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Article | Good Doctor Health Network

Nobita, have you found your Tinker Bell? ──The rights of patients with schizophrenia to seek medical treatment

“I went to several urology clinics, but they all ignored me. Some said I thought too much and canceled my appointment without even prescribing medication…”

Nobita is a Psyche_{Note 1}The patient’s medical record showed “schizophrenia” in the mental and physical department’s medical record. “Schizophrenia” was also called “schizophrenia” in the past.

“Hello, Dr. Lai!” Daxiong greeted me politely after pushing open the door of the clinic.

The bangs that stick to her forehead are too neat, and paired with big, round glasses and a high-collared shirt, she looks like Nobita in Doraemon.

Is he really a schizophrenic patient? I took another look at the electronic medical record to make sure I didn’t click on the wrong patient.

“Dr. Lai, I am a patient with schizophrenia. However, I am very good. I take medicine.”

After finishing speaking, the clinic was suddenly silent. Although nothing was abnormal, the atmosphere became a little strange.

Picture｜Stills from “The Distance Between Us and Evil”

At the age of forty, he seemed to be the primary school boy Nobita in the comics who suddenly stepped into the time machine. Thirty years in the future, his childish soul was forcibly stuffed into the uncle’s body, barely carrying anything on his back. Just an orange schoolbag.

“Hello, Nobita, I am Dr. Lai. I am very happy to hear that you took the initiative to share your past medical history with me, and I am also very happy that your schizophrenia is well controlled. You are really not simple!” In the face of constant embarrassment, as an attending physician, I have to show my ability to make awkward conversations at any time.

“Yes, Dr. Lai, let me tell you, I feel that it is not smooth to pee recently. At the same time, my body also feels very tired, and I can’t do anything energetically. A while ago, I had a consultation with Dr. Xiao Chen from the Department of Psychosomatics He said that after he helped me adjust my medication, he confirmed that it was not a psychosomatic problem, so he suggested that I go to the urology department.

“I checked on the Internet myself. I was worried that I had prostate problems and suspected that I was entering male menopause. But I went to several urology clinics, and they all ignored me. Some said that I thought too much. They even canceled the appointment for me without even prescribing any medicine. There were a few nice doctors who prescribed medicine for me, but no one was willing to check me up, and they didn’t even help me with the follow-up consultation.” Nobita was thoughtful and thoughtful. Speak clearly and methodically.

“Doctor Lai, are you afraid of being infected by me? However, I remember that my schizophrenia is not contagious, right?”

“I really, really took my medicine obediently and very hard!” Nobita said again. As if he was afraid that no one would believe him, his tone was sincere and eager.

Additional screenings at the same scene:“The Distance Between Us and Evil” Lin Zhexi: I finished it, but other patients did not

Picture｜Stills from “The Distance Between Us and Evil”

Desire for treatment opportunities like normal people

I was a little angry and had a sour nose.

All they want is a chance for treatment like normal people. Accept the examinations you need to take, take the medicines you need to take, say what you want to say, and be listened to, believed, and loved like a normal person.

Schizophrenia is a disease caused by an imbalance of dopamine in the brain. In the past, drugs had many side effects, but with the continuous innovation of medical treatments, their efficacy and side effects are no longer the same as in the past. Therefore, Nobita takes medication regularly and his symptoms are under stable control. Although he still occasionally experiences auditory hallucinations, it is more than enough to maintain normal life functions.

The exact cause of schizophrenia is currently unknown, but the incidence rate is as high as 1%, which is more than 50 times higher than the cancer patients we treat every day. But to many surgeons, it seems that cancer is the only disease that requires surgery.

Under capitalism and society is accustomed to pursuing the best return rate, these patients have no output value at all.

Picture｜Stills from “The Distance Between Us and Evil”

I still remember that when I was in college, the Department of Psychosomatics was practiced at the Songde Campus of Taipei City United Hospital, which was formerly the Taipei City Sanatorium.

Songde Campus is very large, with several buildings in the three campuses scattered among the Xiangshan Mountains where birds are singing and flowers are fragrant. Although it is only a ten-minute drive from the school, it feels like a paradise. At that time, the patient I was taking care of was a schizophrenic patient in his fifties. I remember everyone called him Brother De.

De Ge lives in the acute ward of the psychosomatic department. The acute ward of the Psychosomatic Department has its own iron gate and surveillance system, as well as its own dedicated security guard. Generally speaking, only those with severe mental illness who require acute treatment are admitted, such as those who injure themselves or others; those who have chaotic behavior and are unable to take care of themselves; those who have obvious mental symptoms and refuse to seek medical treatment, or those who are in the withdrawal period of substance abuse.

De Ge has been ill for more than thirty years, and his medical records are about as thick as two large textbooks.

The psychosomatic department only takes up one week of our trainee career, and as a professional “trainee medical student”, as long as we understand what happened in the past month and the current drug treatment goals, we can successfully graduate. Therefore, although we are interested in his past, all kinds of obscure and difficult-to-understand proper nouns are like the iron doors of the acute ward, firmly locking us out of the door of the mind and body department.

