The found herself alone in her boyfriend’s flat,

The book, Brain on Fire: My Month
of Madness, takes us through a clinical course that the narrator of the
story underwent. In this case, Susannah Cahalan, who provides the readers with
an autobiography that delves into her struggles to balance career and personal
life aspects. In the beginning, she is emotionally overwhelmed and develops
strange behavior and unique mental illness. Her symptoms began vaguely, but her
mental and physical health deteriorated as time went by, given that her problem
was not properly diagnosed from the start. At first, Susannah developed
hallucinations due to her obsessions on anything that occupied her mind. For
instance, she was so obsessed by the bedbug threat that she was convinced the
pests had infested her apartment. She even said that the two red marks on her
left arm were bedbug bites. Susannah went ahead to seek the services of an
exterminator to carry out a clean-up and even forced him to spray the
apartment, despite his protests that he had checked everything and that the
bedbugs were just imaginary (Cahalan, 2012).
He had tried to convince her that the apartment had not been infested by bedbugs
in vain.

Physically, Susannah would
experience a sharp pain in her head and then abdominal cramps with nausea. A
few days after the bedbug incident, Cahalan found herself alone in her
boyfriend’s flat, searching obsessively – and uncharacteristically – through
his emails and letters for proof of betrayal. She felt a tingling in her left
hand, which then went numb. A neurologist, and an MRI, found nothing amiss; her
gynecologist suggested possible glandular fever, which was also soon
discounted. But the symptoms continued to build: panic attacks in public
places, more uncharacteristic and dramatic failures at work. She began to
ricochet between wild weeping and absurd happiness; she paced floors, unable to
settle; insomnia became the norm. And then, one night, she suffered a
full-blown seizure and blacked out. The neurologist diagnosed stress and too
much partying; a psychiatrist diagnosed possible bipolar disorder. During
Susannah’s breakdowns, she visited healthcare facilities and professionals for
medical help. She was referred by her gynecologist to a neurologist for medical
check-ups. During her visit to Dr. Bailey’s place, an MRI and blood tests were
carried out (Cahalan, 2012). The hospital
to which Susannah was taken when she had her first seizure also
conducted a CT scan and a blood test (Cahalan,
2012). At her mother’s house, Susannah became emotionally unstable again
when 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. 

These
breakdowns that Susannah
had during the progression of her disease and subsequent
interactions with the healthcare system occurred because she was usually
overwhelmed by thoughts. This happened, especially when she felt helpless and
inept. For instance, after the failed interview with Walsh, she felt
incompetent, and this feeling consumed her thoughts and had a delusion (Cahalan, 2012). Susannah also lost her mind
after she had been discharged from the hospital after her first seizure and
taken to her mother’s place for care because she tried to write a story and
failed. Earlier on, in her office, she had become angry and cried when the
thoughts that things were not working her way, especially her forgetfulness
that made appear incompetent at work, possessed her.

It
can be asserted that the role of nursing improved, and at the same time,
detracted Susannah’s clinical course. Initially, Susannah had a few encounters
with healthcare personnel at Dr. Bailey’s hospital and the hospital to which
she was taken when she had a first seizure
(Cahalan, 2012). The nurse at Dr. Barley’s hospital was professional and
helpful as he assisted Cahalan to undergo the MRI. He even had a conversation
with Susannah, in which he asked about her occupation. However, instead of
taking the interaction as an approach of developing a therapeutic relationship,
Susannah regarded it as flirtatious and this even affected her clinical course
because it affected her thoughts, leading to her increased anxiety (Cahalan, 2012). However, assurance by various
health practitioners that her condition would improve helped her for some time,
which led to the temporary improvement of her symptoms. After her first
seizure, personnel at the hospital discharged Susannah, advised that she should
see a psychiatrist, and hoped that she would not have another seizure after the
examinations found nothing wrong with her. This would lead to the development
of significant deterioration of her mental health because the cause of her
problem was not established. The conduct of the nurse who performed an EEG on
Susannah appeared to her as something that had been planned. Therefore, her
assurance that nothing was wrong with Susannah was received with fury. With
such kinds of angry bursts, the clinical course of Susannah’s mental status deteriorated.
At New York University Langone Medical Center, nurses played their role of
monitoring Susannah professionally as she underwent medication. However, this
did not lead to an immediate improvement of her clinical course as the feeling
of being under surveillance infuriated her more. Nurses Edward and Adeline had
proved helpful as they created a calm and motivating environment for Susannah
and she always stayed positive to medication
(Cahalan, 2012). The nursing staff even allowed Stephen, Susannah’s
boyfriend, to stay past the recommended hours as this reduced her escape
attempts.   

