COMMENTARY

My Unforgettable Patient: A Man Called Voltaire

Nassir Ghaemi, MD, MPH

Disclosures

October 03, 2019

Nassir Ghaemi, MD, MPH

Every physician remembers a few patients from the past, sometimes fondly, sometimes not so fondly, but indelibly. For most of us, the first months of clinical rotations left the deepest impressions. That's how it was for me, especially with Voltaire.

He was one of my first patients on the psychiatry ward at the Veterans Administration hospital in Richmond, Virginia. Even after practicing psychiatry for three decades, every now and then my mind veers back to Voltaire.

That was his nickname, he told me, what his colleagues and friends called him, because he was so witty and smart. He was a doctor too; he had been a surgeon, if I recall correctly. But early-onset Parkinson's disease robbed him of his career. His hands shook and his body writhed, and he could no longer operate. Diagnosed in his mid-forties, he had severe symptoms that required high doses of L-dopa which, over time, made him psychotic and manic—hence, his presence on the psychiatry ward at the VA.

His disease was tough to manage; too much Sinemet made his body move all about, but too little froze him up. I remember seeing him sitting in the hallway, his arms and legs gyrating as he experienced an "on" time with the drug. He didn't seem uncomfortable; rather, he was smiling and talkative. Other times I'd see him completely still during an "off" period. He would stare at me, unable to speak.

His clinical story wasn't very complicated: medication-induced manic/psychotic symptoms. But it wasn't the clinical facts that intrigued me. What stood out was the man. He was energetic and engaging. He loved talking to students like me, and we loved to listen.

A search on the Internet reveals nothing; like so many in the pre-digital era, he is missing, a ghost on the Web, as if he never existed...

Maybe that all was part of his mania. (I've since spent decades with hundreds of manic patients, who can often be charismatic, fun-loving, talkative, creative, and humorous). But my recollection is that even when his symptoms improved, he was still this bubbly, engaging character. He was still Voltaire.

I never saw any despair in his face, no depression, no sorrow about having such a chronic, severe disease so young. He obviously mourned the loss of his profession, but he also seemed ready to keep living, to move forward however he could.

After I finished my rotation, I never heard about or saw him again. A search on the Internet reveals nothing; like so many in the pre-digital era, he is missing, a ghost on the Web, as if he never existed. Not even an obituary.

People like Voltaire stick with you. I'm not sure I would have ever met such a man except in a psychiatric ward. That's one long-noted privilege of being a physician: You see people from all walks of life, people from social classes or economic groups you might not otherwise know well; and you sometimes see them naked, undressed from social pretense and common interactions. You get to glimpse them just as they are. And you do so not just once or twice, but over and over again.

I'm not sure I'd have the same reaction to Voltaire today. I'd probably walk by him more quickly in his frozen "off" periods, listen to him less intently in his talkative "on" periods. In fact, I'm sure I've seen more Voltaire-like patients over the years and not really noticed.

As medical students, we know we are there to learn, so we approach each patient as a lesson. We hope to learn something from each one. Years and decades later, we may become much more experienced as physicians, but our antennae for learning often become weaker. Voltaires pass before our eyes, and we may chuckle or get a brief kick out of it, but we know we have to move on to the next person in the waiting room.

In that way, I've never met another Voltaire. Or maybe I have and didn't realize it.

But I do know that at least this one did exist. There was once a modern Voltaire, out there in a VA hospital in Richmond, Virginia, in the late 1980s. He lived, and suffered, and likely has died. But he left behind a lively memory in those who knew him, especially those med students who were aware enough to know that he was special.

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