Out of the blues: Lessons learnt from the past

People look forward for weekends, but Saturday evenings used to spell horror for me. Saturdays are the days when I remain awake till late, almost 1 am, giving time to myself.
I know there are a lot of areas in life I have to work on, many mistakes I can't help but repeat and many events that make me feel I have emerged as an imperfect but a strong warrior in the battle of life.

With a plethora of thoughts flooding my mind, my eyes stay fixed into nothingness. Everything seems meaningful and meaningless at the same time and my head finds itself too powerless to contain a bagful of contrasting beliefs and emotions. And then comes the dark, murky, morbid past that once threatened to ruin every bit of emotion I had. I almost felt myself slipping away into a depression which would be refractory. It is not easy to self-prescribe anti-depressants being a psychologist, because you know they might just be supportive therapy and you might end up taking them for a lifetime.

There was a time when I could not do my patient work, take rounds or attend meetings at workplace. I just used to manage enough energy to drag myself to work place. Being at the work place made things worse. Many of my regular colleagues were surprised to see a person like me dragging along in a depressive stupor, but all I could tell them was ''I need time for myself''. It is great to have a ''Doctor's Room'' in the Premier ICU where one can sit peacefully in an air conditioned room on a sofa. However, people would still come and with that fear, perhaps, tears would not!

Not being pessimistic, one hard truth of life is that no one wants a lousy soul around, especially when one in in the medical profession- All the more when that lousy soul is a psychologist. Psychologists are psychologists only when it comes to 8 hours of profession. I guess we are humans and we do have the right to experience emotions and feel weak from time to time. It is not self pampering. It is liberty.

A life incident shook me up to the very core and I began questioning my self identity. However, when the hot molten lava froze down a bit and my vision was not so clouded, I began to see that the incident of pain was not only meant to teach me a lesson but also make me a better professional. A 24 year old student taking hasty case histories, aiming to make perfect diagnoses and looking for every opportunity to chart out a perfect treatment plan, medically and therapeutically, turns into a 25 year old psychologist with tons of patience to listen and feel the gravity of the patient's problems. Suddenly, the ''symptoms'' turn into ''Bothering issues'', ''Complaints'' turn into ''problems'', ''perfect diagnoses'' turns into ''Arbitrary diagnoses'' and ''chasing perfection'' turns into ''living with imperfection''.


Four months later, my clinical practice has undergone an absolute change. It used to rely on knowledge earlier.....now it combines knowledge with experience and empathy: two quintessential qualities that make a clinician worth remembering. In the entire heart wrenching journey, I can never forget those who managed to make me laugh when I did not even want to smile: my colleagues, Dr. Khushbu Thakkar and Dr. Minal Patel. I'd like to share 10 basic tenets that life forced me to look at after this storm passed by.

10. Youngsters have the knowledge but lack the experience. Energy makes you apply, experience gives you wisdom and inspires you to learn more.

09. Every human being has the right to express emotionally. You cry, doesn't mean you are weak. It means you have been strong enough for too long and need to break down once before rebuilding yourself

08. Keep yourself open to learning options

07. No knowledge goes waste

06. We are stronger than we think we are.

05. Pain is a must: not only to teach lessons, but also to make you a refined version of yourself

04. The easiest seeming things must undergo a solid test to prove how solid it is

03. In the end what matters is how much you lived, how much you loved and how much you helped someone who cannot return you the favour.

02. There is a supernatural force: Call it God or something else, it is there

01. YOU NEED A BUNCH OF CRAZY, WHACKED OUT FRIENDS WHO CAN MAKE YOU KICK EVERY PROBLEM OUT OF THE WINDOW IN LESS THAN A SECOND!!!

That's a snapshot from my real life!

Psychoses: A new angle to Parkinsonism

Parkinson’s disease affects millions over the world and is not a pleasant experience for the patients and their families. Parkinson’s disease (PD) is one of the most debilitating neuro-degenerative disorders which occur because of gradual death of dopamine generating cells in substantia niagra (an area of the mid brain responsible in formation of dopamine neurotransmitter).

