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Introspections   |    
Charlie
Joel Yager, M.D.
Am J Psychiatry 2000;157:1753-1754. doi:10.1176/appi.ajp.157.11.1753
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"Joel—you sonafagun!"

The familiar voice—I hadn’t heard it in years—hit my ears as I walked into the locked ward that morning. I was a new chief resident—trying to maintain my cool and decorum.

When I hurriedly locked the door from the inside and turned around, there he was—in my face, grabbing and pumping my hand and my arm—Charlie—one of my close college friends—a fraternity brother. He had also been pre-med—a year behind me—we had taken some classes together. I’d sort of been a big brother to him, but I’d lost touch with him shortly after college, 8 years ago.

"Charlie! My God! What’s happening?" I blurted out—already embarrassed, quickly guessing that Charlie, my old friend, admitted to my ward—was in the midst of a full-blown manic episode.

"Manic—damn it—but you can get me out of here!" He pleaded, pulled at my sleeve. I asked him to walk with me as a I went to the nurses’ station to put down my coat and briefcase—and to find out what happened. I extricated myself and got through the door while Charlie, pleading and enraged at the same time, pressed his face against the nurses’ station window, alternately sad and furious.

"John—what’s going on?" I took the first-year resident’s sleeve and pulled him to the back of the nurses’ station. John had been on call the previous night and had admitted Charlie—brought in handcuffed by the police, his fearful and exhausted parents following close behind.

"Joel—this is awful. I know this guy knows you—he was blabbing your name all over the place—saying you’d have him released as soon as you came in. He’s in terrible shape—tore up the apartment—his parents are terrorized—he’s been sick for about 3 years now—he was hospitalized twice in another city and came back to New York a few months ago. It’s been all they could handle—he’s refused to get treatment. He says they’re all crazy, but he’s fine—you know the story. He threatened me—I took several male staff with me when I interviewed him—I was afraid he would tear into me!"

John had prescribed the usual medications, but Charlie refused to take anything. John had waited for the morning, for rounds, to speak with me and with the attending psychiatrist, before starting any intramuscular medications.

I felt stunned. I had always figured that training in a residency program close to my home and college might result in my occasionally seeing patients whom I might have known from the neighborhood. But this was closer than I’d expected.

"Let me talk with him," I said, not knowing what I would say or whether my attempt to intervene would make any difference at all. Charlie was high as a kite.

"Look, Charlie—let’s go into my office."

We sat down. He looked at me, demanding.

"Just get me out of here!"

"Charlie—you know I can’t just do that."

"Then the hell with you!" He stood—menacing—and quickly turned to storm out of the small office.

"Charlie, will you just sit down for a few minutes and tell me what happened to you?"

He turned, glowered momentarily, sat again, and started to spew out the events of the past few years—he hadn’t gotten into medical school—moved to another city to start graduate school and work in a lab—hoped to get into medical school later—got depressed and flipped into a rip-roaring manic episode—voices—visions—he would be a great physician—in fact, he already knew more than most doctors—everyone knew that—everyone could tell—they were jealous of his brilliance—had to keep him off the streets so other people wouldn’t know how smart he was—they tried to poison him with dreadful drugs—just made him sick—just made him stiff—tried to make him think he was crazy—"NOW, GET ME OUT OF HERE!"

I found my eyes tearing up—I was trying to fight off a wave of emotion—I couldn’t. Charlie looked at me—he hesitated—his face fell.

"You know, Joel—this really sucks!" Charlie started to sob—deep anguish—wracking cries. His crying split me open. I started to cry too—hard—I couldn’t stop. He reached over and grabbed me tightly. I pulled back momentarily and then realized that all he wanted at that moment was to be held. I held him, trying to fight back my tears.

"Charlie—this is too hard—for me—for you. I think you really know you’re in trouble. Will you please just take the stupid medicine and stop giving me this crap?"

"OK—for you—this time."

Over the next 3 weeks, with fits and starts, Charlie more or less cooperated with treatment and agreed to take medication, his mania gradually subsided, and he was discharged to follow-up care. Although I left the city at the end of the year and never saw him again, I’ve heard that he’s been rehospitalized several times subsequently.

Charlie never made it to medical school.

Address reprint requests to Dr. Yager, Department of Psychiatry, School of Medicine, University of New Mexico, 2400 Tucker, N.E., Albuquerque, NM 87131-5326; jyager@unm.edu (e-mail).

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