frustrations

M's pdoc just called... She's full of ideas for helping him to be more stable AND not be buried under side effects. I think she's wonderful, and I'm glad that she wants so much for M to be better. But I'm also so frustrated trying to communicate with her... 

Sometimes I think we aren't speaking the same language. She's been seeing the kids every week for a while now, and usually she tells me how good M looks. It doesn't matter if he's tearing the house apart at home, and I can't take him out in public because he's so unpredictable... He looks good to her. 

After feeling frustrated that she didn't seem to be seeing what I see, I finally decided maybe she is right. For someone who is developmentally delayed and has severe schizophrenia which hasn't been responsive to treatment, he's doing fine. I decided that maybe my expectations are just too high... that this is "normal" for someone with his unique challenges. 

So I told the pdoc that. I said M was fine, I'm glad he looks good to her, and I'm going to work on adjusting my expectations to more manageable levels. 

Her response? 

He really doesn't look that good. She's concerned about him and thinks we need to make major med changes, ones that would require him to be hospitalized (in the psych unit of course) for an extended period of time. Sometimes I just can't win for losing... 

She wanted to talk tonight about hospitalizing him to make these major med changes. We would be slowly reducing the only medication that is known to be helpful with treatment resistant schizophrenia and replacing it with another antipsychotic (one that he's taken several times in the past with only marginal success). 

Why would she think this is a reasonable option? While tapering his clozaril the hallucinations would increase, he would lose insight into them and start believing that what he was seeing and hearing was real. He would become very frightened of the scary ones, and possibly panic and try to run away from them. He might also get aggressive and volatile if the voices told him to do something and in his compromised state of mind, he did it. (They often threaten to kill him if he doesn't do what they say... that's why insight is so important!) He would be in terrible mental pain, possibly banging his head or wanting to die to quiet the voices. I know this is what it would be like because we've tapered that med before and this is what happened. 

I think, as a physician, his pdoc is focused on "fixing" (curing?) M. That's what doctors do... they make people better. But some people with schizophrenia don't get better... their illness is not responsive to meds, or only partially responsive. M is one of those people. 

Rather than put him through hell trying a medication that we've already tried, one that hasn't done enough... Why not accept him as he is, and try to help us all live with the reality of life with schizophrenia?! 

I know she means well. I know she cares about him and is doing the best she can. I just wish she could forget she's a doctor for a little while, and think about things from M's point of view.