Initially, PD presents itself with some obvious, movement related deficits which include muscle rigidity, shaking and trembling, slowness in movement and drooping eyelids. Later on, as the disease progresses, it causes cognitive deficits (problems related to thinking, memory, judgement). Dementia is a dangerous psychiatric by-product of PD whereas Depression is one of the most common co-morbidities which is obviously related to the debilitation and loss of dopamine.

Neuro-cognitive deficits can be seen in early phases of PD which relate to difficulties in making judgment, slurred speech, strange thoughts and impaired mood. Patients often experience apathy and an inability to experience normal range of emotions. As the disease progresses, one can also not the visuo-spatial difficulties, memory impairments, impulse control disorders, hypersexuality and psychotic symptoms.

Medicines for PD include Levodopamine, the aim of which is to replace the lost dopamine in the brain. Co-adjunct treatment alongside Dopamine agonists are antidepressants and Pacitane. However, Pacitane in some cases is known to trigger delirium. An anti-depressant is also started alongside.

However, despite these medications, as PD advances, an individual may become more vulnerable to environmental stressors and these stressors combined with dopamine deficiency may cause psychotic reactions.

One of my patients with old ischemic heart disease was admitted for Angiography when I saw him. He maintained a good conversation despite the obviously visible tremors and mild hyperexcitability. Since he was already 82, I thought it was a normal reaction to hospitalization. The medical chart hadn’t mentioned anything about him being on Levodopamine or Pacitane.

He inquired about the procedure of angiography as any other patient would. However, after the angiography, his reaction changed markedly. He started showing irritability, became extra-sensitive to bodily symptoms and showed increased drowsiness. I still treated it as a normal, transient psychiatric reaction to hospitalization and the pain in the radial area to angiography.

However, on the third day, he developed severe psychosis. He started experiencing visual hallucinations and began responding to them. He saw his friends and people who weren’t present in the room inquiring after his health and started answering them.

Since he was in the ICU, I was left with no other option but to communicate with his grandson. The young boy then told me that his grandfather had been diagnosed with PD about one and a half months back but hadn’t adhered to medication which is the reason why the tremors still persisted.

I could suddenly see the block fitting in and the clouds suddenly started to disappear giving way to light. I could see that the old man’s psychotism was directly related to PD. He was shifted to the general ward from the ICU as he became haemodynamically more stable. The foley’s catheter, IV cannula and the monitor leads were removed. He felt much better and the presentation of psychoticism gradually decreased but not to the desired level.

His newly acquired psychiatric reaction was a matter of concern for his family members too. The only plan I, along with the admitting cardiologist could devise was to restart him on PD medications and revisit his neurophysician.

The possible prognosis is that we can expect the tremors, gait and psychiatric reactions to improve once the patient restarts on PD medications. The only way to know about his current state of well-being is nto wait until his next follow-up. 

The turmoil inside my head

When did life ever come out as a fair game?

When did life ever show it is just?

Does poetic justice exist only in books and films? Or is it just a creation of a hopeful mind?

A million thoughts cross my messed up head as soft guitar chords are heard setting up a painful tune. I just realize the sound comes from my Laptop's super advanced Altec Lansing speakers and I realize that I am being drawn away by my own thoughts. I find it difficult to focus on the tangible items lying in front of me. I find it difficult to orient myself t time and space despite a mug of strong black coffee.

Perceptual splitting and eventual schizophrenia?

Naaah.....My mind is used to making diagnosis and trying to prevent the occurences before treatment is left as the only option.

More thoughts......Not one of them is positive. 


Only my heart and my God know how I have managed work and studies for such a long time. But the speech of God is not audible and to my heart, no one listens---not even me! Who's to give the testimony?

Wow! My sense of humor may not be good, but my sense of sarcasm is improving incredibly!

Now was that a display of sarcasm??????!

The mug of coffee is still lying here, untouched and I am staring at the laptop screen without a single expression on my face. I could've been dead!
I need to get up and force myself to get oriented to the real world. I need to shake myself of the emotional unreality and put my legs into the freezing waters of the Arctic reality. 

More thoughts, I'll meet you in the shower. That's how I take 30 minutes to complete my bath! Ohhhhh the world here in my head gives me so much more pleasure than the real world. I don't mind splitting my brain in a million pieces. I'll take the responsibility to hold those pieces together.