“Is it hot in here, or is it just me?”
The patient interrupts himself mid-interview as he shifts in his chair. He’s sitting directly in the afternoon sun. He’s squinting. He fiddles with the zipper on his jacket, pulling the garment halfway off, then back on.
My classmate, the interviewer for the psychiatry session, tells him he is sitting directly in the sun but forgets to suggest he move.
For the remainder of the interview he doesn’t move. It’s an hour-long interview. He’s paranoid, suicidal, and incomprehensible. He lapses into tangents, interrupting those tangents to ask if he’s going on tangents. Sometimes he forgets the question as he’s answering. It’s hard to hear what he’s saying because he mumbles. It’s also hard to hear what he’s saying because the words don’t piece themselves together in structure I can decipher. Most of what he recalls takes place two decades ago.
He’s still squinting, looking at us curiously, telling us about all the voices he hears at the bus stop. It’s like they can read his mind.
A large part of me wants to interrupt and drag his chair a foot to his left, or a foot to his right. Either direction would do.
It’s not hot; it’s just you.
Now he’s quoting a song from 1988. “Do you understand what I mean?” he keeps asking. We sense his fervent desire to be understood. I squint my brain really hard and try to put myself in the literal hot seat with him. I’m gleaning a vague meaning, but it’s probably not the meaning he means.
And now he’s crying. He apologizes too much for it.
“Any more questions?” our professor asks as the interview closes, addressing the rest of us onlookers.
What I really want to ask is, why don’t you move? When you walk out of this room, what other things will paralyze you? Why can’t I understand your mind’s language, and why can’t you speak my mind’s language?
I don’t have anything to ask, I say. Not right now. He’s crying, for god’s sake. It’s not worth re-opening the topic of his childhood abuse to get another line for the write-up.
After the interview, the professor asks us what we thought of the interaction. I pause. The first thought that comes to mind is a rather simple-minded one: I feel really, really bad.
My classmate answers first. “The patient seemed to have a lot of trouble giving us any sort of timeline.” I nod in agreement. The professor talks about the difficulties of having an unreliable narrator.
I feel really, really bad. I feel really, really bad. I haven’t said anything yet; I think they’re waiting for me.
Finally, I offer: “The patient mentioned that he was ‘feeling between a rock and a hard place.’ Using an idiom, he seems to have the capacity for abstract thought, which is not characteristic of schizophrenia.”
It’s a good finding. It’s helpful for diagnosis. Unlike my original thought, which I eventually share but bury within clinical observations.
I am thinking of T.S. Eliot. I guess this is how the world has been ending for our patient. Not with a bang but a whimper. It’s a series of withdrawals from life, slowly and relentlessly, for decades. He has no family, no friends, and no home. He has confusion and sadness in their place.
And he (can’t? won’t?) move his damn chair out of the sunlight.
We draw a concept map on the board to help sort out the 60-minute tangled stream-of-consciousness.
And how should I begin? asks a character in another of Eliot’s poems.
Note: Certain medical, social, and temporal details have been changed to preserve anonymity (while hopefully not altering the narrative and message).