"Don't bother spending too much time with him," my nurse said, "he's just whacked out on drugs." She pantomimed taking a hit off a joint and laughed.
He was 17, high, and hard to talk to. Eyes darting around the room as if the cupboard in the corner was out to get him. Sunken back in his oversized shirt, with his crisp new hat pulled low over his face, engrossed in the TV. Mom, clearly concerned, started the conversation before I could even open my mouth.
"Doc, he is acting WIERD lately."
That will happen, I thought to myself, when your kid starts smoking lots of pot.
But I soldiered on, trying to avoid judging prematurely. It was a perfect case for a mother bringing in her drug-addled child. The interview was difficult, because he had an extremely flat affect - a medical term for not showing any emotion - and simply didn't seem to trust me. He was, however, incredibly straighforward about his drug use. Marijuana every 3-4 days, because it made him feel safer.
There is a lot said in medicine about a sixth sense; that feeling that something simply isn't right. People smoke weed for a lot of different reasons, but when they do it because it calms something inside of them, you start to wonder.
Rather than simply chalking his behavior up to drug use, I questioned him further. It was futile at first, but as I kept at it in my doctor persona, he slowly opened up. Suddenly he started talking about Michael Jackson's death... and how it was "really telling him things" and how "nobody seemed to understand it" but him. CNN was was sending him messages through the TV screen.
He continued, painting me a picture of persecution and fear. He had been followed to the corner store the other day, and he knew they were spying on him through the adjacent aisles. He could overhear wisps of their conversations about him. This had been happening for years, but nobody ever listened. The weed made him feel safe, if only temporarily.
The nail in the coffin was that his biological grandmother and mother both had severe schizophrenia - a fact that somehow was missed each of the 3 times in the past month he was admitted to the Emergency Department for "bizarre behavior". Previous notes documented "substance abuse" and not much more.
After reviewing his records, I went back into the room and discussed my concern that he was manifesting signs of paranoid schizophrenia. I had made an appointment for him with Behavioral Health, and he was to go there straight from the ER.
The mom simply thanked me, a look of deep sadness in her eyes, and went to sit on the bed with him. He snuggled up to her and dropped his head on her shoulder, eyes glazed over as he watched the news coverage about Michael Jackson's death. She started crying, quietly, as I left the room.