“Hey Dr. Plaster, we have a problem in Room 12,” the resident said taking a deep breath while shaking his head.
“It’s a middle aged guy with a straight forward STEMI.”
“Is he crashing?” I interrupted. “Can you handle it? What are you doing standing here?”
“No. He’s actually pretty stable.”
“Then call the cath team and get him out of here. Pronto! You know how to handle that. What’s the problem?”
“He doesn’t think he is having a heart attack. He says it’s just a ‘tummy ache’ that he gets every time he rides his bike lately.”
“What?” He almost had my full attention now. “Show him the EKG and explain to him…”
“He thinks he’s 12-years-old,” the resident said interrupting me giving a pained look.
“Wait, wait, wait! What? Is he having a psychotic break?”
“I don’t think so,” the resident said with a shrug. “It’s really weird, though. He presented to the Peds ER first complaining of a belly ache. They took one look at him and sent him over here. But he keeps telling everyone he’s just a kid and belongs over there. He even insisted on wearing one of the Peds hospital gowns. You know the ones with dinosaurs on them. He got kind of afraid when they rolled him over here.”
“He’s not a sexually precocious 12-year-old who just looks like a middle aged guy, is he?” I was starting to get really confused.
“My first husband thought he was a sexually precocious 18-year-old for 25 years of our marriage,” the charge nurse said after overhearing our conversation. “That why I canned his a…”
“Thank you for your non-helpful opinion,” I said cutting her off. “He’s having a psychotic break,” I said turning to the resident. “Does he have a guardian? If not, get psych down here to certify him and get him to the cath lab before you have a crashing 12-year-old on your hands.”
“Well, that’s what’s strange, Dr. Plaster. He’s here with his wife. They’ve been married for 20 plus years. She claims he is perfectly sane. He’s never seen a psychiatrist. She claims he doesn’t have hallucinations, delusions or suicidal ideation of any kind. Well, he did join the Boy Scouts. But when they found out that he wanted to be a scout and not a scout master, they thought it was kind of creepy and refused to let him join.”
“Well, he’s having delusions now,” I said pedantically, “If he thinks he’s 12-years-old.”
“I… I understand how you feel about this, Dr. Plaster,” said the resident. “But how do I say this without seeming to insult to your age? It’s a different time now than when you began your practice a few years ago.” I saw the charge nurse bend over and start walking like she was using a cane.
“Very funny,” I said smirking at her mocking me. “How old is he actually?”
“Fifty-five,” the resident said. “But he really believes that you are only as old as you feel.”
“Oh, come on,” I huffed. “That’s just a slogan to sell vitamins to old geezers.”
The charge just pointed to me as I glared silently at her.
“Dr. Plaster…I talked at length to him about this. He knows his body is 55-years-old.” “How is that not delusional thinking?” I said. “Isn’t that the very definition of a delusion, thinking something that in reality is not true? If we don’t have a hard reality to deal with, how is psychiatry supposed to help anyone? If a patient presents to a psychiatrist thinking that he is the President of the United States, should we convince him otherwise or play ‘Hail to the Chief’?”
“But he feels that “he”, the true person inside of the body, is only 12. It’s his reality. Do you acknowledge that?”
“Ok, I get it, it’s 2021. And I’m an old dog. But this is not a new trick I care to learn. His body, which we are treating, not his feelings, is 55-years-old and has partially obstructed coronary arteries. Now go in there and give him the Boy Scout handshake and tell him that we will give him the First Aid merit badge if he goes to the cath lab. And if he doesn’t he will never make Life Scout, let alone Eagle.”
“Please don’t mock him, Dr. Plaster,” the resident said sympathetically. “These seem to be deeply held beliefs on his part. He deserves your respect as a person, even if you don’t agree with him.”
“I’m…truly sorry,” I said sincerely. “I shouldn’t have said that.”
“He thinks that we should be able to treat his body in a way that would somehow make it more like a 12-year-old that he feels like inside. He thinks he has too many ‘grown man hormones’ and he would be just fine if we treated him with some kind of hormone blocking agents.”
“Let me go talk to him,” I said finally.
“Thanks,” the resident said handing me the chart.
“Hi, Mr. Sanders, I’m Doctor Plaster, the attending physician in charge of the Emergency Department tonight. Dr. Adams, the resident physician, told me you were reluctant to go let us take you to the cath lab for a look at your heart.” I was surprised to see a heavy man with a thick black beard slumped on the bed looking comical in his children’s hospital gown barely covering his big belly.
“He probably told you he thought I was crazy, too. Am I right?” he said with a look I had a hard time interpreting. He seemed a little intimidated by me, but trying to fight through his fear. He reminded me of how my kids used to look talking back to me when I scolded them.
“No, quite the opposite,” I said sincerely. “Though he was surprised by your perspective on your age, he was quite sympathetic.”
“So you came into be the heavy and brow beat me, huh?”
Actually I had, and he had seen right through me. But now I was intrigued to really know this man.
“Well… I do hope that I can convince you to go to the cath lab. But first I’d like to hear your thoughts about how you see yourself. It just might help us to communicate a little more clearly. What do you think?”
He studied my face for a long moment. Then he seemed to relax and take a deep breath. “When I was a kid I had a great time. I liked my life. I loved my dog. My parents thought I was great. That was the real me.”
“Junior High was really tough on me, too,” I said with a sigh without taking my eyes off his softening face. “I went out for basketball because my brothers had been good athletes and I thought that was how I could keep my father liking me. The coach kept me on the team. But I was the last boy and they didn’t have enough jerseys. So I had to wear a tee shirt and change with one of the other boys in the unlikely event that I ever got in a game. My father was embarrassed and he took it out on me by mocking my gangly appearance.”
It was deeply painful recalling that decades old memory.
Mr. Sanders started to weep. “I know how you feel.”
“I think you do,” I said. “I don’t know what wounded your heart so long ago. But it was real. And it has caused lasting scars. I’m just concerned about another wound that is going on right now. We can prevent this one. But you have to trust us to take you to the cath lab now…before it’s too late. I know you don’t know me. But I know you better now. Will you trust me?”
He studied my face again. Then without breaking eye contact, he reached out and placed his hand on mine resting on the bed rail. “Ok. Will you come talk to me afterwards?”
“Yeah,” I said with a softening smile. “We can share some good memories from Boy Scouts.”