grandmother’s death and it ended up changing me forever. After the event I didn’t really talk and I started sleeping the days away. I had typical grieving reactions such as thinking I heard her voice or seeing her out of the corner of my eye. I cried for months and found it very hard to not wake up thinking of her. I couldn’t even watch TV shows or commercials that contained grieving people or I would become very upset.

Fast forward 3 years later, and things have become like what Johnny Cash said regarding his brother’s death “I kept talking but everyone stopped listening, so I stopped talking about him”. In this time period, it feels like I have built a wall, a defense system against tragic events effecting me personally. While this may seem cold, it is required if you are a doctor in a field with death being a normal expected event, for example: In my ICU rotation we had someone die around once a day and if I had opened myself up to the experiences of the family because I would have not made it thru. I thought the barriers I had formed over the years were near complete as I had gone thru patient deaths unscathed. Yet, when this patient’s daughter, who I have known only for 6 months, started grieving my defenses completely failed.

I suppose I should have predicted this, for the wall itself is in part a charade. If I was completely healed from my loved one’s death, couldn’t I bring myself to visit her grave? Couldn’t I think of her and things we did without crying? Would I avoid talking about her for fear of the emotional response it will bring?

So I would say yes, in this case an autistic man grieves like any other man.

Never Give Up-An Introduction to my life

Warning: As someone with high functioning autism, my writing can be very dry and be filled with facts and information. Consider this a warning for all of my posts.

Never let your past stop you from moving ahead with your life. Although you may have made mistakes or taken a bad path in the past you can *always* return to the path of success, it just will be a little more complicated and may take longer. To support this I will describe my story, the factors against me, and the bad choices I made.

In the beginning: As a small child I was developmentally delayed and had a very severe speech problem.  It was to the point that my “educators” thought I averbal (lacking verbal skills, unable to communicate verbally) and was put in a special education class. My mother even signed a release for a researcher to publish a “Case review” (Case reviews are medical articles focusing on a specific patient with a rare or unique presentation of a disease or disorder) about my condition(my mom doesn’t remember what I was diagnosed as: I wonder if it was autism? Aspergers? A genetic condition?).  After standardized testing I was allowed to re-enter the general student population but had to take speech therapy for 6 years. Then in high school we had standardized testing(yet again) and I was placed a year ahead in some classes (math, English, science). Problem was when I became 12 I suddenly felt overwhelmingly depressed. I began cutting myself nonstop in discrete places on my body.  I didn’t put an effort in anything and had no interests or hobbies. I struggled with even getting out of bed and my longest school attendance streak was 4 days in a row.  It got to the point of being hospitalized for psychiatric reasons several times which in turn made school even more difficult. So, logically, I dropped out in 11th grade to wallow in my depression. But I was lucky enough that there was an “alternative highschool” near me and there were people to push and get things done in my name. The school allowed me to graduate with a highschool diploma, were very lax with time restrictions (which I struggle with), and worked around my mental illness.

After highschool I had a very hard time mentally. I attempted suicide multiple times and was in and out of psychiatric hospitals. I thought everything was hopeless and I was convinced I would die by suicide or some other violent means before I was 21.  I even started receiving shock treatments (electroconvulsive therapy, ECT or EST) because of the crippling effect of my depression. But thanks to my psychiatrist, wife, and family I was pushed into going into community college.  I started in computers but switched to liberal arts aiming to go to an ivy league college. I still battled depression and there were multiple times I almost committed myself to the hospital. Yet, despite all this, I ended up being accepted to an ivy league school.

At this prestigious school, my depression got worse and I felt alone on a campus of +10,000 students.  I became jaded with medicine and didn’t apply to medical school at the time most students did. Instead I moved to a different city, quit my psych meds and started cutting myself profusely again. Eventually I applied to medical schools and was accepted even though I am perhaps one of the worst interviewees there can be.

While in med school I was told repeatedly that I “didn’t have a doctors personality” and I would “never last”. They were right in some part, as I did have some trouble with social aspects and intercommunication skills. My depression also hit a low and I was involuntary committed to the hospital my 3rd year of medical school. I then had a wonderful time as my lovely dean tried to block me from being reinstated as a student after finding out it was a mental hospital that I had spent time in.

Yet, despite all of this: the speech problem, the supposed mental delay, the overwhelming specific obsessions, dropping out highschool, the multiple forced hospital admissions, the 100 plus procedures that fried my brain, and all the people telling me it’s impossible and I can never do it, I am a full-fledged doctor. Not only that, this supposed mental handicapped, mentally ill, socially inept person scored higher than at least 50% of his healthy, normal, non-mentally ill fellow students.

Point is: We all have challenges and no matter how large they seem or how everyone is yelling “you can’t do that”, you CAN achieve your goals and there IS a way. You just have to search for it, press HARD, and
don’t give in.