D

r. Fine was an exceptional rheumatologist.

He’d studied at a top medical school, completed a research fellowship at the National Institute of Health, and finished up with a fellowship at Harvard. He was known for his exceptional clinical skills, split his time between Israel and the US, and patients traveled from all over to visit him and hear his diagnostic wisdom. In fact, there wasn’t another person I’d trust more in the diagnosis and treatment of systemic lupus erythematosus and other complex rheumatological conditions.

But Dr. Fine was no psychiatrist.

This was much to the detriment of his wife. Her story was quite straightforward but had quickly become unnecessarily complicated.

Mrs. Fine had a history of postpartum bipolar disorder dating back to the period after her second child was born. Her initial symptoms of depression had been essentially overlooked due to their unspoken mutual agreement to “pull it together.” The third child’s birth had been a bit more complex and the need for multiple weekly ultrasounds. This time Mrs. Fine’s mental illness took over earlier, even before delivery, and presented with a more severe set of symptoms, including manic and psychotic symptoms.

After the birth, Dr. Fine’s wife suffered tremendously for a solid six weeks until she returned to normal. It was only because he’d stayed home, bottle-fed the baby, and hired a full-time psychiatric nurse to be with his wife 24/7, that the family remained intact. No one on the outside knew too much about what was going on at home with Dr. and Mrs. Fine.

The situation stabilized and there weren’t any serious discussions about what to do in case Mrs. Fine had another episode. Dr. Fine, for his part, didn’t think she needed a psychiatrist because he “knew what to do” and was “happy to spend the extra time with the family if necessary.”

So they continued in a similar pattern during Mrs. Fine’s fourth pregnancy. In fact, she continued to appear stable even up until the week after Yitzi’s bris milah. And then things came crashing down.

Baby Yitzi was a bad sleeper and his need for midnight, 2 a.m., and 4 a.m. feedings soon ruined Mrs. Fine’s sleep to the point where she became progressively ill. Her circadian rhythms completely eroded, Mrs. Fine became floridly manic with concerns about how to “best feed the Mashiach!” Dr. Fine’s own powerful will to deny the severity of her symptoms started to unravel when she stopped sleeping altogether and threw out all of their dishes and silverware because “Melech HaMashiach can’t eat from treif kelim.”

Dr. Fine was finally forced to confront the obvious when a neighbor who worked at the Interior Ministry and doubled as a Hatzolah driver brought his wife home. Apparently she’d stormed into the Ministry building demanding they change her baby’s name to “Melech HaMashiach” and issue new passports so she could “take him all over the world to let everyone know.” The neighbor was able to calm her down and convince her to wait at home for the paperwork to process, but was very specific with Dr. Fine that his wife clearly needed medications, if not a hospitalization.

Dr. Fine sprang into action. He called up the visiting psychiatric nurse to come to the house again and ran to the local SuperPharm to fill prescriptions for benzodiazepines, sedatives, and other sleeping aids. “If I can only get her to sleep she’ll be cured and we can get back to normal,” he thought. But the nurse didn’t like what she saw and became worried for her own license. Mrs. Fine was too sick to play games with this time — she began breaking a hole in the ceiling to allow baby Yitzi’s “Mashiach light shine bright into the whole world.”

Dr. Fine was convinced he could still handle the situation on his own, but the nurse decided to leave the name of a psychiatrist behind in case he changed his mind — which he did when the neighbors called the police after a new set of “treif” silverware came flying out of the window later that afternoon.

Hearing him talk on the phone, it was clear that Dr. Fine was hopelessly outmatched by the situation. I offered to come to the house for a home visit, which Dr. Fine was more than happy to agree to. By the time I arrived at the house it was very likely that Mrs. Fine was going to need a psychiatric hospitalization for the safety of her family. The place looked like a warzone and at least three little voices could be heard crying in their rooms. Dr. Fine, who was holding baby Yitzi in his arms, looked like he was at his wit’s end.

“All she needs is a bit of sleep, but she doesn’t want to take the sedatives now. Too much work to do, you know. She’s got to clean up for Melech HaMashiach. He can’t have a messy room, you know.” He laughed nervously.

“Is your wife willing to talk to me, Dr. Fine?” I asked.

“Of course not. Really the issue is just that she needs some help with sleep, like I said. But I don’t really know that much psychiatry. I mean, I know a lot of psychiatry. I just need some advice.”

I wasn’t clear where he was going with this, but I didn’t like it. “Dr. Fine, your wife seems pretty sick. I’m happy to see her and to make recommendations for her treatment —and to let you know if I think she meets criteria for psychiatric hospitalization or not.”

“Chas v’shalom, Dr. Freedman!” he exclaimed. “I just need you to recommend a medication and I’ll give it to her. Zyprexa? Haldol? Risperidone? Which is best?”

I tried not to frown. “I can’t give you a medication without seeing your wife. It’s not a good idea, and it’s not sound medicine. You know that, Dr. Fine.”

“I know, I mean, what should I give her?”

“Didn’t you just tell me she’s not willing to take medications in any fashion?”

“Of course, she won’t take them. I’m going to hide them in her food.”

“That’s illegal, Dr. Fine. You know I can’t have a part in this,” I said flatly. My mind was in a whirl. Should I call the ambulance myself, tell him to do it, or try to see the poor woman in the other room who had begun screaming Tehillim at the top of her lungs?

Hashem took the decision out of my hands. The neighbor who volunteered for Hatzolah suddenly came upstairs and told Dr. Fine that he’d activated emergency services and his team was on the way. Dr. Fine tried to protest. Baby Yitzi, who was still in his father’s arms, began to cry as well. Luckily this neighbor was resolute. He told Dr. Fine that he’d also called the police to ensure that Mrs. Fine would get to the hospital. It was the right decision and the place where she’d get the help she needed, whether or not Dr. Fine agreed.

Originally featured in Mishpacha, Issue 727. Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman can be found learning Torah in The Old City or hiking the hills outside of Jerusalem.  Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.