I’m a psychiatrist. Two patients described the same street corner.

I’m posting this here because it gets removed everywhere else, even though I’ve removed identifying details. Since I’m changing names, call me Dr B. All you really need to know about me is that I’ve been practicing inpatient psychiatry for ten years.

Last week, I admitted a patient in his mid-20s, Patient 1, with no prior psychiatric history. He was fidgety. But trying his best not to be. He’s a high school dropout living at home with his mother, and working in retail.

When I asked what brought him in, he said, “It’s not a voice. It’s there! It waits for me around the corner.”

Thinking he meant corners of the room, I asked, “Which corner?”

“No. I’m safe here. It’s downtown on the corner of Harden and Jasper.“

I wrote it down without thinking much of it. By the time we finished talking, I was convinced this was a routine psychotic presentation. He stayed voluntarily.

After we spoke, I looked it up, and there’s just a coffee shop there.

Collateral from his mother was helpful. According to her he had experienced months of social withdrawal and isolation, then suddenly that morning, he announced he was going downtown as if nothing was wrong. No substance use history. No prior medical history.

Now, yesterday, I admitted another patient. Patient 1 was well out of my mind. I had discharged him a few days ago, back to mom.

Patient 2 was also mid-20s. She walked into the room as if she were being jerked or fighting with some invisible rope. Her fists were clenched and writhing like she was trying to crush a tin can into a ball. It was hard to watch. She sat down, stared at me with calm eyes, and before I could start the interview, she said, “You’re going to think this is schizophrenia. It’s not.”

I’ve heard this before, and when they say this, it’s usually schizophrenia. When it’s not, it’s another diagnosis.

I nodded.

“I don’t hear voices.  No one tells me to do anything, but I know someone is watching,“ she paused, her voice became shaky and anxious now, “me from the corner, so I’ve been avoiding it.”

“Corner of the room?”

“No, I think I’m safe here, but it’s at the corner of Harden and Jasper.”

Now, psychosis has patterns. People give vague fear a source. God. The government. Organized crime. Something powerful and external. It’s rarely original or this specific.

But, these two patients described the same location on different days. That alone isn’t impossible, but they have no known connections. She was from out of state attending the university across town.

One explanation would be shared psychosis or ‘Folie à deux’ as I learned it in school.  Except for that to work, they have to know each other. I’m still trying to figure out how they do.

She seems to be better this morning. None of the gait or hand-wringing. She even gave me permission to call her roommate for collateral history.

I apparently have a drug rep dinner downtown in a couple days, a couple of blocks from that intersection. I know I shouldn’t indulge delusional material. I know better. But I’ll let everyone know what I find.

I checked my reservation email twice this morning to make sure it was still there. I don’t remember signing up for the dinner. And the invite link email and reservation confirmation were received at 2:13pm. At that time I was in a family therapy meeting for a patient with first break psychosis.

If anyone has any suggestions, I would greatly appreciate it. I have to get back to charting.