Broken Brain Maintenance

Time to take this ol' brain out to get some fresh air. I'm going skiing, will be back Apr. 7th, check back then for more posts. Meanwhile, take care of your brains

Cheers,
Stuart

Analyze This

Self-cutting is next, promise. But this is more pressing: I just had a long tete-a-tete with a patient of mine who's had suicidal thoughts lately. He's an ex-athlete, ex-alcoholic, who's suffering from, among other things, a bad case of depression. What can I do about it, other than start him on antidepressants? Nothing much. He needs serious treatment right now, but the only way to get the psych department interested would be to convince them he's gone completely bonkers and thinks he's the President of Romania or something. Well, you know, he's just a guy who's depressed. I tentatively asked him whether he might entertain the notion that he's the President of Romania, to which he suggested that I should go see someone myself. I think he's probably right. Know any good shrinks?

He said he's come this close to doing the deed a couple of times, but that his love for his family keeps him from doing it, for now. So we made a deal: If he does decide to chuck up the sponge, he will call me on my cell first, just to let me know he's going for it. He gave me his word, we shook hands on it, and I think he's the kind of guy who will not go through the embarrassment, even posthumously, of not having kept his word.

Another thing I usually tell my suicidal patients: We have the power to end our own lives at any given time. Therefore, if we choose not to do it now, we will always have that option later. We can take comfort in that -- no one can take that option away from us, and therefore it's not absolutely necessary to do it right now. We can always postpone it, and still keep that option. So - don't do it now, because it's final, and you should definitely look at the other options first.

Of course, the rational approach often fails, especially when the depression is so deep that it's beyond the reach of any rational thought. But a couple of times I've found I've managed to get my point through.

I'm no shrink, and I wouldn't mind some more ammunition for these encounters. So help me out: What would you tell someone who's contemplating suicide?
 

How NOT to Kill Yourself

I'm in one of my disillusioned moods again, so if you do choose to read this, be warned: it's cynical. This is stuff you don't need to know. This is the kind of talk doctors engage in when they've had an overdose of psych patients...

Before proceeding to read this, check the instructions on how NOT to kill yourself with a shotgun, look here. If you're still interested, read on..

There are various ways to kill yourself that I wouldn't personally recommend. For instance, dousing yourself with gasoline and setting yourself aflame is generally a bad idea. Chances are you'll survive, but lose most of your skin, and end up looking really freaky, after a couple of months of extensive surgery and intensive care.

If cordless bungee jumping is your idea of a cool exit, do make sure you do it from at least the fifth floor. Second floor is just not high enough. Again, with surgery and intensive care, you'll be discharged in a couple of months, a cripple with brain damage.

Valium is the classic suicide attempt drug -- with an emphasis on the word "attempt". I haven't seen any successful Valium suicides. You'll end up sleeping real sound, and eventually taken to the ER, where a world-weary doctor, rolling his eyes, will stuff charcoal into your brand new stomach tube. You'll be discharged after a psych consult. As an emergency medicine teacher once told me in medical school, the only way to kill yourself with valium is to stuff so much in your mouth that you choke on it. However, successful cash-ins have been made with a mix of Valium, alcohol, and perhaps some antidepressants thrown in for good measure.

Throwing your house of dust in front of a moving vehicle will not guarantee a one-way ticket to eternity. More often than not, what you get instead is a round trip to the OR and intensive care again, and go home to an even more miserable life than before.

[edit] Added 2009-08-09: Before you take any drastic action, please see this if it's the last thing you do:
http://www.youtube.com/watch?v=XnuAyFCZjdA

Coming up in The Broken Brain: Self-Cutting. Stay tuned, but only if you really want to read about it..
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Kills the Body First

Today I told a lady that she will die, but first she will waste away. I gave her the news that she has ALS. Also known as amyotrophic lateral sclerosis or motor neuron disease, this is a major bummer of a diagnosis: On average, the patient will have 3-5 years to live, during which time she will lose her ability to move. Her mind, however, will stay clear. Eventually, she will lose control of the muscles that she uses for breathing, and unless she has a tracheotomy done and put on a ventilator, she will die. She told me straight off she'd rather be killed than dependent on machines. I said nothing. As I've said before, all of medicine is about probabilities, not absolutes, so I can't tell her when she will die. Some die within a year. Some, like Stephen Hawking, continue to lead very productive lives for decades. Prof. Hawking is, of course, a rarity in many respects.

