Lupus, sanity and my reflections on mind.

 2025-03-09 03:02:09    |     Dr. Sabarinath Mahadevan    |     Medical and philosophical.

I once read a tweet that stayed with me for a long time: "The first step to stay grounded and clarify your priorities is to contemplate your own mortality for just 60 seconds every day." I’ve always been a bit hesitant, to be honest, even fearful, about visiting this hospital. It’s an inpatient facility that treats nearly every condition you'd encounter in a textbook on psychiatry. One of the reasons for my hesitation—okay, let’s admit it—my fear, is the thought that often crosses my mind: Why are these seemingly normal people here? I wonder if they can't just convince themselves to stay sane.

More importantly, I sometimes worry: Will I end up like this one day, overwhelmed by the stresses of the world, unable to cope with internal conflicts and prejudices? These thoughts are unsettling, but there’s another more practical reason for my hesitation. Every time I’m called in, a staff nurse hands me a massive file filled with records of a patient who’s been in that ward for months. Most of the medications listed are ones I last encountered during my second year of medical school—drugs that modulate dopamine (the "reward" hormone), serotonin (the "feel-good" hormone), and benzodiazepines (the sleep-inducing agents). But let me spell it out: after that pharmacology exam, those mnemonics vanished from my mind like smoke in the air. As I drove to the hospital, these thoughts swirled in my mind.

A colleague once casually remarked that current psychiatric treatments are like repairing a watch with a hammer. I thought, Well, in our country, the hammer also comes with the handles of social and financial constraints. As I flipped through the thick drug chart, interrupted by a teen yelling at the nurse for not providing a smartphone, I couldn’t help but observe the contrast. To an outsider, the shout might seem terrifying, but to the nurse, it was no more than the sound of a trumpet to a deaf man. Calm and unbothered, she simply said, "Dr., you just continue, never mind." In the midst of this chaos, a well-built businessman was making a fuss over the snacks that didn’t impress his taste buds. Meanwhile, an elderly man in his 60s complained about not being able to sleep and demanded all the lights be turned off. Yet, the nurse continued her duties as if these requests were no more than the hair falling into her eyes.

I began to wonder: How does one work in such an emotionally charged environment without it affecting their own emotional well-being? Can the constant waves of human emotion leave an imprint on the emotional resilience of the healthcare team?

I told myself, "Let’s not overthink this time. Just shoot on the rheumatology questions, comment on any autoimmune issues, and leave with a clear mind."

I met my patient, a gentleman in his 20s, who seemed to come from a well-off rural family. He had been a taskmaster managing people at his factory. He answered my questions clearly, with no signs of joint pain or rashes—nothing that would entertain a rheumatologist’s interest. As the nurse placed a file containing two months’ worth of records in front of me, the patient asked, "When can I go back home?" I replied, "Soon, once you get better," the usual non-committal response.

As I scanned through his file, I noticed something unexpected: his anti-nuclear antibody was positive. That’s what had prompted the call for me. He had been admitted with a history of self-harm and suspected fits—symptoms I hadn’t anticipated. Anyway, neurological (fits) or psychiatric (self-harm) symptoms could well be the first signs of neuropsychiatric lupus. I ordered a few more tests to gain clarity. My friend, a surgeon, once commented, "Rheumatologists always keep writing those rare tests." I couldn't help but laugh inwardly and convince myself to keep writing more tests, adding more weight to the existing records.

As I continued reviewing his records, I was interrupted by another patient shouting at his caretaker to switch on the TV. The nurse, unfazed, simply dialed the lab for the test and made a note in her nursing chart. As I prepared to leave, a voice behind me called, "Hello, doctor, can you help me?" A man in his 40s, speaking in a clear English accent, caught my attention. "I’m not your doctor, I’m from a different specialty," I answered, trying to move on quickly. "What specialty are you, then?" he asked. "I’m a rheumatologist," I replied. He offered a handshake and introduced himself as a social and preventive medicine (SPM) doctor. I quickly apologized for my response and wondered, though, Why is an SPM doctor here? Is he called for any sort of epidemiology study here? He then asked if I had read the book by Park, the well-known textbook of preventive medicine. I gave him a sheepish smile and admitted, "Yes, a long time ago." I was still puzzled. Why would he ask me that here, of all places?. you see doc, even i will forget, if i dont revise today, he continued.

The nurse soon came over and comforted me, "Doctor, I’ll handle this." But as I stood there between a textbook request and the nurse’s signal for me to leave, I couldn’t help but wonder what brought this SPM doctor here. Later, the nurse told me that he had been admitted with symptoms of bipolar disorder and mania(The feel we all get when we think we’re the most popular person on this planet). she continude there are few more doctors as well admitted here. I gave a firm handshake to the nurse and thanked her team for doing a wonderful job of keeping the world sane.

As I drove back home, thinking sadly about this doctor asking for a textbook revision in a psychiatry ward, the tweet I’d read earlier resurfaced in my mind. The second-best step to remain grounded? A visit to a psychiatry ward, where all our egos and accomplishments dissolve, leaving us eternally thankful for the grace to remain sane.

PS-The names and content in this blog are fictional. Any resemblance to actual persons or events is purely coincidental."