I return now after a bumpy year to continue on my quest for describing a bedside manner by telling true stories about medical doctors that reveal their human side. This story may not do that but is interesting anyway.
Having completed my medical residency training in the 1960s, a tumultuous period in America, “Make Love, not War” was the mantra that permeated the culture of the “Flower Children.” Like the beat generation before them, they desperately tried to break away from the conservative practices that this country sanctioned. I had minimal exposure to the Flower Children’s period since I chose to study medicine. I appreciated the exceptional music of that era from Bob Dylan, The Beatles, Jim Hendrix and others that captured the ethos of that period. At that time, I remember attending a medical meeting in San Francisco near a park occupied by the Flower Children. They were a colorful group dressed in different outfits with a mix of loud and dazzling colors. Assembled in a disorganized and non-intrusive manner making no deafening noises or booming music and generally no hoopla, they appeared peaceful and non-threatening. They seemed to be a generation that preferred to demonstrate their independence in colorful clothing, hairstyles of different colors, music, and drugs. They were devotees of drugs that produced psychedelic effects and hallucinations which transported them away from the chaos created by their elders. This story is about one of their favorite drugs, LSD, lysergic acid diethylamide. Unlike heroin of the prior generation that dulled the senses, it produced a heightened feeling of being alive with the ability to communicate with an imaginary world of visions, almost spiritual at times. The standard anti-anxiety drug used by the population also evolved in this country from housewives on Miltown in the 1950s, followed by Librium in the 1960s, then Valium and the current flavor of the decade, Xanax. The Flower Children were not alone as disciples of psychotropic drugs.
One morning on medical rounds with my new intern, Jim, I learned that one of the patients admitted the previous evening to my medical service was a medical student. It was rumored that he had achieved the highest or one of the highest scores on the MCAT (medical college admission test). He had graduated from Harvard and was a follower of Timothy Leary, the infamous proponent of LSD. This wondrous drug was claimed to have many beneficial psychological effects. Our patient was admitted that evening with the diagnosis of labyrinthitis, an imbalance of the middle ear causing dizziness or vertigo. Neither Jim nor I admitted him since were not on duty that night. The new patient was in the first bed on a large open ward of male patients on the seventh floor of the hospital. The location of the bed was close to the nurse's station so they could keep an eye on him. Jim had examined him earlier that morning prior to rounds, and he was puzzled by the diagnosis. Admitting a patient with that diagnosis to a hospital, especially a city hospital handling life-threatening illness, was unusual. More commonly the emergency room discharged a patient home with this diagnosis with a handful of sea sickness tablets. The other thing confounding Jim was that his physical examination was normal. There were no physical signs suggesting the diagnosis of a middle ear imbalance. Jim also remarked that his patient who I will call Jack for this story had a strange affect and did not speak or answer questions. Jack was restrained in bed with an apparatus that allowed movement of his arms and legs. Restraints should not have been necessary for this diagnosis unless the patient was confused which is not usual with just a middle ear imbalance. The restraints allowed some movement while keeping the patient in bed. We assumed they were needed to prevent a confused and dizzy medical student from falling out of bed. After all, it was for the patient’s protection and God help the resident who doesn’t appreciate the need for preventing such accidents especially when caring for a medical student. With new patients, I usually examined them after completing rounds to allow more time for taking a history and performing a physical examination. Jim and I were examining the fourth or fifth patient on the ward when we heard a commotion with loud noise coming from the first bed. Jack had taken off his restraints, jumped over the bed rails and headed to the nearest stairwell. I told Jim to take the fastest route to the ground floor and block Jack’s exit from the hospital. Jim as a recall was a rather muscular fellow with a physique resembling a football tackle. Our patient was a tall, gaunt guy who could be easily stopped. I followed my patient who had had a head start. In the stairway, I could see him on the fourth-floor landing looking down at Jim, who amazingly had reached the ground floor. I yelled to Jack to return to bed and reassured him that we would not harm him. There was no answer, and he had moved out of sight. All I could hear were clanking noises like metal pots banging together. The empty green oxygen tanks were stored on the stairwell landings. It soon became apparent that the sound was produced by Jack dragging an empty tank along the stairwell railing. At the time, these tanks were about 4 to 5 feet in height and heavy even when empty. Jack was attempting to lift the green tank and hurl it down the stairwell at Jim. I yelled to Jim to get away from the stairway and call security.
Security did rescue Jack and he was taken to a locked psychiatric ward on the hospital grounds. The following day, I heard that he was transferred to another psychiatric hospital in the city that was not affiliated with our hospital or medical school. I heard that the other hospital had discharged him three days later. I wasn’t expecting to hear more about Jack. However, on the fourth or fifth day following his release, I walk in the ward and found the staff huddled together looking at something on an empty bed. As I approached, I asked what was happening and they held up a newspaper. The headline on the first page of the paper read LSD killer in large bold print. Jack after leaving the other hospital had returned home and killed his mother in law. From what I recall it was a gruesome murder in which he stabbed her more than one hundred times. Not exactly a rational way to handle a troublesome mother in law.
Following the murder, the buzz in the news was that he had a history of taking LSD and continued using it before he was hospitalized. It was all a bad trip (a term that was used to describe the opposite of a high) that made him murder his mother in law. Another theory was that he had experienced an acid flashback, which is a sudden, unanticipated event that can be terrifying. This “Flower Child” drug could make you do terrible things and not just make love. For several months, various theories were bandied about by a generally uninformed public. The final verdict was that Jack was a very smart paranoid schizophrenic who could get high grades on tests and high from drugs, but his twisted psyche prevented him from becoming a doctor.
Unfortunately, there were no tests at the time to screen for severe psychiatric disorders in medical school applicants. Passing the MCAT test provides important information about one’s intellect but nothing about their personality. The problem is that there is no easy way to open a window into a person’s psyche or soul to enable us to determine the amount of mental stability required to become a doctor. That said how can we predict a physician’s bedside manner?