By Phil Johnston, MD

Physician Phil Johnston was deeply affected by work with disadvantaged groups overseas as a medical student and in inner city Indianapolisas a resident in Family Medicine.  He followed this as a calling and has practiced for nearly 40 years at SoutheastHealthCenter, one of six Indianapolis HealthNet clinics.  NACHC invited Dr. Johnston to share some of his collection of stories about life as a health center doctor in two part series.  The patients names have been changed to protect their privacy:

The clinic where I began my practice was housed in what was once a Methodist Church. The church had followed the migration of its congregation to the suburbs and sold their old building to the neighborhood association for one dollar. A local grant of several hundred thousand dollars helped transform the old church into a passable medical space with eight examining rooms. For a few years, a mental health clinic occupied the third floor of our building; this relationship broadened my appreciation of the emotionally debilitating disease of schizophrenia.

A chronic disease that affects one’s perception of reality, schizophrenia often appears
with disturbing symptoms in late adolescence and early adulthood. Pervasive delusions,
disordered thinking, frightening auditory and visual hallucinations are among the spectrum of symptoms that drastically interfere with everyday life.

Two of my most endearing schizophrenic patients were a mother and daughter, Ava and Emily
Barnes who, at ages eighty one and fifty three lived together, sharing the peculiarities of their
illnesses. One day after they were leaving the examining room the daughter, Ava, took me aside and said, “I’ve been worried about Mom for a few months. She always sets an extra place at the table on Saturday evening because…” (and she hesitated a bit here), “she thinks Lawrence Welk is coming to dinner. She’d never put food on the plate before, but now she’s giving him a helping of everything! What can I do – she’s wasting a lot of food!”

I groped for an answer.

“Well, Ava, I suppose you should just plan on Mr. Welk’s portion being left-overs for you the next day…? And, perhaps you should tell your mother that Lawrence is eating dinner with another Champagne Lady tonight before the show.”

Although they were stable on their medications, Ava and Emily had a few recurring medical needs. For reasons that I have yet to discover, schizophrenia also seems to be associated with excessive toenail growth. Ava and Emily came in regularly every three months for podiatric care. They were both of such girth that they were unable to muster the strength and flexibility needed to trim their huge nails. Nail trimming was a peculiarly fulfilling diversion for me as a physician, but even with a pair of stout nail trimmers, the actual trimming was a hazardous occupation. My medical assistants soon learned to leave the room after dropping off the trimmers, fearful of being injured by a piece of nail that commonly ricocheted off the walls or ceiling in the heat of battle. I learned to be more cautious myself after one incident. I’d seen Ava and Emily for their respective trims early in the morning and drove home after finishing clinic hours to a fond hug from my wife. But she then pushed away and stared up at my head.

“What’s that in your hair?!” she asked, apprehensively. As I brushed my hand over my head, a sizeable chunk of Barnes toenail fell to the floor. In reflecting on the day, I wondered if anyone else had looked at my head closely enough to have detected what my wife saw instantly.