The Beat Goes On

A Walk On The Dark Side One frigid January night, a farmer brought his wife in. They came in an old truck, he in clothes obviously yanked on in haste, his pale-blue eyes with the foggy look of interrupted sleep. She still wore her nightgown and slippers, a worn brown coat thrown over her shoulders. A neighbor had found her wandering down the country road in her nightgown, no shoes or even a bathrobe to keep out the bone-chilling mist. Her husband, soundly asleep, had not been aware that she’d gotten out of bed, much less left the house. He was very troubled when the neighbor finally was able to wake him and explain what had happened. It was the third time in a month that she had been brought back from such a midnight walk. Even though he had to get up before dawn for chores, he sensed she could not wait until morning to be seen by a doctor. As I entered the room to register the patient with my clipboard in hand, the husband stood up. It was a courtesy seldom seen in our ER. He held a battered hat in his hands, and nervously turned it round and round. His rumpled overalls smelled of barn. He was a big man, probably in his early fifties, with receding brown hair beginning to turn gray. His wife sat quietly in the examining room chair, seemingly unaware of her surroundings. She was big-boned and thin. Her shoulders were broad and her arms muscular. High cheekbones gave her a vaguely Asian appearance, belied by her long, straight blond hair, which fell below her shoulders, still damp from her nighttime stroll. With her large, brilliant blue eyes and her tall, big-boned frame, the word that sprang instantly to mind was “Valkyrie.” I glanced quickly at the name on the ER sheet and asked her the necessary questions. She spoke with a distinct accent, but her English was good. Although she understood what was being said, she seemed unable to focus and the answers came slowly. When I got her to birth date, I had to prompt her for the year. She just looked at me blankly. I turned to her husband. “She’s 41,” he responded. “Are you a citizen, Mrs. Cole?” When she nodded her head, I added, “How long have you been in the United States?” As if she were counting the years one by one, she finally answered. “Fifteen years.” When I had finished, I gave her the form to look over, to make sure it was right, and then sign at the bottom. She looked at it for a long time and finally slowly signed her name. She put down the pen and folded her hands on the clipboard, staring off into space. I gently extracted the board. She did not move her hands at all. An hour later, the doctor and the couple came down to my office. Mr. Cole was talking to the doctor, and appeared worried. “I don’t know,” he said. “It doesn’t sound like my wife belongs in a place like that. What would they do to her up there?” The doctor reassured him that she would be well cared for, and stressed how important it was that his wife get help without delay. “She needs a psychiatrist now,” he concluded. “It will only get worse if she doesn’t get help immediately.” Perhaps it was the word psychiatrist that did it; perhaps he couldn’t admit that there was anything mentally wrong with his wife. Whatever thoughts went into his decision, the farmer straightened up and said firmly, “My wife is going home with me. I can’t put her in any nut ward.” He took his wife’s arm and led her, tall and wraith-like in her white nightgown, back down the hallway to the exit. The doctor walked with them, trying to persuade the husband to admit her into the hospital but to no avail. She did not appear to hear any of their conversation. As the department quieted down, I went out to chat with the nurses. “It’s a real shame about that Finnish woman,” one of them commented. “Her husband obviously was upset by the idea that his wife could be a candidate for the funny farm, but I’ll bet she’s admitted somewhere by the end of the month. She’s definitely decompensating.” It didn’t take even that long. The very next night the farmer brought his wife back. This time she was not responding at all. If someone sat her in a chair, she did not move from it. When the nurse held her arm to take her pulse and blood pressure, she left the arm in the same position after the nurse was through. She no longer answered any questions, or, indeed, said anything at all. Her gaze was fixed straight ahead, her wide blue eyes staring unseeing. It took the same doctor who had seen her the night before just five minutes to send them back to me to do the admission book work. This time the husband was meek and did not argue. “Please do something to help her,” he said. “I want my wife back--I didn’t know it would get this bad. I don’t understand what’s happening to her.” The diagnosis read “catatonic schizophrenia, acute. ” “I know it’s hard to accept,” the doctor told Mr. Cole. “But you did the right thing by bringing her in. She is at least on the road to getting the help she needs.” Although we non-physicians were not privy to the follow-up on patients, I did learn later that she had been discharged to a psychiatric hospital. What caused this woman’s break with reality? What kind of relationship did she have with her husband? Did she ever come out of her catatonic state enough to respond and tell her side? That was the only unsatisfactory part of my job: I never got to read the end of the story.