A Phone Call from an Insane Man Brings a Life Changing Lesson

“I am the prophet Elijah. Shave your head and come to me.” The words over the phone would have been disturbing to hear from anyone but the fact that they came from someone I knew and loved was frightening and caused me to fear for his safety. He was clearly out of his mind. What could I do? I saw only one option. I called the police on my friend.

I had known him for years. He had his quirks and idiosyncrasies and had made more than his share of foolish financial decisions but I had never thought him to be mentally ill. It was when the strange calls and Facebook messages started coming that I knew he was in real trouble.

It began with his impulsive decision to move in with a woman he had just met. He was an avowed Christian and the decision was against all he said he believed in. For him to make such a choice after only a few dates was deeply concerning. It was during that conversation telling me about his new found love that I realized something was seriously wrong. He wasn't making any sense.

His speech was fast and pressured and he darted from one topic to the next. His attitude toward me was unusual as well. He had always respected me and often come to me for advice but in this conversation he had elevated himself to the role of counselor. He repeatedly tried to tell me what was wrong with my life, what to do and where I was off course. The change in demeanor was drastic. It seemed his view of himself had expanded overnight. Halfway into the conversation it dawned on me. He had bipolar disease and he was manic.  

When people enter the manic phase of bipolar disease it is almost impossible to reach them. The chemical imbalance in the brain leads to grandiosity, a sense of superiority that makes receiving counsel or advice from others impossible. In his case his grandiosity included hyperspirituality. He claimed that God was speaking to him and giving him remarkable insights that he had to share with me. 

I begged him to get help, but he would not, could not, listen. Within a few days he was fully psychotic and standing on the top of his still moving and driverless car yelling at the world to repent. In a very proud Facebook message to me he described how he fled from the police and ran to a church parking lot before being taken into custody. He was placed on a psychiatric hold, but he somehow escaped from the facility and holed up in a local hotel. It was from the hotel that he sent me the message claiming to be the prophet Elijah. 

It was months before I heard from him again. He was significantly better but still displayed some of the signs of the disease. He was hypomanic, overly focused on competing in sports and showing poor judgment in finances. I asked if he was still taking his medications. He wasn’t. I asked if his psychiatrist had made the decision to stop the medications. He hadn’t. My friend had decided on his own that he no longer needed the medication. I looked him in the eye and told him as seriously as I could, “You have a mental illness. Your thinking is broken. You don’t get to make this decision. See a psychiatrist and do what he tells you. Period.” He promised he would, but he didn’t.

We don’t talk anymore. In my mind there is nothing to say. I find it hard to engage in small talk when the most important thing in his life, his mental health, is not being addressed. I am like a broken record to him, saying the same thing over and over, “See a psychiatrist, see a psychiatrist.” I mourn the loss of relationship but must accept there is nothing I can do.

I recently had a patient come in who was eerily similar. I had seen him three years earlier and diagnosed him with bipolar disease in the hypomanic stages. Remarkably, I was able to get him to see a psychiatrist. One he started to feel better he took himself off of all of his medications. When he came back to see me it was for a skin condition. He was quite surprised when I declined to treat the skin problem until he saw a psychiatrist. I told him what I tell all of my patients who refuse my recommendations, that bad medical care was not an option.

“You can get bad medical care all over town but you can’t get it here, " I said, "In this office we do what is best for you.” As I had with my friend a few years ago I explained that he could not allow broken thinking to guide him in making decisions about his health. Because of his disease he needed to listen to an expert who had his best interests at heart. I reminded him that although he felt normal now, once the disease turned into the manic phase he would be unable to listen to medical advice. He had to see a psychiatrist.

When I think of these stories I think about how we all do this to varying degrees. We place way too much confidence in our ability to figure things out. Our marriages can be falling apart, we can be struggling at work, battling to stay sober or dealing with anger but we don’t seek counsel from those who can help us. We think we can do it on our own and we trust our own broken thinking to guide us. How foolish we are.

It takes incredible effort and humility to ask for help but that is the path to success and health. I came to grips with this myself 5 years ago when anxiety disorder and panic attacks invaded my life. I swallowed my pride and went to see a psychiatrist. I remember how freeing it was to say, “Tell me what to do.” It was hard to trust and put myself in someone else’s hands but it was necessary and it was a turning point for me.

Would that we all learn this lesson. Often the road to wellness begins by simply asking for help.

-          Bart

Are You Smart Enough to be President?

“Do you believe in evolution?”

