I hear a lot of pretty crazy stories in my line of work. Sometimes it’s a struggle to believe the patient. How is it that some people have that much bad luck?
Today has been particularly weird. I learned today that one of my patients has been stalked by some overseas financial company for the past 15 years. Apparently, they keep tabs on her in every city she has ever lived. She has suffered some horrific trauma in her almost 70 years of life, so I’m going to cut her a bit of slack and not rush to have her admitted to the psych ward though sometimes I have to wonder if that’s the right decision. She admits she’s been living in fear for the past 15 years and is convinced she is still followed. When I discussed this with my colleague, she pointed out to me that a history of trauma can often lead to a particular state of hypervigilence in an individual. She is sounding very paranoid, but something has probably triggered a memory of a past trauma and she is projecting that feeling onto something else. Does that make sense? I am still trying to wrap my head around the entire thing.
My patient isn’t delusional. She’s not making this stuff up, I believe that something happened with this financial organization years ago but how she has interpreted it is likely not what actually happened. My question is why now? Why is she bringing this up all now? The answer, after some thought, is actually quite simple. Her boyfriend of over 10 years abruptly ended their relationship a year ago. She has been floundering ever since. Overnight her world was turned upside down. She felt abandoned, used and tossed aside. At first there were a lot of somatic complaints; insomnia, headaches, depressed mood, etc. She clearly was entering a situational depression. She would speak tangentially a lot of the time, going back and forth between her early years in Europe and her relationship with her ex-husband, the abuse she suffered at his hand, etc. It is quite clear that she has spent most of her life surviving one form of abuse or another. It is truly heartbreaking.
There there’s another woman who disclosed to me that a few years ago she started having flashbacks of horrific beatings at the hand of her mother from the time she was in the playpen. When I asked what triggered the flashbacks, she broke down and told me she’s been stalked by an individual in the public sector for the past 9 years. Suddenly, after 7 years of treating this woman, she makes sense to me. I always felt there was just something missing in her story. There was a wall that was impenetrable and it has finally started to crumble. She’s ready to start dealing with her trauma. Her biggest fear, she told me, was that I wouldn’t believe her story and I would think she was crazy.
And then there was the young male professional who came in because of chest pain. While taking his history, I asked about drugs of abuse.
Me: “Do you smoke cigarettes?”
Me: “Cocaine? Heroine?”
Him: (chuckle) “No.”
Me: “Okay, then let’s check your blood pressure —“
Him: (interrupting) “You didn’t ask about crystal meth.”
Me: “Riiiight. Okay then … let’s talk about that.”
Wow. I almost dropped the ball on that one. He went on to tell me that he started using crystal meth last summer and it was a causal thing, but when the chest pains started it freaked him out and brought him in. He said he could stop whenever and didn’t feel the need to seek out addiction counselling. So, I sent him for some routine cardiac testing and he booked a follow up. (I can tell you that I really struggled not to let my jaw hit the floor when he told me I didn’t ask about crystal meth!)
Fifteen minute appointments are not nearly enough to tackle such disclosures, but this is the nature of family medicine. There’s no telling who is going to have a breakdown, who is going to admit infidelity, drug abuse or sexual deviancy. In some ways, this is what makes family medicine so much fun. It never really is boring for very long.