Lucy in the Sky without Diamonds

At the time of my medical residency training in the 1960s, a tumultuous period in America, "Make Love, not War" was the mantra permeating the "Flower Children" culture. Like the beat generation before them, they desperately tried to break away from the conservative standards that this country sanctioned. I had minimal exposure to the Flower Children's period since I was studying medicine. The exceptional music of that era of Bob Dylan, The Beatles, Jim Hendrix and others captured that period's ethos for everyone's enjoyment, including mine.

I remember attending a medical meeting in San Francisco near a park occupied by the Flower Children. They dressed colorfully in various outfits in loud and dazzling colors. Disorganized and non-intrusive, making no loud noises or booming music and generally no hoopla, they appeared peaceful and non-threatening. Their generation preferred to demonstrate their independence with colorful clothing, hairstyles of different colors, music, and drugs. Devotees of powerful drugs producing psychedelic effects and hallucinations transported them away from the chaos created by their elders. 

This story is about their premier drug, LSD, lysergic acid diethylamide. Unlike heroin that dulled the prior generation's senses, it produced a heightened feeling of being alive with the ability to communicate with an imaginary world of visions, almost spiritual. The familiar anti-anxiety drugs used by the general population had evolved from Miltown in the 1950s, followed by Librium in the 1960s, then Valium, and the current flavor of the decade, Xanax. The Flower Children were not the only disciples of psychic altering drugs.

One memorable day during medical rounds, I learned a medical student was a patient on our medical service admitted the previous evening. Rumor had it that he had achieved the highest or one of the best scores on the MCAT (medical college admission test). He had graduated from Harvard and was a follower of Timothy Leary, the infamous proponent of the wonderous drug LSD that claimed to produce many beneficial psychological effects. That evening, the emergency unit admitted him with labyrinthitis, a diagnosis of an imbalance of the middle ear causing dizziness or vertigo. Neither Jim nor I had seen him when admitted to the unit since we were not on duty that night. The new patient was in the first bed of a large open ward of male patients on the hospital's seventh floor. The bed was close to the nurse's station so they could carefully observe him. Jim had examined him earlier that morning before rounds and was puzzled by the admission diagnosis. Admitting a patient with that disorder to a hospital dealing with life-threatening illnesses is unusual. The emergency room discharges a patient home with this diagnosis and usually treats them with a handful of seasickness tablets.

Another thing that confounded Jim was that his physical examination was negative. There were no physical signs to suggest the diagnosis of a middle ear imbalance. Jim also remarked that his patient, who I will call Jack for this story, presented with a strange affect. He did not speak or answer questions and required restrains to keep him in bed. Restraints should not have been necessary for someone with the diagnosis unless the patient was confused, which does not usually occur with middle ear imbalances in young patients. The constraints allowed some movement while keeping him in bed and were needed to prevent a confused, dizzy medical student from falling out of bed. 

After completing rounds, I usually examined new patients to allow more time to take a history and perform a physical examination.

Jim and I were examining the fourth or fifth patient in the ward when we heard a loud commotion from the first bed. Jack had taken off the restraints, jumped over the bed rails, and headed to the nearest stairwell. I told Jim to take the fastest route to the ground floor and block Jack's exit from the hospital. Jim was a muscular fellow with a physique resembling that of a football tackle. Our patient was a tall, gaunt guy who did not appear menacing. I followed my patient, who had had a head start to the stairway, where I could see him on the fourth-floor landing looking down at Jim, who amazingly had reached the ground floor. I yelled at Jack to return to bed and reassured him that we would not harm him. There was no answer as he moved out of sight. All I heard were clanking noises sounding like metal pots banging together, produced by empty green oxygen tanks stored on the stairwell landing. It soon became apparent that Jack was dragging an empty tank along the railing. The metal tanks were about 4 to 5 feet in height and heavy even when empty. Jack was attempting to lift a green tank over the stairwell railing and hurl it down at Jim. I yelled to Jim to get away from the stairway and call security.

 Security did rescue Jack and placed him in a locked psychiatric ward on the hospital grounds. The following day, a mental hospital in the city, not affiliated with our hospital or medical school, accepted him as a patient. A few days later, I heard that they had discharged him after three days of observation. I wasn't expecting to hear more about Jack. A few days following his release from the psychiatric hospital, I found the staff huddled together, looking down at something on an empty bed. As I approached, I asked what was happening, and they held up a newspaper with the first-page headline reading in large bold print, LSD killer. Following his discharge from the other hospital, Jack returned home and killed his mother in law. From what I recall, it was a gruesome murder in which he stabbed her more than one hundred times. 

 Following the murder, the news buzz was that he was a chronic LSD user and continued using it up to the day of his hospitalization. Was it all a bad trip (a term used to describe the opposite of a high) that made him kill his mother-in-law? This "Flower Child" drug could make you do terrible things and not just make love. For several months, there were various theories bandied about by a generally uninformed public. The final verdict was a brilliant young man with a paranoid psychosis could get high grades on tests while high from drugs. However, a twisted psyche prevented him from becoming a doctor.

 Unfortunately, there were no tests at the time screening for severe psychiatric disorders in medical school applicants. Passing the MCAT test provides essential information about one's intellect but nothing about their personality or psyche. The problem is that there is no simple window into a person's mind or soul to determine the required mental stability to become a doctor. That said, how can we predict a physician's bedside manner?