Jeffrey Hauck
Houston, Texas, united States

I found myself in a grassy field. Lush green below, sapphiric blue above. My mother was with me, and we walked through endless space discussing trivialities that I am sure were important at the time. I turned to her at one point, and she gave me a bizarre look—clearly, something was wrong.
Quickly, I felt the sensation of my teeth falling out of my mouth. Terrified, I tried to scream for help, but my mouth would not open. I motioned with my arms, indicating that I was in perilous danger, hoping my mother would recognize what was happening to her son and lend motherly comfort. But she stood in front of me, motionless. Slowly, my field of vision became a dark tunnel. My mother faded away, and I could no longer see her.
I was alone and terrified. Frozen in space and unable to communicate with words, I was lost in strange darkness.
Then I woke up.
I remembered this vivid dream as my pediatric hospital team entered the room of a patient we were meeting for the first time. Her name was Carla, a fourteen-year-old girl diagnosed with suspected catatonia secondary to substance use. When I first saw her, she was lying on her hospital bed, eyes closed and unmoving. Her limbs were stiff, and raising her arm revealed a statue-like rigidity, a unique finding specific for catatonia. She had arrived at the hospital from a psychiatric facility, was estranged from her parents, and had no direct family contacts apart from her brother.
The attending physician had heard enough, and with an overwhelming schedule of patients, ushered us out of the room to continue our morning rounds. However, I asked if I could remain and briefly complete the history and physical exam. The attending agreed, noting that Carla would be a great patient for me to follow as the team left the room.
Returning to her bedside, I took a moment to reflect on what Carla must be feeling. Patients with catatonia are not sleeping, and in most cases are conscious of their surroundings. She could hear and understand us, but her condition did not allow her to communicate back. She was in a state a fourteen-year-old should never have to experience. Did she have questions? Was she in pain? She must be scared, isolated, and confused; I knew I would be. Then, I realized why I was reminded of that dream from many years ago.
What did I want my mother to do in the dream?
I leaned down and touched Carla’s arm. I told her that she was in a safe place, that she was surrounded by an excellent team, and that we understood how she must be feeling. I explained that I knew she could hear me, and that she would recover. I ended by telling her that she was not alone, and I looked forward to spending time caring for her during her hospital stay. Carla did not react, but her nurse nodded reassuringly. I hoped I had helped to comfort her, even a little.
The next day, Carla had improved markedly. The nurse called early and told us that she had awakened and asked for food. I was ecstatic and made my way to her room. When I saw her this time, she was lying in bed, facing forward, but her eyes were open. Overnight, she had been given lorazepam, which was certainly a large part of the reason she had improved so drastically. A small part of me hoped she would remember what I told her the day before. Despite her progress, she was still unable to communicate well, and when I spoke to her, she did not react.
I reintroduced myself, explaining everything as I had at our previous meeting, and asked if she had any questions. A small tear left her eye as I finished. Over the next couple of days, I visited her as many times as I could and reminded her that she was not alone and that her condition was only temporary. I wanted her to remember that she was not powerless, even if she felt so.
Time passed, and Carla’s symptoms became less pronounced. She regained motor function. We spoke for the first time four days after her admission, and she told me she was hungry. I laughed and told her she could eat whatever she wanted.
“A hamburger,” she whispered.
I spoke to the nurse, and she was ordered a full dinner with a hamburger as the entrée. I learned later that she ate the entire meal — her first whole meal in almost a week. With her symptoms improving, Carla was admitted to inpatient psychiatry. Though I was sad to see her leave our service, I was overjoyed with her improvement. I went to see her before my shift ended, told her goodbye, and that I hoped to see her in the future. She was weak, but able to speak in hushed tones and nodded to me before I left.
A week passed and I never stopped thinking about Carla. One late afternoon, I stopped by the inpatient psychiatry unit and asked where she was. The nurse directed me to her room, and I saw a small figure standing near the bed. As I stepped inside, she turned and greeted me with a laugh, and we hugged.
She uttered a heartfelt “thank you,” and in that moment, the memory of my dream was replaced by the warmth of her smile.
JEFFREY HAUCK is a third-year medical student at the Baylor College of Medicine in Houston, Texas. He is interested in the intersection between medicine and philosophy and wants to write more narrative works in his career. He wants to apply into forensic psychiatry and is a member of the Baylor College of Medicine medical humanities track.
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