Flash Friday #2: Medical records

There is a line on my medical record that reads “emotionally labile x2”. I’m seeing the line for the first time as I scan the record now. 

It pulses off the page: Emotionally labile. 

Because I read a lot of records these days, I should clarify that this is from my recent intake with the speech therapist named Maria. Who has a young son. Who appears to be a fan of cats. Who works in a disorganized, windowless office in a building labeled “stroke center” in large black letters. I used to bike past it on my way to overpriced workout classes, singing The Chicks to myself. 

I’m scanning the record and searching for objective measures of my cognitive performance. 

More lines pulse off the page. Speech/language evaluation: mild-moderate deficits. Cognitive/linguistic evaluation: ditto. With respect to my answers (read: errors) reciting a list of numbers, “expect this is inline with patients baseline.” I used to test my memory for fun, splayed out in a set of pajamas, trying the theories from Moonwalking With Einstein, learning Turkish, Arabic.

I should clarify that I’m searching for an objective measure because many days I spin inside myself, unsure which symptoms are real. My fourth grade teacher, Ms. Sailor, told us the story of a two-masted sailboat called Albatross. On the Albatross’ journey home from the Galapagos, she was hit by a white squall, an unpredictable and violent windstorm. She stood no chance. When the squall hit, the Albatross capsized suddenly, sank instantly. According to Ms. Sailor*, whose brother was on the ship, members of the crew thrown underwater were so disoriented that they didn’t know which way was up. They had to follow the air bubbles to the surface. Some were lost, entangled in the ship’s lines. Sitting in my fourth grade classroom, I didn’t get it. How could they possibly not know which way was up? 

It’s an “objective measure” that catches me. I’m repeating it over and over, googling again and again. Bringing it up on the way to dinner. To my dad on the phone.

Here’s what I’ve learned. Emotional lability “refers to rapid, often exaggerated changes in mood, where strong emotions or feelings occur. These very strong emotions are sometimes expressed in a way that is greater than the person’s emotions.” Emotional lability is often characterized by “uncontrollable laughing or crying, often at inappropriate times…[these outbursts] can also be completely unrelated to the patient's current emotional state.” 

And here’s what I know. Throughout the 50 minute intake I was, in fact, low energy and in generally low spirits. During my senior year of high school I was voted “most cheerful,” along with a boy named Billy Love**. In the yearbook photo, Billy held me in his arms and our smiles were bested only by my blindingly bright green sneakers. Back at the intake, exercises included the reciting of numbers in sets of 4/5/6/7, the drawing of pictures from memory with a dull Ticonderoga pencil, the answering of yes or no questions after listening to a story about dragons. It was draining. There were cheery “good jobs” when I got five simple math problems correct. It was painful. I was in low spirits, and drained, and pained, but fine enough and all reasonably so. 

I’m re-scanning the record and growing beyond angry. 

Because I never once reviewed my medical records before this year, I should clarify that I care because this line will be gold for the insurance company. And because of the whole “hysteria” thing in medicine that I’ve only recently become aware of. 

I see a line on the record that says, “the patient is a good candidate for speech therapy given stimulability and motivation to improve skills.” I wonder if I portrayed my unrelenting hunger for improvement, for treatment, for something to do fully, desperately enough. I remember when Maria exclaimed how good for me this would be, how she looked forward to seeing me for twice weekly appointments as soon as October. Only three months from today, and only six from the referral, and only a year since the onset. 

Another thing I know. The tears came precisely at that moment. Followed by a plea: “isn’t there anything sooner?” (yes). A meager stream of biological response. Not a tidal way. Not a downpour. Not a new character in the windowless room. A few droplets, a lazy metronome. Despite my mild-moderate deficits in short term memory, I know this telling to be true.

Because I lose focus easily these days: back to the record and the line and the definitions and the promise of objectivity. Were the patient’s tears uncontrollable? Did their mood rapidly change? Were these emotions expressed in a way that was greater than their own emotions? Are patients in this building usually delighted to be there? And if so, wouldn’t it have been polite for Maria to ask, simply, “what’s wrong?”

I’m thinking that Maria may be overworked, possibly drained, and likely trained to look for diagnoses. But in this record, she is also probably, professionally, carelessly, losing the forest for the trees. 

And me? I’m losing the forest for the white squall that barreled through, unexpectedly knocking the trees onto my path. And I’m pouring over these records, hoping they’ll show me the way out.

*A reminder to add Ms. Sailor to my growing list of perfect names for (im)perfect people (see Anthony Weiner).

**Billy Love as well.

Writing was my anchor during long covid. I’m grateful this period is behind me but I don’t want to forget it. Thanks for going on a bit of the journey with me. Xoxo.