There are a number of questions I would ask an aspiring presidential candidate if given the chance, but this is not one of them. In a world where ISIS is on the move in Iraq and Iran is working to develop nuclear capability, where nations in Europe are facing overwhelming debt and Russia has invaded Ukraine, in a nation with so many underemployed or not looking for work and with congress seemingly unable to accomplish anything, a candidate’s views on the origins of life seem rather irrelevant.

Nevertheless this is the question posed to Wisconsin governor Scott Walker by a British journalist during his recent trip to London. Some folks back home were critical of Walker’s dodge of the question and attacked him for being anti-science. The question was a bit of a set-up, for Walker is the son of a Baptist minister and likely to believe that God played a role in the creation of the universe. This belief in God has not hampered his ability to govern the state of Wisconsin so it is silly to make it an issue. That did not stop the journalist from asking it.

So why was the question asked? I believe it was an attempt to find a way to easily discredit Governor Walker. The reasoning seems to be that intelligent people believe in science and since evolution is science believing in it is a measure of one’s intelligence. There is only one problem with this reasoning. It is false.

As a physician I took a LOT of biology courses, including biochemistry, molecular biology and evolutionary biology. I learned the material well enough to graduate Magna Cum Laude. People have accused me of many things over the years but I have never been called unintelligent.

In spite of all of this education I don’t believe the theory of evolution provides a reasonable explanation for the complexity of life we see on earth. While evolution may have appeared reasonable in the time of Darwin advances in molecular biology and genetics have revealed obstacles to the theory that Darwin could not have imagined.

A single gene for a single protein can consist of thousands of units of DNA. The protein can be non-functional if a few units are lost, changed or out of place (sometimes a single mutation can be damaging). This means that for evolution to occur thousands of molecules need to randomly line up in perfect order. Even if that were to occur, the new protein would be useless unless it improved the function of the organism, which means that several thousand other randoms things needed to occur as well. This is a monumental challenge! When we think of the amount of DNA that would have to be correctly assembled to code for such dramatic developments as sight or flight the odds against evolution are, from a molecular perspective, even more astronomical. This makes random evolution statistically impossible.

As impossible as I believe it to be, the point of this post is not to debate evolution. The complexity of such a discussion is beyond the scope of any blog. The point is that intelligent, well-educated and reasonable people, people who are well-versed in the subject, can reach the conclusion that the theory of evolution does not adequately explain the observable world. This conclusion is thoughtful and rational. Because of this, Scott Walker does not need to shy away from his beliefs and neither do any of us who believe in a Creator. 

The manner in which we can confidently assert our faith was illustrated several years ago when I engaged a friend in a discussion about evolution. He initiated the discussion at a baseball game. He considered himself an "Evolution buff" and well-versed on the subject. In spite of this he did not have a basic understanding of molecular biology or genetics or of the remarkable complexity of life. When confronted with the reality of the massive amount of information needed to encode for the simplest life forms he assumed a defensive posture and retorted, “Well, You can’t prove there is a God!” My reply caught him off guard.

“I do not need to,” I responded. “The burden of proof is on the person with the least likely explanation. Say we were walking together on a beach and came across sea shells scattered on the shore. You declared that the shells were carried there by the waves, I disagreed and said a child with a basket had come along and scattered the shells on the sand. In such a case the burden of proof would be on me.

If we came across sea shells that spelled out the words “Have a Nice Day,” and you again declared the work of the ocean and I again argued for the work of a child, the burden of proof would be on you.

The amount of information contained in the simplest life form is infinitely greater that a few words on the beach. You day it is random chance, I say it is a sign of an Intelligent Being. I do not need to prove anything. You have the least likely explanation. The burden of proof is on you.”

With that the discussion ended. He did not walk away convinced of my position but I do believe he walked away knowing that my position was neither naïve or ignorant. Something to think about the next time someone is mocked for believing in a Creator.

-          Bart

If you have an interest in learning more about the subject I encourage you to check out Reasons to Believe, an organization of scientists and researchers who believe in a Creator. Remember you can share this post with friends, subscribe to the blog and receive posts via email, or follow me on twitter @bartbarrettmd

Valentine Stress and How to Handle it!

I am not a fan of Valentine’s Day. It has always been stressful, even as a child. In elementary school I stressed over selecting Valentine’s for the classroom exchange. The Valentines came in boxes of 25 or so, usually united with a singular theme, Mickey Mouse, Puppies, Kittens or The Monkees. On each card was printed some silly pun or mushy sentiment such as a kitten card with “Be my Purr-fect Valentine.” Picking the right theme was important. I pitied the boy whose mom bought him the box of puppy cards because she thought they were “cute.” Recess was not fun for him that day.

