The book, Brain on Fire: My Monthof Madness, takes us through a clinical course that the narrator of thestory underwent. In this case, Susannah Cahalan, who provides the readers withan autobiography that delves into her struggles to balance career and personallife aspects.
In the beginning, she is emotionally overwhelmed and developsstrange behavior and unique mental illness. Her symptoms began vaguely, but hermental and physical health deteriorated as time went by, given that her problemwas not properly diagnosed from the start. At first, Susannah developedhallucinations due to her obsessions on anything that occupied her mind. Forinstance, she was so obsessed by the bedbug threat that she was convinced thepests had infested her apartment. She even said that the two red marks on herleft arm were bedbug bites.
Susannah went ahead to seek the services of anexterminator to carry out a clean-up and even forced him to spray theapartment, despite his protests that he had checked everything and that thebedbugs were just imaginary (Cahalan, 2012).He had tried to convince her that the apartment had not been infested by bedbugsin vain. Physically, Susannah wouldexperience a sharp pain in her head and then abdominal cramps with nausea.
Afew days after the bedbug incident, Cahalan found herself alone in herboyfriend’s flat, searching obsessively – and uncharacteristically – throughhis emails and letters for proof of betrayal. She felt a tingling in her lefthand, which then went numb. A neurologist, and an MRI, found nothing amiss; hergynecologist suggested possible glandular fever, which was also soondiscounted. But the symptoms continued to build: panic attacks in publicplaces, more uncharacteristic and dramatic failures at work. She began toricochet between wild weeping and absurd happiness; she paced floors, unable tosettle; insomnia became the norm. And then, one night, she suffered afull-blown seizure and blacked out. The neurologist diagnosed stress and toomuch partying; a psychiatrist diagnosed possible bipolar disorder.
DuringSusannah’s breakdowns, she visited healthcare facilities and professionals formedical help. She was referred by her gynecologist to a neurologist for medicalcheck-ups. During her visit to Dr. Bailey’s place, an MRI and blood tests werecarried out (Cahalan, 2012). The hospitalto which Susannah was taken when she had her first seizure alsoconducted a CT scan and a blood test (Cahalan,2012). At her mother’s house, Susannah became emotionally unstable againwhen she tried to write a story but failed as her mind could not concentrate.
Her mother and Allen had to take her to Dr. Bailey again. Thesebreakdowns that Susannahhad during the progression of her disease and subsequentinteractions with the healthcare system occurred because she was usuallyoverwhelmed by thoughts. This happened, especially when she felt helpless andinept.
For instance, after the failed interview with Walsh, she feltincompetent, and this feeling consumed her thoughts and had a delusion (Cahalan, 2012). Susannah also lost her mindafter she had been discharged from the hospital after her first seizure andtaken to her mother’s place for care because she tried to write a story andfailed. Earlier on, in her office, she had become angry and cried when thethoughts that things were not working her way, especially her forgetfulnessthat made appear incompetent at work, possessed her. Itcan be asserted that the role of nursing improved, and at the same time,detracted Susannah’s clinical course. Initially, Susannah had a few encounterswith healthcare personnel at Dr.
Bailey’s hospital and the hospital to whichshe was taken when she had a first seizure(Cahalan, 2012). The nurse at Dr. Barley’s hospital was professional andhelpful as he assisted Cahalan to undergo the MRI. He even had a conversationwith Susannah, in which he asked about her occupation. However, instead oftaking the interaction as an approach of developing a therapeutic relationship,Susannah regarded it as flirtatious and this even affected her clinical coursebecause it affected her thoughts, leading to her increased anxiety (Cahalan, 2012). However, assurance by varioushealth practitioners that her condition would improve helped her for some time,which led to the temporary improvement of her symptoms. After her firstseizure, personnel at the hospital discharged Susannah, advised that she shouldsee a psychiatrist, and hoped that she would not have another seizure after theexaminations found nothing wrong with her.
This would lead to the developmentof significant deterioration of her mental health because the cause of herproblem was not established. The conduct of the nurse who performed an EEG onSusannah appeared to her as something that had been planned. Therefore, herassurance that nothing was wrong with Susannah was received with fury.
Withsuch kinds of angry bursts, the clinical course of Susannah’s mental status deteriorated.At New York University Langone Medical Center, nurses played their role ofmonitoring Susannah professionally as she underwent medication. However, thisdid not lead to an immediate improvement of her clinical course as the feelingof being under surveillance infuriated her more. Nurses Edward and Adeline hadproved helpful as they created a calm and motivating environment for Susannahand she always stayed positive to medication(Cahalan, 2012). The nursing staff even allowed Stephen, Susannah’sboyfriend, to stay past the recommended hours as this reduced her escapeattempts. Itappears that during Susannah’s diagnosis, medical personnel relied most on hightech methods. The reason for this is that only one normal examination wascarried out while a few interviews and medical history of the patient weresought during her interaction with the healthcare system.