It
appears that during Susannah’s diagnosis, medical personnel relied most on high
tech methods. The reason for this is that only one normal examination was
carried out while a few interviews and medical history of the patient were
sought during her interaction with the healthcare system. However, every time,
Susannah had to be examined, MRI, EEG, CT scans, and spinal taps, among other
high tech tests, were conducted to rule out some illness and determine whether
she was suffering from some suspected ones
(Cahalan, 2012). Reliance on information technology and high tech
machines for diagnosis may mislead medical practitioners as some patient’
conditions can be out of the machines’ scope. In that case, practitioners end
up treating a non-existent or pre-determined condition. Misdiagnosis may also
occur as high tech procedures require sophisticated infrastructure, stable
conditions, and highly trained staff.  However, when low tech diagnostics are
utilized as was done by Dr. Nijjar, then the doctor is assured of treating the
patient rather than the monitor. Dr. Nijjar utilized this approach, whereby he
sought Susannah’s full health history and spoke to her as a personal friend to
get all the information that would lead to proper diagnosis (Cahalan, 2012). The main message in this
point is that low tech diagnostics are essential and unique because they do not
rely on programmed outcomes. At the same time, they enhance therapeutic
relationships as they create room for friendly interactions between patient and
doctor. It should be noted that a greater percentage of a patient’s diagnosis
is always in her or his story. Therefore, accurate diagnosis relies more on low
tech methods.

The
differences in terms of healthcare for people with mental illness and those
that develop problems due to other physical conditions as highlighted in the
book are significant because their understanding leads to the appropriate
treatment of the real cause of illness. For instance, if one is diagnosed with
mental illness that has not been caused by a physical problem, his or her
treatment will focus only on her condition. However, a mental illness that is caused
by physical problems requires more than the treatment of the mental illness.
The physical problems have to be alleviated to enhance the treatment of the
mental condition because leaving the physical problems will lead to recurrence
of mental illnesses. In some cases, the mental illness temporarily lapses while
it deteriorates in other cases. This was the beginning of a terrible month,
almost all of which she cannot remember, because her illness obliterated her
short-term recall, but which she has painstakingly reconstructed from the
accounts of her family, her doctors, some erratic diaries and some hospital
video.

Delusions
– that people were speaking to her out of the TV, or that her father had
murdered his girlfriend – were joined by paranoid hallucinations, cruel
aggression and desperate attempts to escape. The list of possible diagnoses
lengthened: epilepsy, multiple personality disorder, schizo-affective disorder,
bipolar disorder. Her blood pressure was dangerously high and she was
increasingly unable to walk properly, complete simple cognitive tasks, or even
speak, but test after test for physical ailments came back negative. The only
thing anyone knew for sure was that her white cell count was up, and that she
was worsening by the day.

Unable
to control her mouth or tongue, she began to drool and grimace and to make
constant involuntary chewing motions. Eventually she began to enter a catatonic
state. She is both forensic and sensitive throughout about the effect of all
this on those closest to her; their panic and helplessness, and in particular
their increasing fear that she would be transferred from the epilepsy unit to
the psychiatric ward.

This
was the point at which her savior appeared, in the form of a moustache-pulling
Syrian neurologist, Dr Souhel Najjar. He asked her to draw a clock. After a few
attempts, she did so – with all the numbers squashed into the right-hand side:
low-tech, indisputable proof that the right hemisphere of her brain was
seriously inflamed. “Her brain is on fire,” he told her parents.
“Her brain is under attack by her own body.” Focused treatment began
immediately. In Susannah’s case, Dr. Nijjar, addressed all physical problems by
performing a brain biopsy and determining the cause of her problem, which was
found out to be the immune system’s attacks on her brain; Anti-NMDA receptor
encephalitis.

Isolation
and love is another nursing role-related theme evident in the book because
professional healthcare personnel’s behavior and concern in isolated patients
is of great importance. If a nurse performs actions that make the patient feel
appreciated and wanted, then his or her medical condition can improve as he or
she more likely to cooperate. Susannah was in the advanced monitoring unit of
the hospital, where she was under surveillance all the time. She felt isolated.
However, the actions of concern and love by the nurses helped make the
situation better because they could allow her boyfriend, Stephen, to stay past
the visiting hours. Moreover, nurses Adeline and Edward showed their concern
and love to her by treating her with respect and conversing with her in the
right manner (Cahalan, 2012). This eased
the tension and enhanced her cooperation as they had developed a therapeutic
relationship with her.  Love was also
shown throughout this book by her family, friends, co-workers and especially
Stephen. Stephen’s commitment to her was commendable. The two hadn’t been
together for very long and he could of left; but he chose to stay and encourage
her daily. He believed “She was still in there.”      Susannah
said she never felt completely like herself again after the illness. If Stephen
had been with her for a long time before the illness, he might find that he
feels distant from the ‘new’ Susannah but because they were not as close
before, he can see the changes and recognize them but can still adjust to her
new personality.