Tales from the Couch

Seeing the patient from psychiatry’s perspective

The New Patient

An unknown risk

Jeanette B was a 22 year old woman who four years earlier, had been diagnosed with schizophrenia. She was extremely dependent, had never worked, and lived in another state with her parents. When her mother became ill, her parents felt they could no longer supervise her at home. Her brother and his wife, living in New York City, agreed to oversee Jeanette. She would move to New York and live one block away from them. They’d obtained a lovely one-bedroom apartment for her. She would be closely supervised, with her brother and sister-in-law checking in on her; and with arrangements for Jeanette to attend a day-care facility.

Jeanette, her mother, father, brother and sister-in-law came to the initial consultation. It was evident Jeanette was quite infantile, and despite taking powerful anti-psychotic medication, presented with the hallmark signs and symptoms of her disorder.

Her family was quite supportive. We spent nearly two hours discussing the new living arrangements; the day-care facility; Jeanette’s feelings about being away from her parents for the first time; and the concerns of her parents, brother and sister-in-law were openly explored.

I anticipated a rocky beginning for Jeanette as it was her first attempt at semi-independence. She would be in a new and strange city. I wondered how she would adjust.  On the plus side, she was stable on her regimen of medication and a well thought-out game plan seemed to be in place. 

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Because I was concerned about Jeanette’s ability to cope, I agreed to see her for twice weekly sessions until the newness of the situation wore off. We would then consider tapering the frequency, depending on her accommodation to these new circumstances and her overall stability. I made a careful assessment of her brother and sister-in-law’s willingness to take on this supervisory role. They were supportive and realistic, and there was a good chance things would work out. 

At the end of the session, we made scheduling arrangements and the family departed. 

About three hours later, I received a telephone call. 

“Dr. Rubinstein, this is Dr. Jones, an intern at Lenox Hill Hospital’s Emergency Room. We have your patient here.”

Alarmed, I asked which one. 

“Jeanette B,” he said.  “She jumped from the subway platform in front of a southbound train at the 77th Street Station. At the last second, she changed her mind and jumped out of the way, but lost her pinky.”

Aghast, I called her brother and sister-in-law. 

Very soon, arrangements were made for Jeanette to return to her parents’ home.

I thought about the repercussions for me had Jeanette been successful in what was either a suicide attempt or gesture.

And, I pictured the headline in the next day’s local newspaper:

“Leaves shrink’s office, goes around corner and jumps to death in front of train.”

Mark Rubinstein, M.D., is a former professor of psychiatry at Cornell. His most recent book is the novel Mad Dog House.

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