I noticed Carl Bixby’s 40-year-old hands first, a strange focus for me since I usually find myself immediately drawn to a patient’s eyes: the downward gaze of depression, the frenetic glances of mania, the hypervigilance of psychosis. But these hands, erupting from the red flannel sleeves of his shirt, commanded my attention. They were too big for the rest of the man, even though he was big himself. Thick calluses stood out like cat’s pads amid webs of crevices edged with grease. Dried blood lined new scratches, and numerous scars marked the old. They were strong hands, I thought to myself--well-worn rather than worn-out. They were the kind of hands you’d pray would reach for you if you were drowning. Nothing fragile about them. Grab on as hard as you like. Just as I convinced myself to search the man’s face, he dragged my attention back to his wonderful mitts, slapping them on his knees twice to herald what he was about to say.
I’m broken, he told me. His hands went up to his head. Up here. My brain. Somethin’s broken inside. His thick fingers spread through his long but perfectly trimmed red-brown beard. Suddenly he looked beside himself with grief.
No other patient has ever come to me with a direct complaint about his or her brain. Whatever the role of disturbed brain chemistry or anatomy in producing psychiatric symptoms, the usual view of a sick body part--as in, My leg hurts!--is generally absent. The self may feel injured, the world may appear changed or bizarre or hostile, but the brain, under cover of its own pathology, almost always escapes anything more than vague suspicion.
I looked him squarely in the eyes for the first time. The room seemed to close in around us as he looked back at me--no, stared back at me, his eyes locking on mine and not letting go. I noticed that he hardly blinked. He leaned forward in his chair, as if to see what I had to say.
Your brain is broken? I asked.