In surgical thinking, the line between good and bad is very clear, and the bad ones must be cut out. But the mind-body department learns to coexist peacefully with symptoms and trauma, and seeks a dynamic balance between body and mind.

I used to laugh at myself that I was simple-minded and had strong limbs, and could not adapt to the teachers in the Department of Internal Medicine._{Note 2}I chose the Department of Surgery because of my overly precise teaching of medical record writing and ward rounds. Only later did I realize that I couldn’t accept the fact that internal medicine was limited by the patient’s age, multiple chronic diseases, and even many “God’s jokes” and other innate limitations. I was often forced to stand by and watch.

This is not my philosophy of life. If that’s the case, then I’d rather not meet it. Entering surgery with this belief, there were bumps and bumps along the way, but it was a long training. Although everything cannot be perfect, from a medical perspective, at least surgeons will have fewer regrets after a bloody battle.

Guess you want to see:“The Distance Between Us and Evil” Family Psychology: I have schizophrenia, will this family still love me?

Picture｜Stills from “The Distance Between Us and Evil”

Is it the world or them that is sick?

During the week in the psychiatric ward, I accompanied De Ge to receive group therapy, have meals together, and play badminton and table tennis together.

“Do you know what’s in my stomach?” I remember that Brother De would ask me this every time I met him.

“There is a third prince in my belly. He holds a fire-tipped spear in his hand and a hot fire wheel on his feet. He kills all the bad guys in the world.”

After Brother De finished speaking, he would start reciting a string of Martian texts that I didn’t understand, and then walk away with his magical Bagua steps.

On the last evening of the shift, patients in the acute ward were asked to undergo electrocardiograms. Asking the guard to open the iron door, it happened to be the patients’ leisure time before going to bed. I watched some people looking for “friends”, sitting down to eat snacks and chatting with each other, some people were reading aloud with picture books attentively, and some people were dancing and mumbling to themselves.

They seem to be happier than us!

It’s been a long, long time since I’ve seen someone laugh so freely and without thinking.

I couldn’t help but ask myself: “Are they the ones who are sick, or is it the world?”

Let’s not become data-healing machines.All treatments should respond to the patient himself

“Nobita, I will help you arrange relevant examinations. Don’t worry.”

Although it is not common for prostate hypertrophy to occur at the age of forty, resulting in difficulty urinating, I still follow the standard procedure and arrange examinations step by step. Not more, not less.

“Dr. Lai, thank you.” Nobita stood up politely. Before leaving the clinic, he suddenly bowed ninety degrees to us.

“Thank you, doctor, thank you nurse.” Nobita’s voice was so loud that the nurse in the next door’s clinic looked over with concern. If a patient with schizophrenia comes for treatment, everyone is always used to covering each other. This is an unwritten tacit understanding in the clinic.

A week later, Nobita returned for a visit.

“Nobita, your prostate is not too big for your age, and your urine flow rate and bladder residual volume are also normal, but the blood test results show that your male testosterone is low. The direction you suspected last time was male menopause. , there is nothing wrong. However, in order to make a precise diagnosis and whether to perform further supplementary treatment, we need to carefully check whether you have relevant symptoms.”

Then, I printed out the health education leaflet I compiled on male menopause from the printer, explaining the possible symptoms listed by Saint Louis University in the United States one by one.

“We don’t want to be reduced to machines for treatment data. All treatments should respond to the patients themselves.” I still remember the first day I entered the clinic. Before I put on my white robe and actually stepped into the hospital, my senior said to us. What the rookies say.

At that time, I still didn’t understand it, and I wanted to desperately apply what I had learned in books in the past few years to patients. Later, I slowly understood what my predecessors said.

The so-called “medical treatment” is two aspects of the same thing. It is not difficult for doctors to “treat” patients. However, medical data is often only the tip of the clinical iceberg. For the huge and undisclosed iceberg that sinks in the hearts of patients, we must use “healing” to melt the indescribable fear, unknown, and uneasiness in their hearts. This is the most important value of a doctor’s existence.

Picture｜Stills from “The Distance Between Us and Evil”

After ruling out the contraindications related to male testosterone supplementation and informing him of possible complications, Daxiong began to regularly supplement testosterone in my outpatient clinic and return for consultation once a month.

Every month, he would happily share with me what aliens had said to him recently and how they wanted to occupy the earth.
However, he said that because he takes medicine obediently, he can slow down his thoughts and movements, and can somewhat distinguish whether it is reality or hallucination, so that he will not be controlled by them.

“Dr. Lai, let me tell you, you have to be careful recently, there may be flying saucers invading the earth. However, I have told the aliens that Dr. Lai and Xiaoling are good people and cannot harm you.” Once in the outpatient clinic. , Nobita reminded me like this.
Xiaoling, the outpatient nurse and I winked and smiled tacitly.

“I think you are like his Tinker Bell.” Xiaoling once said to me after Nobita visited the clinic.

“I’m not that great. Dr. Xiao Chen from the Department of Psychosomatics is.” I answered with a smile.

To me, Nobita is just an ordinary, ordinary patient. I never gave him too much pity or sympathy. But if he feels flattered by this, then it should be that this society has always owed him more than you and I imagined.

“All living beings are sick.” So are you, so am I, and so is the entire society.