An Unfortunate Patient

“It was such a bizarre scene. I’m tempted to call the market and see if I can get some details,” said the host. “She was sobbing. I mean really sobbing. Luckily, her mask absorbed the tears.”

The guests had finished the first course, a simple mixed greens salad with some toasted almonds and just a sprinkle of Gorgonzola. The sharp vinaigrette had brightened everyone’s mood. Paul was gleeful to have such a compelling little story to accompany the appetizer. He’d been planning this dinner party for weeks and wanted it to be perfect.

“It’s a good thing,” said Dr. Brownstein. “Tears can actually spread pathogens. Ebola can lie dormant inside a person’s eyes for months after acute symptoms. Did she go to Africa recently?”

“For God’s sake honey, don’t talk about pathogens at the dinner table,” said his wife. She could see that the host was mortified. “It was probably Schuman’s market, right? They’ve been wearing masks at the meat counter ever since Covid.”

Paul nodded his head in confirmation. “It was Schuman’s.”

The doctor actually sputtered a laugh at this revelation. Both his wife and Paul gave him an annoyed look.

“Oh, I’m sorry Paul. I’ve got to explain.” The doctor paused for a moment, obviously turning something over in his mind. “I’ve got a story for you.”

“I’ve got a patient, let’s call her Emily. Emily is extremely intelligent, she was getting a degree from a great school and had a promising career ahead of her. She’s got bipolar disorder but she was high-functioning for years. Most people don’t know much about bipolar, but it was like a super power for her.

There’s a state called hypo-mania which is characterized by an elevated mood, high energy, and often staggering creativity and productivity. Of course, with bipolar there are ups and downs. When she’s up, she’s a brilliant writer, but when she’s down there’s no spark. She was able to handle most of her more administrative work in her down time. She’d do editing, submit to contests, and try to focus on her self-care until another hypo-manic episode presented itself. The episodes last for days, sometimes weeks. She won several awards for her poetry and a few short stories at university. I’ve read some of her work and it’s really compelling.

“I love these case studies,” said the host. “So what’s the problem?”

“I’m getting there Paul, bear with me. I’ve been seeing Emily for a few years, since her symptoms started presenting. Her parents were worried that she wasn’t sleeping much and she could be irritable at times. Then, things would shift and she’d withdraw. She really wasn’t getting dangerously high or low though, and she was cycling pretty slowly, so Emily wasn’t too concerned, but her mother really wanted her to be on some sort of medication.

Emily hated it. Patients who experience mania are often very reluctant to lose that part of their personality. It’s impossible to convince some of them to stay on their medicine, even when they start to suffer pretty severe consequences. She was very stable on the medicine, but she missed the high. Most people have never experienced a euphoria like that, especially not for days or weeks. It’s kind of like being on drugs. Our brains produce some really powerful chemicals. When they’re gone it has a serious psychological impact.”

Paul interjected again, “So she went off of her meds.”

“Exactly. She was having trouble in school. She wasn’t having fun with her friends and she is normally very outgoing. She wasn’t excited about classes. She had a lot of work to do and was starting to feel overwhelmed. We talked when she came home on break, and I knew she was going to stop. Honestly, I really can’t blame her. I’d probably do the same thing. She was over eighteen at that point, so I couldn’t inform her parents, but they had to know. It was a game changer for her.

Her mood started to elevate slowly and she was hypo-manic a few weeks later. I asked her to check in with me regularly to try and monitor the situation. Her emails were getting longer and more descriptive. She wrote a few papers related to mental illness and asked me to be a subject matter expert a few times. She shared the finished works with me and they were pretty mind-blowing. Her insight into her own condition seemed excellent at first, but things started to change.

I got a call from her mother a few months later and she asked me if I had talked to Emily. I let her know that Emily hadn’t signed a release form after she was eighteen so I couldn’t share any information with her, but I could listen. She told me that Emily had been spending a lot of money on her credit card. She was dating a lot of young men and worried that she was getting promiscuous. When they would speak, Emily was full of energy and she was getting excellent grades. There were highs and lows but college was a piece of cake. Mom knew that she was off of her medication. It had been a few weeks and there was no sign of her slowing down. She was starting to worry.

The next time she was home, her mother staged a sort of intervention with the family. They confronted her about her medicine. I think she started taking them here and there, but she wasn’t taking them as prescribed. She was probably drinking, it is college after all, but that is a huge problem, as you can imagine.”

“The next course will be out in a minute doc. What happened!” said Paul.

“I’m not sure what precipitated it exactly, but she started showing psychotic symptoms. Delusions. Hallucinations. I think she probably started doing drugs with her friends, honestly, but a lot of mental illness can get worse as kids get older. I visited her in the hospital and she was pretty scared. She went back on her medicine but it didn’t help with the delusions.”

Everyone was looking at the Doctor, amused, but ready for the resolution.

“I know this seems like a total tangent, but you’ll get it in a second. Remember when she ran up mom’s credit card? She spent thousands of dollars on a very old copy of Grimm’s Fairy Tales. She was working on a rewrite for a project and for some reason became completely fixated on it. Remember the Frog Prince? Well, there’s a witch in there that turns a prince into a frog. The moral of the story is something about honesty. The princess lies about something. It’s very weird. Well, I think Emily has been lying to her parents about the alcohol, drugs, men, who knows what else. She’s totally wracked with guilt right now.

She started to get paranoid that the witch was going to turn her into a frog. Maybe she thought the book was possessed or there was a real witch or something—but whatever it was, it was going to punish her. It would turn her into a frog, her friends, her family. Everyone frogs. Now she’s hallucinating. She’s delusional. Her brother found her in the pond in their back yard, totally naked, covered in mud. Everyone looked like a frog to her. She’s out of the hospital now, but she just can’t shake it.

“That is just too bizarre,” said docs wife. “A bit of a departure from the conversation though, hun.”

“No!” Paul stood up and looked at doc, wide-eyed.

“Yes, Paul, it’s her. She can’t write anymore. It’s pretty sad, but also kind of funny. She said that she can’t type with her frog fingers. Frogs have a very limited vocabulary. It’s wild. I’m going to try and get her on complete disability, but her mom is having a hard time accepting it. She got her a job at Schuman’s behind the meat counter. She quit on her first day. She was totally inconsolable.”

Just then, Paul’s wife popped out of the kitchen with a platter. “Frog legs, a French delicacy!” she said, and was baffled by everyone’s strange reactions. “They had them at Schuman’s and we just had to try them.”