Friday afternoon I had the biggest laugh in weeks—I read my psychiatric report.
When I was in the Emergency Department requesting palliative care, Dr. Jishi told me that first I would have to be screened by psychiatry. She didn’t say why.
If two guys are sitting in a bar complaining about their boss and making threats about killing him, one guy gets a pass under the heading of free speech. The other guy, who has a psychiatric history, can get handcuffed and taken out under mental hygiene law. I don’t know why I had to have a psychiatric screen in order to get palliative care, but I did. A psychiatric history will get you lots of special opportunities that, for example, having a sexually transmitted disease will not get you.
Last Friday morning psychiatrist Thomas Falci—an old guy who may be the exception to the “old guys are good guys” rule—showed up to interview me. This Friday I asked to see his note in my chart, expecting it to be half a page of scrawl. Shock to me, his “note” was five pages, typewritten, single-spaced.
It should have started with a statement that at the time of the interview the patient had a blood sugar level over four hundred (120 is normal).
Dr. Ronald Fish, who is almost an old guy, is a psychologist who has been seeing me here at Crouse. At my request—I kinda-sorta already knew—he researched the effect of chronic hyperglycemia on cognitive and emotive function. Fact: high blood sugar causes cognitive function to diminish and can end up causing dementia. So I’m getting dumber. It also causes depression. I knew this, too.
Reactive depression is caused by life events and you know it because your mind keeps going back to what is bothering you. You either can keep pushing the subject away or you can turn and face it. After I stopped taking antidepressants, I learned to face my problems and fix them so I am pretty darned good at dealing with reality. But in recent years I’ve been sinking into depression with no apparent social experience triggering it. That’s when you know that you’ve got a physically originated depression. That gray fog just keeps rising, and I’ve known that it’s high blood sugar causing it.
Chronic hyperglycemia also causes poor impulse control and intolerance of frustration. Yeah, tell me about it. My suicide attempt on April 16 has been attributed by Dr. Tucker to depression. Nope, didn’t happen that way. What did happen was that for many months I had long reflections on suicide as a rational choice. No less an authority than Dr. Thomas Szaz committed suicide based on rational choice, not depression. I decided, during times when I was not depressed, that suicide was a valid choice for me. And then, on April 16, coming out of my doctor’s office with a glucose level of 484, rational choice was combined with poor impulse control, and there you go.
So Dr. Falci’s note about me should properly have placed the interview in context: the patient is gorked by high blood sugar. It didn’t. Psychiatry is not a science. It does not deal with objective, quantifiable, repeatable test results. It is all about one man’s interpretation. The DSM (Diagnostic and Statistical Manual) that is the bible of psychiatric diagnoses, is not based on statistics. According to psychiatrist Dr. Peter Breggin, who has repeatedly challenged the damage done by psychiatry, diagnostic criteria are established by a bunch of psychiatrists sitting in a room talking and then taking a vote. Ain’t nothin’ scientific about it.
So Falci’s report starts out that the patient “was asking to be put on DNR [Do Not Resuscitate] status when she did not have an objective life threatening illness.” Two things wrong with that. First, I probably decided on DNR when I was about twelve years old. I come from ten generations of farmers. “To every thing there is a season, and a time to every purpose under the heaven: A time to be born, and a time to die; a time to plant, and a time to pluck up that which is planted . . .” My parents, aunts and uncles, and grandparents were DNR even before DNR was codified into medical law. And to us, you don’t wait until you’re faced with a terminal illness before you make important life and death decisions. You plan your life and take care of business.
Second, who says I don’t have “an objective life threatening illness?” Is this guy so simpleminded that he only can conceptualize “life threatening” as one cancer or another case of Parkinson’s disease? Babe, when you have two urinary tract infections, diabetes and kidney failure, and can’t take drugs then you for sure are experiencing threats against the continuance of your life.
Falci then went on to write that I was “engaged to a man in the Air Force.” For shame, for shame. The late Lt. Robert Dobrow was in the Marine Corps, and you know how we feel about that!
After a bunch of slightly out-of-kilter mumbo jumbo, Falci zeros in on what he repeatedly calls “immune deficiency.” At no time have I ever used the term “immune deficiency.” What my research has taught me is that immune breakdowns come in three types. First, immune deficiency, which is a condition in which the immune system fails to measure up to need. For example, if you have AIDS then you can count on getting multiple colds, flu-like illnesses and pneumonias because your immune system is compromised and cannot screen out bugs. I do not have immune deficiency.
Second, immune dysfunction can result in allergies, which is a condition in which your body creates antibodies to certain substances, e.g., I am allergic to shellfish.
Third, the immune system can develop hypersensitivity, e.g., “Goodpasture’s Syndrome (in which an antibody against an epitope in the glomerular basement membrane results in rapidly progressive glomerulonephritis).” This is all very complicated; I don’t much understand it.
I do not say that I have “immune deficiency”; I say that I have “immune dysfunction.” Falci didn’t listen—or didn’t know the difference. But he did write that “We did ask her who gave that term and one of the family doctors told her that.” And there’s that little sneer—“one of the family doctors.” In fact, the source was James B. Tucker, MD; Chief of Hospitalist and Emergency Medicine; Director of Medical Education and Family Medicine Residency, St. Joseph’s Hospital Health Center; Professor, Department of Family Medicine, SUNY UMU. Dr. Tucker spent three hours on the phone trying to get me a hospital-to-hospital transfer to the Cleveland Clinic immunology section, which is more than any psychiatrist ever did.
No less a “family doctor” than James Tucker says it’s “immune dysfunction, type unknown, resulting in hypersensitivity to medications.”