The night before Valentine’s Day I sat down with a list of the kids in my class and went through the agonizing process of selecting the appropriate card. The unwritten rule that a card had to be given to every child made it difficult. How do you pick out a Valentine for the toughest kid in the school? Pick the wrong card and you might end up gathering your teeth off of the blacktop. There was the additional challenge of selecting the one for the cute girl. You wanted it to be special, the best of the box.

The next day in class every child taped a white paper lunch bag, appropriately decorated, to the front of their desk. The girl’s bags were adorned with hearts and flowers, the boys typically with just their names, for if a boy’s bag was too decorated he would be spending recess with puppy card boy. Each child went around the room dropping their Valentines into each recipient’s bag. Some kids attached chocolate or boxes of candy hearts to the Valentines. I hated those kids. Show-offs.

When I opened each Valentine I always hoped that it would be special, that I would get one of the “good ones.” I wanted so desperately to be liked, to be one of the cool kids. I wasn’t, and somehow Valentine’s Day reinforced that.

Valentine’s Day can do that. It can reinforce the negative perceptions we have about ourselves and our relationships and can amplify our loneliness. This is my 34th Valentine’s Day with Lisa and romantic loneliness is a distant memory for me, but memories of loneliness still cause my heart to break for others on Valentine’s Day.

I think of those who so desperately want to be noticed and loved and who through no fault of their own have no one to call their own today. For them the floral displays and heart balloons in the Supermarket may bring sadness instead of joy. I think of some of the older people in my life who have been widowed and who now are without the Valentines that had been by their side for so many years and think of the heartache that comes with reminders of romance.

As I do I am reminded that this is the nature of earthly love. It can be elusive and frustrating. Even at its best, as it is in my marriage, it cannot last, as with all earthly things it will someday come to an end. So on this day of celebrating love I intentionally remind myself to be grateful for the only love that endures forever, the love that God has for His children. His promise, that He will never leave us or forsake us, helps sustain us through the lonely and difficult seasons of our lives.

-          Bart

Remember to share this post with others who might enjoy it. It just takes a click! You can also have posts delivered to your inbox by clicking the subscribe button or receive notices of all posts and other things Bart by following me on twitter @bartbarrettmd. For those in the Southern California area, I will be speaking Wednesday Morning at the Closer Walk group at EV Free Fullerton. Email me for details. If you are interested in having me speak to your group you can contact me through the website as well.

A Parent's Refusal. A Child's Pain

“I don’t feel comfortable with the medication you prescribed. I want to see a specialist!” The man was adamant on the phone, almost angry. I was stunned. Prednisone is a very common and, in the dose prescribed, incredibly safe medication. I had prescribed it hundreds of times in the past without any complications and was surprised he was so worried about it. Of greater concern was the fact that the medication had been prescribed two days earlier to treat debilitating pain from an inflammatory arthritis and that by not giving it to their child the parents had allowed him to suffer in agonizing pain. They were willing for him to endure days of needless suffering because of something they had read on the internet! How could this be?

The child had not been feeling well for a while and had gone to the local emergency room. The ER doctor ordered a number of tests including a chest x-ray and a urinalysis. Based on the results he made the diagnosis of both pneumonia and a bladder infection (a rather uncommon combination) and prescribed antibiotics. The family came to my office for follow up a few days later and saw my physician's assistant.

They told the PA  that after 5 doses of the medication a rash had developed and so they made the decision on their own to discontinue the medication. They were certain it was an allergy but in actuality the diagnosis was unclear. Nevertheless, there were no signs of infection in the urine or on physical exam, the rash seemed to be fading and the child seemed to be feeling well so the PA made the wise decision to not start any new medication until some of the tests were repeated.

I saw the little boy 5 days later. The rash was still fading, but a new symptom, severe joint pain, particularly in the knees, had developed. I ran through a list of possible causes of such pain and felt that there was likely to be an inflammatory process as the cause. The diagnosis of HSP (henoch-schonlein-purpura) rose to the top of the list. It is typically a harmless immune condition that resolves on its own but it can cause kidney issues, which could explain why the urine was abnormal in the ER. I ordered more tests. We discussed treating the joint pain but decided to wait as it had eased somewhat that morning.

The results came back the following day and included a normal chest x-ray, normal blood work, normal kidney tests and a normal urinalysis. The only abnormality was an elevated marker for inflammation. I called the parents to review the results and learned that the joint pain was again severe. Confident in the diagnosis of HSP I prescribed prednisone, the one medication that I was certain would quickly relieve her pain.

