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Fix Me

 

As I sit writing this morning, the sun has finally made its return to the skies. The rain has stopped for the moment. Continuous gray skies tend to dampen the spirit and create a bit of depression in many people. This year has brought more gray skies than many of the ones I remember from the past. A sidebar from all the rain is flash flooding and water saturated soil. We have a septic system which does not operate well connected to a saturated leach field. For a few days, we could not flush our commodes. I welcome the sun, drier weather, and toilets that flush.

A middle-aged woman arrived in the office a few days ago to get an evaluation for her depression. Her husband accompanied her. I like patients to bring someone they trust to their appointments, especially if the patient has brain fog or cognitive disturbances of some kind. Many people record our sessions. I encourage them to do so. It helps cut down phone calls after they leave the office.

She did not appear depressed. How does a depressed person appear? Probably no different than a happy or non-depressed person. But people suffering from depression seem to have a cloud over them, their energy is different, it is blue. They seldom smile. They tend to have a flat affect which is accentuated by their monotone discussions of their medical history and events leading up to their up to our visit. One can feel the depression in the room. This person did not give off any subtle or overt vibrations of depression.

Medical histories are essentially autobiographies. Abbreviated self-accounts of life as perceived by them. Many times, those significant others who accompany the patients have different opinions about what the patient experienced as they recite past events. Sometimes there is a huge discrepancy between what is reported by the two people sitting in the room. Never-the-less, the autobiography unfolds bit by bit. It takes a bit of tooth-pulling to get depressed patients to reveal their story. They seldom want to disclose their tale to another physician who probably holds no power to overcome their illness. No words can soothe their soul or uplift their spirits. They stay in gray.

This new patient told a great story. Her husband affirmed many of her life challenges and confirmed many of her milestones associated with her mood change. Her story was cohesive, focused and not desperate. When she finished, she looked at me and asked, “Can you fix me?”

The term fix had a funny feel to it. I was not sure what the patient meant by fix.

The past weekend, I tried to fix the septic system at our home to bring relief to our situation. Even though I changed out the burned-out pump in the lift station and drained down the thousand-gallon septic tank itself, I did not know how to free the baffle to allow the house lines to drain into the tank. It took an expert to spring the baffle. The rains took their toll on our office satellite dish. I could not fix the signal for our televisions in the shop. We will need an expert to troubleshoot and remedy the situation. Previously, I had fixed the problem. However, the current situation did not respond to my standard adjustments. How does a physician fix depression?

The great Eighteenth Century, French Enlightenment philosopher Voltaire once said, “The role of the physician is to entertain the patient, while the patient heals themselves.” He was a witty writer. Sometimes I think he was correct in his assessment of our healthcare system and physicians in general. However, this patient could not fix herself. She had tried everything she could think of to return her mood to the one she enjoyed in her adolescent and early adult life. She had been on almost every medication approved by the FDA to raise her mood. None of them worked. She told me, “You are my last resort.”

She uttered another phrase that rocked my senses. I sat a moment in silence. Thought about her biography, looked at her laboratory tests, looked at her thermography and I asked her, “Have you ever had a concussion? Did you fall and hit your head in your twenties?”

She looked at me as if I was a Soothsayer. She replied, “Yes, I tripped and probably had a concussion when I was in my mid-twenties. I blacked-out for a minute. But I recovered fine. No headaches. What does that have to do with anything?”

I looked at her. I smiled, and said, “Everything. I don’t think you have endogenous depression. You have four hormones that are out of accord with each other. Let’s adjust them one by one and see if you feel better when they are more in accord with each other.”

She replied, “Hormones? Really? Okay. I’ve tried everything else. How did you know that? That is so weird.” Her husband was silent.

I adjusted two hormones on that day, something I seldom ever do. I have not re-evaluated her yet. I look forward to her next visit. I believe hormones can fix hormone imbalances. Drugs can fix chemical imbalances. Hormones cannot fix chemical imbalances, and chemicals cannot fix hormone imbalances. She has a mood disturbance caused by a closed head injury years ago. The trauma affected her pituitary gland which controls nine essential hormones in our bodies.

What say you, Voltaire? “The role of the physician is to entertain the patient, while the patient’s hormone levels adjust themselves.”

Doc

 

 

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