Schizophrenic patient has an infection that has turned gangrenous.
Amputation is necessary to prevent the infection from spreading.
Patient has paranoia about doctors, doesn't trust anyone.
Is refusing the procedure. Seems to understand the risks. Is still refusing.
What do we do?
The schizophrenia means the patient is not considered competent to make her own medical decisions. The family wants the amputation. Two doctors sign off and say it's absolutely necessary.
So the patient, despite refusing, is wheeled into surgery and her leg is amputated.
Clearly, this won't help the patient and her paranoia that doctors are trying to harm her.
I mean, the doctors just cut off her leg. Despite her refusal. She has reason to be paranoid.
Who's being served here? The patient, or the family?
The patient is the one who has to deal with the loss of the leg. The patient is the one who has to go through the rest of her life like this. Who's to say that the patient would want to live like this, the mental illness on top of the loss of the leg? Well, the family and the doctors say she would, and so that's why the procedure was performed.
Is there a lesson here? I'm glad I'm not a surgeon? I'm glad I'm not schizophrenic? I don't know quite what to take from this one.
Wednesday, June 23, 2010
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Were the patient not schizophrenic, would she still refuse the amputation? Does she have the opportunity to continue to enjoy life, despite losing a limb? Did she refuse the amputation because she didn't want to live without a limb, or only because of a lack of trust? If it's the latter, shouldn't she still be able to accept the loss and continue on with her life?
ReplyDeleteThe rules/ethics of medicine seem very much like the rules/ethics of warfare.
ReplyDeleteThere is a theory in dealing with schizophrenics, that feeding into their hallucinations/paranoia/dellusions only furthers the illness.
ReplyDeleteTo give into her paranoia, only deepens the illness ...to challenge those thoughts requires the healthy part of the mind to contend with the unhealthy part ... in hopes of at least helping them to see some light of truth.
she may never trust doctors ( I know people who aren't paranoid that dont' trust doctors!) my step mother who has paranoid schizophrenia is convinced that a doctor is trying to kill her by refusing to treat her with chronic lyme disease ...instead giving her 'poisons' that are really for psoriasis ...but she takes them because it makes the 'lyme' worse (she has psoriasis not lyme)
It's not easy to stand up to these people ... it's heart breaking and gut wrenching. It's much easier to say "yeah, I get it, not sure what you did to the governator to make him want to kill you that must be scary" than it is to say "sorry, mom, but Arnold S. Has absolutely no idea who you are. It is the dellusions that have you convinced he has a 'medical hit list' and you on the top'
This, is telling her the truth, but it increases her anxiety and frustrates her.
There is no easy way to deal with this level of mental illness.
OMG, sounds kind of like my ex. He was totally convinced that the Vatican and the Illuminati were out to "get" him, and to top THAT off, he claimed to be a lycanthrope.
ReplyDeleteOuch. You aint paranoid if they really are strapping you down and cutting your foot off.
ReplyDeleteMy sister is Schizophrenic. She believed that there are 'things' crawling on the walls at the mental health clinic. Her therapist makes house calls. They literally have therapy sessions with her sitting on the floor under the kitchen table explaining that the mirrors need to be covered so that 'Paul' can't come out and murder her cat. Said cat is also in attendance so he can guard her from the 'things'. They are clear, and have lots of legs, and they can crawl in through your ears and nose and eat your brain to make you (more) crazy.