episode_0100

Episode 100. A disease that gets better, a disease that doesn’t get better (3)

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Natalie was fiddling with a heart specimen bottle that was sitting on the examination table. Someone else might have been annoyed, but… … .

This patient is truly innocent, and it appears that the neural circuitry that allows him to think that he might offend others is broken.

I decided to just understand.

Streptococcal tonsillitis and ADHD. Those were the two diagnoses I concluded for Natalie.

“So, there were two cats in front of the dorm. Actually, I don’t really like cats, but I guess there are a lot more people who like cats than those who don’t, right?”

“Patient.”

“Yes. Why?”

“There’s a lot of nonsense.”

“Ah. I hear that a lot, but I don’t know where to start. The other professor said something similar during the last interview. At the time, I thought it was a compliment for being active, but now that I think about it, it might have been a criticism.”

I sighed.

“Take a break. Let me explain.”

“Oh, yes. Sorry.”

“The patient seems to have bacterial tonsillitis, not a cold, so we will treat it with medication. It can be easily treated with antibiotics.”

Natalie nodded.

“Yes.”

“Would you like to try it?”

“Ah-”

I looked into Natalie’s mouth.

I could see that my tonsils were slightly swollen. As expected, it looks like bacterial tonsillitis, and I’ll get better quickly with antibiotics.

“Patient. I’m being serious.”

“Yes.”

“The patient seems to have ADHD in addition to tonsillitis. You may not know, but this is also a treatable condition, right?”

“Really?”

“You’ll get better if you take medicine.”

Attention deficit hyperactivity disorder.

AKA ADHD.

It is a disease in which there is a problem with the regulation of dopamine and norepinephrine in the brain’s neural circuits.

The exact cause is unknown, and the mechanism and symptoms are complicated by psychological factors. It is literally a type of neurosis that causes difficulty concentrating and makes it difficult to stay still.

Natalie became quiet. Either shocked or seriously contemplating, the noisy student closed her eyes tightly for a long time and thought.

“Really… … ?”

“Yes.”

It was a look that I didn’t really want to believe. Not that there was a disease, but that there was a cure.

“It seems a bit nonsensical. Your personality can change just because you took some medicine.”

“Oh, if you drink alcohol in moderation, your personality will improve, right? This medicine is similar.”

Natalie looked a little gloomy.

“Do you think I have such a strange personality that I need treatment?”

Yeah, it’s really weird.

But I couldn’t say that. This is probably a symptom of ADHD, too. Rapid mood swings. In everyday terms, it’s called tension.

Natalie’s tension was noticeably lower than when she first came in. She looked limp, like wet spinach. She looked a little pitiful.

“Well, Miss Natalie.”

“Yes.”

“What do you think of when you see people wearing wigs, glasses, or using canes?”

“That could be the case.”

“Hyperactivity disorder is a disease. It doesn’t mean it’s wrong or problematic. It just causes occasional discomfort.”

Natalie sighed.

“I guess so.”

“I’m not trying to insult you. I’m just trying to tell you that you have a choice.”

“Still. I feel like something fundamental might change… … . It’s a little scary. Is this okay? Even if you were the one who was sick, would you have taken that medicine?”

I hear that a lot these days.

“The effect is temporary. It lasts only a day or so. I am not trying to change the patient’s personality by giving them a lot of medicine… … .”

“For example, in situations like the day before an exam or an interview where you need to focus on studying, I’m saying that you can choose a few days.”

“Yes.”

“Of course. You can’t change a person or their personality in a short period of time with medicine, and I don’t intend to do something that dangerous.”

“Then is it always good?”

“Where can there be something that is absolutely good? This is a problem that needs to be seriously considered.”

Natalie groaned and pondered for a long time. It happens sometimes. The disease often stays with the patient for a long time and has a great influence on the formation of the patient’s personality.

Especially if the patient is young.

The most representative example is deafness. In some cases, hearing can be restored with modern medicine and implantable hearing aids, but the problem is what happens after that.

A person who could have lived as an ordinary farmer among farmers suddenly had to live as a somewhat strange ordinary person.

In fact, many people refuse treatment for this reason: the illness becomes part of the patient’s personality, and the person must change when the illness disappears.

In that sense, I can understand Natalie’s concerns. She probably thought of herself as creative, active, and someone who could see things that others couldn’t.

What should I say and what should I do to help Natalie? I thought about it for a while.

Hmm.

“While I have time, I have something to tell Natalie. I had a senior named Asperger. He discovered a disease.”

“He must have been a good person.”

Hans Asperger.

He is a Nazi collaborator who provided the theoretical basis for the slaughter of the physically disabled. I don’t think Hans is a good person.

Of course, there are those who will defend him, but my opinion is that it is true that he sent his disabled son to a euthanasia facility.

anyway.

“Senior Asperger said so.”

“What did you say?”

What did he say? I struggled for a while to remember the specific words Asperger had used. It was so poetic.

Let’s just say it similarly.

“It seems that a little bit of illness is necessary to succeed in art or science. It is said that people who can turn their backs on ordinary daily life, see the world with new eyes, and walk on paths that others have not taken are also needed.”

“Ugh.”

“Of course, the patient and the specific diagnosis are different, but you know what I mean, right?”

“No. I don’t know.”

Natalie shook her head.

How can I say this so you can understand?

“The patient is different from other people, and that must be a gift from God. However, if you keep walking while carrying a gift, you can get tired.”

“Are you telling me to take some medicine?”

I shook my head.

“You asked me earlier if I would take that medicine? To be honest, if I were you, I would never take it. I have a personality disorder that makes me look down on ordinary people. I won’t take a medicine that makes me look like other people.”

“Yes.”

“But you’re not the patient, right? You’re a young student with friends and excellent social skills. Aren’t you a different person from me?”

Natalie nodded slowly, as if she finally understood. It was a long process, but I’m glad that my message was conveyed properly.

“Please explain what kind of medicine it is.”

****

Adderall. A drug made up of mixed amphetamine salts. Amphetamine is a rather unusual substance.

This time, instead of a vial, I put four pills in a small wooden cup and handed it to the patient.

“I’ll give you three days’ worth. If you feel unwell after taking the medicine, you don’t have to take it.”

Natalie was playing with her hair. This patient couldn’t stand it anymore and took my stuff again. He’s so annoying and crazy.

“Why? Shouldn’t I take the medicine consistently for a certain period of time to get better? It’s scary to take it and then stop taking it on my own.”

“First. The patient’s illness is not curable, but he takes it because it can make his daily life easier. Medicine does not change his personality.”

“Ah.”

“Second. Amphetamines can calm and focus ADHD patients, but they have the opposite effect on the general population.”

“How is that possible? Even though it’s the same person, shouldn’t the effect be similar? Like both of them feeling better?”

Actually, I don’t know exactly.

“It is a drug that activates the brain.”

“Yes, yes.”

“When a normal brain becomes more active, people become more active as well, but ADHD patients’ brains are in a sluggish state, so they become hyperactive because they are bored. When you return them to a normal state, they become calm.”

“Aha.”

“Food makes normal people admire it, and makes starving people stop begging for food. That’s how you see it.”

Natalie stared at the four pills, as if they were doing something wrong.

“Take the medicine for three days. Tell me if there are any changes in your behavior, if you feel better or calmer, and how people around you react. The most important thing is… ….”

“What’s important?”

“Please tell me if you still feel like taking that medicine in the future.”

“What if I say no?”

“That’s it.”

“What if I say no now?”

“Still the end.”

****

Mint scratched her head.

Why aren’t you coming, you idiot?

“You’re late… … .”