Doctors often complain that patients indulge in maladaptive magical thinking and talk about how hard it is to get them to face reality. Sometimes, it is easier to join patients in their magical thinking.
I remember an incident from an Emergency Medicine clerkship during my fourth year of medical school. I was asked to see an agitated young man whose ED chart said: “Chest pain, agitation, hallucinations.”
He was indeed agitated. When I entered the room he was pacing quickly back and forth, muttering to himself, and rubbing his chest. With some difficulty, I got the following description from him. He’d been lying in bed, listening to Procul Harem and smoking some weed when someone or something in the hallway outside his apartment sent a bolt of electricity through the door and into his chest, which now ‘jangled’ unless he kept rubbing it. He was afraid to go to sleep and didn’t date touch anything metal for fear he would be electrocuted by the charge he was carrying.
He said he had never had this happen before, though he often heard people talking in weird languages. He was not having trouble breathing or coughing and had had no injuries. He was not taking medication because the pills the clinic gave him made it too hard to understand the messages he received and was expected to deliver.
His BP and pulse were normal and he was afebrile. He was thin, well muscled, and looked fit. He let me listen to his chest, though I had to put a piece of cloth between my stethoscope and his chest ‘for my own protection.’
I had no idea what to do next. I knew that if I called psychiatry, they would refuse to evaluate him until he was medically cleared in terms of his ‘chest pain.’ And I knew that if I called the medical resident, he would tell me to call psychiatry. I stepped out and asked the ED nurse, and was told: “You’re the doctor.” Stalling, I said I’d do an EKG, winning me an Olympic eye-roll from the nurse.
When I rolled the EKG cart into the room, he froze. I pointed out that the wheels on both the gurney and the EKG cart were rubber and then helped him onto the bed without touching the metal rails. Reluctantly, he let me attach the leads. (In those old days we did the EKG ourselves rather than waiting for a tech to arrive.)
While I was doing the EKG, he looked over at it and saw the tracing. His agitation increased again and he said: “See. It’s in there. It’s jangling around, trying to get out.”
As I gradually turned the gain down, the tracing amplitude shrank. I told him I was using my ‘recharger’ and sucking the electricity out of him and he would be fine. And he was. Though apparently he came back regularly to have the electricity removed with the decharger.