Sunday, February 20, 2011
The Invincible Ironman
Have you ever seen the patient who will not die? He who cannot be killed, despite every self-inflicted effort to do so? In the medicine ER, they may be called Gomers. Here is the story of the ultimate psych gomer, who I have christened Ironman.
Ironman has been coming to my hospital since my first year of residency. It started out as suicidal ideation. It progressed to overdosing on psych meds. He would get hospitalized on a med floor, transferred to psych, then sent to a nursing home/group home/state hospital. Rinse and repeat, multiple times. Then he started overdosing on a certain medication. A lot of it. I won't say the name, because I don't want to give anyone ideas. But they were real overdoses, with really high levels, that would have killed some people and given end-organ damage to lots more. He has done this multiple times, and the above sequence kept repeating itself again.
More recently, he started swallowing things. Non-food things. Batteries, pins, pens, paper clips. Even a tree branch. Again, any one of these could have been bad, but somehow he survives. The thing is, he IS NOT trying to kill himself! He really just wants to be institutionalized for the rest of his life. Lots of people have the same wish (believe that), but they usually lie to doctors and sometimes succeed. Ironman doesn't lie (at least about his "suicide" attempts), but despite his serious attempts, he continues to thrive.
What I have told you so far covers only his visits to my hospital. I know he has been to every other hospital in town several times. A few weeks ago, this text exchange happened.
ER Doc: You know a guy named Ironman? Says he was discharged from your hospital and overdosed on (that bad med discussed above).
Psych Doc: I'm surprised u never saw him before. Whatever he said, he prolly did it.
ER Doc: He looks pretty bad.
Then last week:
ER Doc: Ironman is back. Swallowed a tab off a coke can.
Unfortunately, I don't think my literary skills have relayed the scope of this guy's pathology. Oh, wait, here are some more examples.
1. He has ripped out IVs. Lots of them. Not because of agitation or delirium, but because he was mad at me for not admitting him to the psych unit.
2. Yes...we are getting burnt out on consulting this guy. Surgery consults all the time for swallowed foreign body, and my attendings won't even go assess for suicidality.
3. If he finds a new med student or doctor he's never met, he will claim that some psych med gives him priapism. I used to punish med students by having them check that one out for me. The best report I ever received from a med student was "half-mast, at best".
4. Once, he was particularly upset on our inpatient unit. He was trying to fight somebody, so he was placed in a seclusion room. He then started eating his own feces. I guess he thought it hurt us more than it hurt him. Cops were called in to help restrain him, and he grabbed onto an officer's apple bag so hard, he had to go home sick. Then Ironman was discharged to jail. At least I didn't have to see him for 3 months.
This is the story of the worst case of a personality disorder I have ever seen.
This is narcissism, borderline, antisocial, dependent rolled into one hot mess.
This is the man who will survive the apocalypse.
This is the legend of Ironman.
Posted by SerenityNow at 8:47 PM