ALS kills the body first. The ALS Society of Canada has launched a public service ad campaign, entitled "What would you do, if you still could?". Check out the video clips. Then, ask yourself that question. Rephrase it: What will you do, while you still can? I think we all need to ask ourselves that question - every morning.

Again, a reference to cinema: In Saving Private Ryan, Capt. Miller, dying, tells Ryan: "Earn this." Miller and most of his men gave their lives to rescue this man, and he tells private Ryan to make it worthwile. What will you do to make your life worthwile?
 

Rules of Neurosurgery

Excerpt from When the Air Hits Your Brain by Frank Vertosick:


"Rule number one: You ain't never the same when the air hits your brain. Yes, the good Lord bricked that sucker in pretty good, and for a reason. We're not supposed to play with it. The brain is sorta like a '66 cadillac. You had to drop the engine in that thing just to change all eight spark plugs. It was built for performance, not for easy servicing."

"Rule number two: The only minor operation is one that someone else is doing. If you're doing it, it's major. Never forget that."

"Rule number three applies equally well to the brain patients and to the spinal disc patients: If the patient isn't dead, you can always make him worse if you try hard enough. I've seen guys who have had two discs taken out of their backs and begged us for a third operation, saying that they had nothing to lose since they can't possibly be any worse than they are. So we do a third discectomy and prove them wrong."

"Rule four: One look at the patient is better than a thousand phone calls from a nurse when you're trying to figure out why someone is going to shit. A corollary: When dealing with the staff guy after a patient goes sour, a terrible mistake made at the bedside will be better received than the most expert management rendered from the on-call-room bed or the residents' TV room."

"Rule five: Operating on the wrong patient or doing the wrong side of the body makes for a very bad day...otherwise it's a res ipsa...short for res ipsa loquitur, or 'the thing which speaks for itself'. It means a malpractice case in which the error is so obvious that even a non-expert can see that a fuckup has occurred. A patient falls off the OR table. You cut off the left leg when it's the right one that's gangrenous....A patient bursts into flames during defibrillation....Res ipsa is checkbook time. Just write in a string of zeroes."
 

On the Button

The Broken Brain now has its own button:
You can use this button for linking to my blog if you wish. Thanks again to the boys at New Links for help, and to Brilliant Button Maker for the utility.

Pain Treatment With Benefits

Sometimes a treatment may have unexpected effects. This month's award goes to the young woman who was referred to us because of her chronic pain syndrome. This is one hell of a condition, it frequently drives people to the brink of suicide --and many take the big leap.

One of the treatment options for chronic pain is spinal cord stimulation. An electode is placed against the spinal cord and a small current is applied to stimulate the fibers in the spinal cord that mediate signals of pain. A pacemaker is then implanted under the skin to generate the electrical current. The patient may then turn the current up or down with an external remote control device. About half of the patients benefit from this treatment.

Not all benefit as much as this young lady. She came in for a follow-up and was quite happy with the pain relief. Blushing a little, she said that there is another effect, which she hadn't mentioned to anyone before. The effect was this: Every time she turned on the device, she experienced repeated orgasms. We concluded that things could be worse and decided not to change anything - after all, the stimulator eased her pain considerably so the treatment was a success.

She was our first patient to experience this, but a literature search did reveal reports of similar cases. Outside of medical literature, ABC News Houston ran a related story last september. Sound like just the thing for you or your girl? Volunteers wanted.

I was immediately reminded of the 1970's Woody Allen movie, Sleeper, where the Orgasmatron was first introduced. A rather clumsy device, that, like a phone booth. The famed Australian high-tech industry has developed a budget version.

I've thought about orgasms a lot (haven't we all). Specifically, about the neurobiology of orgasms. I find it intriguing that we have a built-in neurochemical mechanism to produce the ultimate high, the biggest rush of all. Without using any recreational chemicals, we can produce a storm of endorphins to match and surpass the effects of even the strongest drugs. The biggest kicks from drugs are often compared to orgasms. The implication is this: Since we have this inherent ability, it follows that we are capable of producing the effects of the strongest painkillers, and possibly other medicines as well.


 

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Cheers,
Stuart