Thor the Cute
“You have a patient coming in today,” my Psychiatry resident says to me as I arrive on the unit. “Hopefully they’ll be here this morning so you can do the intake interview before your lectures this afternoon.”
Cool, I think, tuning out the overnight nursing report. And really about time. It has, after all, been kind of slow for my team. Especially for me. When we do get a patient on my team, I always seem to be busy with some other obligation for this medical school rotation. Don’t misunderstand. I have enjoyed the rotation. In fact, I really think I might want to go into Psychiatry. But I swear it has been a week since my last intake.
I tune back into the nursing report as the names of team’s patients bring me to attention just long enough to jot down notes about their overnight activity. As we finish listening to the tape-recorded report, I start to wonder what kind of patient I will get. Maybe a depressed patient, or a schizophrenic. O, God, I hope not another borderline personality disorder. That last one got me in trouble.
After an hour of making myself busy by talking to patients, checking on some labs, and reviewing for the encroaching end-of-clerkship exam, I am reading in the break room behind the nursing station when I notice some activity at the locked door to the floor. I step out of the break room and see the social worker coming in, the one who will be working with my patient, and a man I have never seen before. The nurses start getting some paperwork in order as I start to detail the imposing figure. He is tall, very tall, maybe 6 feet 5 inches tall, and wearing an old, worn, dirty set of gray sweatpants and sweatshirt that do not quite fit him. Somehow, that is appropriate. He has broad shoulders and light gray, almost white, hair that is short but appears to be standing straight up. Even from the fifty feet between us, I notice a very strong jaw, protruding chin, and rather large nose. He also seems to have enormous hands, and is carrying something in the right one. In fact, even for his size, he appears big-boned, though thin. The nurses finish up their paper work and turn him to walk down the hall. Though he does hunch his shoulders forward as so many tall people do, he does appear to lumber down the hall, as though he has difficulty moving his large frame about. Whoa! I make myself busy again.
About half an hour later, the social worker comes back to the nursing station after talking to the patient, tells me she is done, and that it is my turn to do my medical student thing. She tells me he is schizophrenic, but otherwise I know nothing about the patient beyond what I saw when he came in earlier. I take the patient’s chart and make my way around the corner and down to the room at the end of the hall where we do all our patient intake interviews. Here I go, I think, with a prepatory sigh as I knock and open the door.
I enter the room to see the large man I saw earlier sitting quietly on the opposite side of the table in this small room crowded by too many chairs. From the look on this face and his slouched posture, he appears timid, almost scared, almost sad. He looks up at me as I walk in. After sizing me up for a moment, he returns attention to the paper in his hand. The patient is holding a pen and a folded piece of paper with writing on it in his fidgety left hand, which moves from his lap to the table to scratching his forehead; and a small, vinyl-covered bible in his right hand, which is resting in his lap. I notice now, up close, that his facial features seem stereotypically Scandinavian, which might explain the strange name on the chart. In fact, he looks like a broken, retired Norse god. His face seems thin, despite a sharp jaw line and large rounded nose. His strong chin has a deep cleft in the middle. He also has bushy, gray-white eyebrows at the base of a wide, tall forehead with deep-set, blue eyes and very large ears. His whitish hair appears to be thinning. Behind his thin, pulled-in lip he has about three teeth, maybe four. He appears to be the fifty years old the chart says he is, but somewhat tired, almost drained. I sit and begin the interview.
“Hello. My name is Josh, I am a medical student and want to talk to you so I can understand why you are here and how we can help. Okay?”
“Mm-hmm, yeah,” he mumbles meekly.
“How are you?”
“I’m……I’m okay,” he replies quickly, a little stronger this time.
“Why don’t you tell me why you are here.”
After a momentary pause, “Yeah, well, I….I was hoping maybe you could, uh, help me get in touch with my sister, mm-hmm.” I notice for the first time a lisp, that I suppose is appropriate for a man with three teeth. “She, uh, said she-she was moving, I, uh, thinkg, and I want to know if she needs help,” he says softly, as he puts the paper own on the table and starts writing a series of numbers, circling some, underlining others.
“Well, I’ll talk to your social worker after we’re done. She might be able to help you with that,” I offer. “But let’s talk more about you. You transferred here, right?”
