"We Can't Kill Your Mother" and Other Stories of Intensive Care
by Lawrence Martin, M.D.
Table of Contents

NOTE: "We Can't Kill Your Mother" and Other Stories of Intensive Care can be downloaded in its entirety as an e-book from 1st Books Library ($4.95). The book can also be ordered in trade paperback format for $13.50. For purchasing the e-book or print versions, please go to 1st Books Library and enter part of the book's title or the author in their search engine. Below are the first few paragraphs of "JUST GIVE ME A CIGARTTE!"

Harold Switek has two major diseases -- emphysema and paranoid schizophrenia. His lung disease comes from smoking two packs a day for 35 years. Cigarettes did not cause his psychosis, of course. Though "tobaccoism" is a form of addiction, and is now recognized as such by the medical profession, mental illness is not a known complication.

Smoking is distressingly common among hospitalized psychiatric patients. Smoking helps to allay their anxiety, and any attempt to withhold tobacco tends to make for a bad situation. It is almost impossible to get psychotic patients to quit smoking (schizophrenia is one type of psychosis) and psychiatrists are reluctant to badger them about the harmful effects of tobacco. As a result, although in-hospital psychiatric patients are forbidden to keep matches, smoking is not generally discouraged by the psychiatry staff. To allow smoking but not matches, many psychiatry wards install a permanent cigarette lighter at the nurse's station.

I knew Mr. Switek's case would be difficult the moment I heard from Dr. Janis, his psychiatrist.

"Larry? Hi. This is Nancy Janis. How are you? Good. I wonder if you could do me a favor."

"Sure Nancy, what is it?"

"I have a 50-year-old man in Weathergill [Psychiatric Pavilion] who's been there two weeks. He's developed a breathing problem and I can't keep him there any longer. They have no medical ward and I'm afraid he needs to be transferred for medical care. Would you be able to take him on MICU?"

"Sure. How bad is he? Does he need a ventilator?"

"I don't think so. He has chronic emphysema and we have him on oral meds but he's getting worse. We can't give IV therapy at Weathergill."

"What medication is he taking? Anything that might suppress his breathing?"

"He's had schizophrenia for decades. Poor Harold. He's been in and out of hospitals. I've only had him as a patient the past year. The only thing I can control him with is Thorazine. He's up to 800 milligrams a day but I think that's a safe dose. He might be able to go without it for a while, but he'll eventually need it."

"Oh," I said. "Well, we'll see what he's like. That much Thorazine probably can suppress breathing in someone with severe lung disease. I may have to stop it for a short time."

"What's happening is his emphysema is getting worse. I think he needs IV therapy."

"No problem. When will he arrive?"

"I'll call an ambulance now. He should be there within an hour. I'll make sure they send a copy of his medical records with him."

"What's the situation with relatives? Is he married?"

"No. He lives with his 80-year-old mother. She's all he has. I'll call and let her know."

"OK. We'll call you back if we have questions about his psychiatric management."

"Good. I'll stop by tomorrow and see him anyway."