Thursday, April 06, 2006

Lolita And The Elusive I

I am being sexually harassed by one of the patient's on my ward. Bad, eh? Want to know what's worse - she's only 16 years old!
It's a bit sad really. According to her family, just a few months ago Lolita was a happy, normal 16 year old girl. One day she complained she felt a bit unwell. She stayed at home and slept for 48 hours. When she awoke her personality had been altered completely. Gone was any trace of inhibition; in its place a mind focused only on the pursuit of 'fit men' and her newly found habit of smoking rollies.
It looks likely that Lolita may have had encephalitis - a infection of the brain tissue itself. Though it seems to have resolved spontaneously, it has left its mark on her brain. The damage it has caused is too subtle to see on even the most detailed scans, but we can pick it up as changes in the electrical noise from parts of her brain. This damage has also left its mark on Lolita's personality: she no longer has any appreciation of what is socially appropriate.
She has taken a bit of a shine to me and has decided that we are to get married. She sees nothing wrong with walking in while I am speaking to another patient, introducing herself and explaining that I am her husband to be and that the honeymoon will be in Spain. "Only joking", she winks at me coquettishly as I usher her out of the room. Once I've gone, Lolita is always the first to meet and greet the new patients.
Mainly she wants to know about their love life: are they single? do they have a fit boyfriend? are they gay? do they wanna go for a smoke? To the uninitiated this barrage can be a little bewildering; to the experienced, a lot annoying.
The real problem, of course, lies in what will happen when she is outside of the safety of the ward. Whereas I normally greet her screeches of "nice arse, doc!" with a roll of my eyes and flush of the cheeks (on my face, that is - you dirty bastards!), how will your typical sex-starved teenager react? How will they respond to her flirting? Will they stop if she changes her mind? I often see her as I arrive in the morning talking with random (male) passers-by as she smokes her rollies outside the hospital gates and she likes nothing better to go trawling the hospital in searh of 'fit men'. Alas, the only real threat that Lolita poses is to herself. With her new disinhibited, forward personality, there is a strong chance that she will quickly fall into sex and drugs and out of education.
So much for the soul as the seat of our essence. Everything that we are resides solely in the organic structure of our brain and nowhere else. An organ more complicated than anything we have ever dreamt of. Some 100 billion neurones forming an estimated 500 trillion connections with each other, suspended in a web of around 1 trillion glia: these are the building blocks of the brain.
And "I" is the more that emerges from the sum of these parts.
When a kidney is removed or a liver damaged, "I" remains essentially unchanged. Yet, even with relatively mild damage to the brain, the meaning of "I" may be profoundly altered. For Lolita, whereas "I" once embodied a happy, stable child, it now describes an oversexed, irresponsible and socially-inept stranger. At times it is funny to watch, but mostly it's just terribly, terribly sad.


Anonymous Anonymous said...

heartbreaking,and astounding what can happen.god help the poor girl.what can be done if anything to help her medically?.

9:10 am  
Blogger Shiny Happy Person said...

That is heartbreaking. Her poor parents. Prognosis doesn't look great, does it?

9:32 am  
Blogger The Venial Sinner said...

Nah. I doubt there is anything medically possible here. We missed the main event and the damage is done.

We will hand her to the psychiatrists and psychologists in the hope that they can "train" her to act more appropriately

7:27 pm  
Blogger Kate said...

I remember reading about cases like that from my Bio 30 (that'd be final-year high-school biology in Alberta, Canada) textbook. Reason # 364 that I'd never be able to be a doctor - my reaction to that would likely be to either crack jokes or just snap at the poor girl.

10:31 pm  
Blogger Kate said...

Should've added that because I never COULD deal with something like that, the people who do (ie: you) have my utmost respect.

10:37 pm  
Blogger vegas said...

Another neuro classic. Lots of head-scratching, a battery of tests, finally a unifying diagnosis but alas, no treatment. One of the reasons I have re-considering it as a career.

1:04 am  
Blogger vegas said...

(been). Sorry, it's 1am.

1:04 am  
Blogger The Venial Sinner said...

Kate - Don't worry, I've at her snapped myself. She can be quite trying at times.

Vegas - I can understand that point of view, mate, but I think, when you are dealing with something as complicated as the brain, it's scarcely surprising that we're still quite limited in our treatments. I'm sure it'll get better as we undertstand more.

Be a neurologist, if only because it's more interesting than all the other specialities!

1:44 pm  
Blogger Name withheld to protect the guilty said...

That is the nice thing about neurology: there's nowhere to go but up, really. Everything really interesting is yet to come.

6:00 pm  
Blogger Dr Dork said...

A sad tale, but well told. There is little as frustrating to this doc, at least, at being powerless in the face of an awful prognosis.

8:30 am  

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