“Hmm? Uh, yeah, well, y-yeah. From Chicago Reed.”
“Why were you at Chicago Reed?” I push gently, and notice for the first time a slight chewing motion he is making with his mouth.
“Well, y’know, I also want to locate my father, and, uh, I think my sister…she might know where he is. I think he might be in Arizona, um, m-maybe.” While speaking, he begins to write numbers again.
The interview continues much the same way. I am able to get him to admit to having seen a psychiatrist three times, including once eight years ago, once twenty-two years ago, and once twenty-nine years ago. His mother passed away some time ago. He does not like Chicago Reed because people take his stuff. He denies wanting to kill or harm himself or anybody else. He denies hearing voices or seeing things. He denies any paranoia or other delusions. In fact, he gives no reason for being there at all. Well, except that we might be able to help him get in touch with his sister, since the last time he saw her was at McDonald’s. I conclude the interview after about half an hour and retreat to the nursing station to make my notes.
I ask the social worker what she knows about the patient. She knows little more than I do, though his diagnosis at Chicago Reed was schizophrenia. I finish my addition to the patient’s chart, make my report to the resident, and go on to lectures for the afternoon.
The next morning, I read through my patient’s chart, looking for new information from the social worker or the nurses, or the on-call resident. Anything. I find a printout listing about twenty admissions to local community mental health hospitals over the past twenty-three years, always diagnosed with schizophrenia. Well, it’s a start.
At noon, we have our team conference to discuss patients with all the nurses, social workers, psychologist, residents, medical students and the attending physician, who is excited to talk about the new patient.
“So what’s going on with Thor the Cute?” the attending phsyician starts. We all laugh. We all know whom he is talking about.
The social worker and I explain what little we know from him, though she adds some new information. Most of the community mental health hosptials and residences around the city know who Thor is, and think he is adorable and sweet. The social worker also states that she has left a message with his sister, so we might know more tomorrow. We decide to keep him on the Haldol he was getting at Reed, with the presumed diagnosis of schizophrenia. And we start to talk about other patients.
The next day after the morning nursing reports, the social worker catches me. “I talked to the sister yesterday!”
“So, what did she say?” I am excited.
“A lot. You’ll just have to read my note.”
I grab the chart and go into the break room. Quickly, I get to her extensive addition. As I go through it, I check three times to make sure I am reading about the right patient. Thor has two older sisters, a younger brother, and a father. His mother died in 1992. The father is probably somewhere in Arizona, but nobody is really sure. The sister agreed to talk to us on the condition that none of her current contact information be released to Thor. He does not know where she lives now, and she wants to keep it that way. She, like the rest of the family, is terrified of him. When Thor was five years old, his father just began wandering around the country, returning home for a few months every few years. Meanwhile, Thor terrorized his family. Thor had attacked his mother with an iron. He tried to suffocate the other sister with a pillow. Every member of the family has been to the hospital at least once due to injuries he has inflicted. At the age of nineteen, his mother had him removed from his family’s house on court order. Thor began to wander the country, like his father. The sister reports a police record, though she could only recall two specific incidents. In one, he was arrested after pulling a butter knife on a police officer. In another, about fifteen years ago, he was arrested in California after stealing a city bus and was “immediately sent for treatment.” More recently, she has called the police on him a couple of times when she found him standing outside her family’s home, waiting for her. The sister still supports him somewhat, though. She sets up meetings with him every now and then to give him money. They meet at a specific McDonald’s, a public place. He was diagnosed many years ago as a paranoid schizophrenic. And they have found that he is the most quiet and withdrawn when he is the most paranoid. Wow!
I close the chart, put it away, and walk into the patient area. Thor the Cute is sitting in the TV room. Just sitting. He is now clutching some newspaper clippings and a magazine in his right hand, but no Bible. I walk over to talk to him, asking what he has in his hand.
“Oh, uh, n-nothing really. This is just a coupon. It’s, uh, for whatitsay, Rocco’s Pizza. Here.” And Thor the Cute hands me a newspaper clipping. It is a coupon for one dollar off a whole pizza.
“Thank you,” I say. “This is very nice. And how are you today?”