Lessons from Mrs. H, and Mental State Examination: On Tangents and Garlic

Lessons from Mrs H.
by Iris May

One-sided introduction.
I’m a student. May I
ask you some questions,
take a history? I need
to practise.
Sure. Have you seen him?
My doctor? Did he tell you?
I don’t know your doctor.
Familiar name, but we haven’t met.
Why did you come to hospital?
Oh, so you haven’t seen him.
I haven’t either. Not today.
I have questions.
About your treatment?
I have a cat. Perceptive creatures.
Will he know?
Some eye contact. Brief.
I notice suddenly the tissue
in her lap. Her hands folding it,
unfolding it, twisting it,
making it straight. It makes me
uncomfortable, her fidgeting.
Will he know what?
Didn’t they tell you? I have
cancer. I have questions.
I’m sorry.
And I really am.
When were you diagnosed?
That depends on what day it is today.
You won’t tell my children, will you?
No, no, of course not.
Not my place.
Silence. Her rocking,
fiddling with the tissue.
Me, thoughts racing:
Should I still try to take my history?
Maybe I should go. Is it okay
to leave her like this?
I feel responsible. I stayed
too long already. I have become committed.
Why did you come to hospital?
Were you in pain?
My daughter’s pregnant.
Will I be a danger?
If they use X-rays I mean.
I feel trapped. My mind
is shutting down. I need
a panic button, the option
to call time out. I try
to think outside the square.
I realise I am scribbling
meaninglessly on my notepad.
I have a thought. I dismiss it.
It’s silly. Maybe worth a try though.
You have many questions,
and I’m not in a position to answer them –

Oh no. She’s started to cry.
This is not working. –

but I have a pen and paper. You could
tell me your questions. I can
write them down.
Then you will have them
to ask your doctor when he comes.
Prolonged eye contact.
Her hands, at last, are still.
We could do that?
You would do that?
What will he do to me?
Will it work? Will I have
to lose my hair? I don’t want
to worry my family. Do I have to
tell them? Can somebody help me
to tell them? Will my cat
sense I’m sick? Will other people
be able to tell? Will my children
get what I got? Will I survive?
For how long? That’s all,
for now, I think.
Well I should go now. I have class.
Here’s your list. I hope it all goes well.
Thank you.
And she is smiling.

Mental State Examination: On Tangents and Garlic
by Iris May

As I got up to leave him
and thanked him for his time,
he asked me for a favour;
my heart rate began to climb.

See, it’s not that I don’t want
to help a patient if I can,
it’s just this question may be loaded
when it comes from such a man.
He’s floridly psychotic;
a man of stated age,
a little bit unkempt,
but at least he would engage
(unlike some other patients
I’ve talked to on the ward
who circumvent your questions
and sit there looking bored).
His dental hygiene’s woeful.
His fingers are tar-stained.
He stirs tea with a twig that
from the garden he obtained.
He’s friendly and co-operative,
though guarded at the start.
His affect is reactive,
and he seems to be quite smart.
He describes his mood as anxious,
and I guess that you would too,
if you thought the other patients
had been sent to spy on you.
His thought form is tangential,
circumstantial at its best.
He says he’s saved the world before
in his ongoing quest.
He’s grandiose and arrogant,
with delusional perception.
He claims to write most movies
by some form of thought inception.
He denies hallucinations,
and I see no current evidence,
but every night via radio
he “talks to all his friends” –
Hilary and Obama,
and Alice Cooper too.
He’d be very influential
if what he says was true.
He isn’t suicidal:
evil forces are attacking
and he has to stay to fight them!
It’s insight that he’s lacking.
But I digress from telling you:
he asked me for a favour.
As I asked what it was, I felt
my confidence start to waiver.
It’s just one small thing, he says,
please tell me I’m not mad.
I need an honest, tactful answer
without making him feel bad.
In truth, I said, you’ve told me
some things that can’t be true,
but you have said some things
that I must agree with too.
For example, you cannot have been
alive two thousand years,
and I don’t believe you’ve healed
the other patients that are here.
But you made a valid point
we’d all do well to heed:
sometimes a non-judgemental ear
is what people most need;
sometimes we just need someone
to take a little time
and offer us the gift
of a moment of their life.
He looked at me and smiled.
I guess what you mean, he said,
is that I’m not completely nuts,
just partly nuts instead.
I conceded him that point.
It’s just semantics after all.
Thank you, he said, you’ve made my day.
Phew, that was a close call!