However, every time,Susannah had to be examined, MRI, EEG, CT scans, and spinal taps, among otherhigh tech tests, were conducted to rule out some illness and determine whethershe was suffering from some suspected ones(Cahalan, 2012). Reliance on information technology and high techmachines for diagnosis may mislead medical practitioners as some patient’conditions can be out of the machines’ scope. In that case, practitioners endup treating a non-existent or pre-determined condition. Misdiagnosis may alsooccur as high tech procedures require sophisticated infrastructure, stableconditions, and highly trained staff. However, when low tech diagnostics areutilized as was done by Dr.
Nijjar, then the doctor is assured of treating thepatient rather than the monitor. Dr. Nijjar utilized this approach, whereby hesought Susannah’s full health history and spoke to her as a personal friend toget all the information that would lead to proper diagnosis (Cahalan, 2012).
The main message in thispoint is that low tech diagnostics are essential and unique because they do notrely on programmed outcomes. At the same time, they enhance therapeuticrelationships as they create room for friendly interactions between patient anddoctor. It should be noted that a greater percentage of a patient’s diagnosisis always in her or his story. Therefore, accurate diagnosis relies more on lowtech methods. Thedifferences in terms of healthcare for people with mental illness and thosethat develop problems due to other physical conditions as highlighted in thebook are significant because their understanding leads to the appropriatetreatment of the real cause of illness.
For instance, if one is diagnosed withmental illness that has not been caused by a physical problem, his or hertreatment will focus only on her condition. However, a mental illness that is causedby physical problems requires more than the treatment of the mental illness.The physical problems have to be alleviated to enhance the treatment of themental condition because leaving the physical problems will lead to recurrenceof mental illnesses. In some cases, the mental illness temporarily lapses whileit deteriorates in other cases. This was the beginning of a terrible month,almost all of which she cannot remember, because her illness obliterated hershort-term recall, but which she has painstakingly reconstructed from theaccounts of her family, her doctors, some erratic diaries and some hospitalvideo.Delusions– that people were speaking to her out of the TV, or that her father hadmurdered his girlfriend – were joined by paranoid hallucinations, cruelaggression and desperate attempts to escape. The list of possible diagnoseslengthened: epilepsy, multiple personality disorder, schizo-affective disorder,bipolar disorder. Her blood pressure was dangerously high and she wasincreasingly unable to walk properly, complete simple cognitive tasks, or evenspeak, but test after test for physical ailments came back negative.
The onlything anyone knew for sure was that her white cell count was up, and that shewas worsening by the day.Unableto control her mouth or tongue, she began to drool and grimace and to makeconstant involuntary chewing motions. Eventually she began to enter a catatonicstate. She is both forensic and sensitive throughout about the effect of allthis on those closest to her; their panic and helplessness, and in particulartheir increasing fear that she would be transferred from the epilepsy unit tothe psychiatric ward.Thiswas the point at which her savior appeared, in the form of a moustache-pullingSyrian neurologist, Dr Souhel Najjar. He asked her to draw a clock.
After a fewattempts, she did so – with all the numbers squashed into the right-hand side:low-tech, indisputable proof that the right hemisphere of her brain wasseriously inflamed. “Her brain is on fire,” he told her parents.”Her brain is under attack by her own body.” Focused treatment beganimmediately. In Susannah’s case, Dr.
Nijjar, addressed all physical problems byperforming a brain biopsy and determining the cause of her problem, which wasfound out to be the immune system’s attacks on her brain; Anti-NMDA receptorencephalitis. Isolationand love is another nursing role-related theme evident in the book becauseprofessional healthcare personnel’s behavior and concern in isolated patientsis of great importance. If a nurse performs actions that make the patient feelappreciated and wanted, then his or her medical condition can improve as he orshe more likely to cooperate. Susannah was in the advanced monitoring unit ofthe hospital, where she was under surveillance all the time. She felt isolated.However, the actions of concern and love by the nurses helped make thesituation better because they could allow her boyfriend, Stephen, to stay pastthe visiting hours. Moreover, nurses Adeline and Edward showed their concernand love to her by treating her with respect and conversing with her in theright manner (Cahalan, 2012). This easedthe tension and enhanced her cooperation as they had developed a therapeuticrelationship with her.
Love was alsoshown throughout this book by her family, friends, co-workers and especiallyStephen. Stephen’s commitment to her was commendable. The two hadn’t beentogether for very long and he could of left; but he chose to stay and encourageher daily.
He believed “She was still in there.” Susannahsaid she never felt completely like herself again after the illness. If Stephenhad been with her for a long time before the illness, he might find that hefeels distant from the ‘new’ Susannah but because they were not as closebefore, he can see the changes and recognize them but can still adjust to hernew personality.