Late the next day the surprisingly antagonistic phone call came. As I spoke with the father on the phone I quickly realized the problem. The family did not trust doctors. They had been very reluctant to immunize, had avoided check-ups and had only come in when their child was ill. It was clear to me the problem was not that they were not comfortable with the specific treatment I had recommended, the problem was that they did not trust me to know what I was doing. I struggled with how to respond.

 I shared with them that the treatment was safe and effective and that there was no specific specialist for this condition. Further, the specialists that could be consulted would be very difficult to get in to see on short notice. I might be able to pull strings if their son did not respond to the prednisone, as that would make the diagnosis more unclear, but they were refusing to give it. The father repeated the concern that they were not comfortable with the prednisone. In their opinion it was not safe.

With great sadness I told them that there really wasn’t much more I could do. If they trusted their feelings and emotions more than my medical judgment, how could I treat their child? I had made what I felt was an accurate diagnosis and prescribed safe treatment. If they did not believe me then it was up to them to find a physician they could believe. I wished them well and encouraged them to find care elsewhere, letting them know that if they changed their minds and wanted to remain patients they would be welcome.

 I have not heard from them since.

 Families such as these are always hard. Somewhere along the line they become convinced that doctors cannot be trusted, that we casually make recommendations and prescribe medications that are harmful. They are convinced that advocating for children means defending them from doctors instead of working with us to help their child. Every treatment and every immunization becomes a battleground and even the most routine and mundane recommendations are called into question. In the end, the one who pays the price is the one they claim to defend, their innocent child. How sad.

-          Bart 

Doctor Barrett Goes to Washington

Just when I think my life can’t get any crazier, something else unexpected happens. I have been able to do some pretty remarkable things, but going to Washington DC to talk to congressional staffers was something I did not anticipate.

I just got back from what was definitely eye-opening trip to our nation's capital. I was asked by my medical group to join a briefing on proposed cuts to Medicare Avantage, a part of MediCare that is both popular and successful, especially in Southern California. About 75 congressional staff members attended the briefing. The remainder of my one day in DC involved meetings with staff of individual members of the House of Representatives where the same message was shared. I am not sure how much education the staffers received but I learned a lot in one day in DC. Here are some of my observations.

-          Our nation is run by some very young people. Almost everyone at the briefing and all of the staffers with whom we spoke directly were under the age of 30. I hope it is not discriminatory to say I wish those who were advising our leaders possessed a little more life experience!

-          Staffers don’t make very much (many are in the $30-$40,000 a year range) and as a result most don’t stay in their positions for very long (average is about 18 months). So our representatives are being advised by people who are both very young and very inexperienced. Not typically a desired combination.

-          If you are talking to staffers you need to talk fast and stay on message. I was flown to DC to speak for a total of about 30 minutes. I gave a 5 minute presentation at the briefing and then briefly answered three questions. My share in each the smaller meetings was 3-5 minutes of the total of 15 minutes we were allotted. 

-          We are a sound bite nation. Staffers are bombarded with information (about which they take notes on steno pads) if you want them to remember something it needs to be short and it needs to be impactful. I know I nailed the short part but have no way of knowing what the impact was.

-          Congressional staffs are rather large. Each member can hire up to 18 people. Basic math tells you that after you deduct time spent by representatives in meetings and in session there is not a lot of time left to spend with staff, all the more reason to make your points succinctly. I was left wondering how informed our representatives are about the legislation they vote on.

-          Many staffers, due to turnover and age, are not well versed on the subjects they are discussing. Some of the conversations we had were very basic. After the third meeting one of my colleagues started asking, “Do you know much about the type of Medicare plan we are discussing?” In some of cases the answer was “Not really.”

It was a whirlwind day and I was told that I performed admirably. (If there is one thing I am good at it is talking!) I got on the plane home a mere 26 hours after I arrived with a sense of exhilaration and pride. A few days later I am more reflective and I wonder about our effectiveness. We did our jobs well and delivered our message but there are so many voices and so many messages being delivered every day that there is the fear that ours may be forgotten or may fade overtime.

While it may be that our impact will be proven minor in the grand scheme of healthcare legislation I do not want to leave the impression that our trip was not important or significant. We definitely added to the discussion and enhanced the knowledge base of those who advise and educate representatives. But there was something else we accomplished. The three of us that traveled together from California did something amazing on Friday. We participated. We spoke out. We engaged in the process and tried to make a difference. We went not for ourselves but for the people entrusted to our care, for doctors and their patients and for a health system and its employees, all of whom work together to provide care to people who truly need it.

Which may be the most important thing I accomplished. I left the sidelines and got into the game. I didn’t score a touchdown or make a game-saving tackle but for once in my life, I played. Which is a pretty cool thing.

-          Bart

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