A bipolar story

BMJ 2006; 333 doi: (Published 27 July 2006) Cite this as: BMJ 2006;333:245

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  1. Raquel Duarte (s0126305{at}, fourth year medical student
  1. University of Edinburgh, Edinburgh

    Being a medical student has its ups and downs. As I sat in the busy psychiatric outpatient clinic, I was having a particularly “up” day, giggling while the senior house officer vainly tried to hang up the telephone. On the other end was a bipolar patient, currently manic. “Yes, I understand, but I really have to go… Yes, goodbye… No, I am in a clinic….”

    “Pressure of speech,” I ruminated, proud at how good my psychiatric terminology was coming along on only the second day of my attachment. When my colleague finally managed to disentangle himself from the conversation, he looked at me with a strangely vindictive grin and told me that the patient was being admitted and that she would be a “wonderful candidate” for a detailed case study. My shoulders sagged, my grin turned upside down—I'd been looking forward to lunch and a free afternoon. Little did I know what I was in for.

    “Can I see your badge, young lady? It's just I have to make sure you're not an actor pretending to be a medical student. There are a lot of actors here, you know—the patients, the doctors….”

    “No further explanations needed,” I thought, and duly produced my identity badge. Immediately convinced of the veracity of my identity, my patient sat down in the family room of the inpatient ward, and I proceeded to obtain a full, detailed psychiatric history—or rather, I tried to. The truth is, she just talked—about everything from art, to politics, to literature. Because of my complete inability to direct the interview, I let her carry on. “Been here almost three hours already… Damn, shouldn't have giggled at the SHO. Never mind, I'll just have to come back again tomorrow.” Resigned to the fact that I'd have to meet this patient many times before I could get all the relevant facts, I relaxed and was surprised to find myself enjoying all the irrelevant bits of the conversation.

    We both laughed and chuckled like a couple of schoolgirls, me and this 65 year old woman, as I got caught up in her contagious joy and boundless energy. Amid deliberations on Monet and reflections on the situation in the Middle East, she told me about her experience of terrible confusion that somehow, like in a dream, makes perfect sense. I heard about her tragic losses and deep despair, about the havoc this disease can wreck on a family and about how her faith had sustained her throughout. “Mania… psychosis… depression.” She didn't just give me a history of bipolar illness, she told me a story and took me on a journey to discover a person struggling with a disease but who, in spite of or perhaps because of it, was a whole and wonderful human being.

    Now, when I meet a “bipolar,” “depressed,” or “schizophrenic” patient, I try to look past the diagnosis and often find someone who has had to endure more than most of us and thus has a wealth of experiences and stories to share. While we may not always have the luxury of time to listen, these are people who deserve all our compassion and respect.

    “You're my angel,” my patient gushed as she gave me a hug. She was wrong, of course, just “over-familiarity.” The truth is, she was mine.


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