crazy versus stupid, and how to tell the difference

I had a post-surgical appointment with my orthopedist on Tuesday afternoon, followed by an appointment with the dean who oversees the students in my cohort. my surgical wound looks as it should look, and the swelling seems to be on the decline. I will be allowed to work mornings for the reminder of this week. When I get my permanent cast (meaning the hard fiberglass cast I'll have until my leg heals, not meaning I'll have it for the rest of my life), which I hope will happen on Friday, I will be allowed to work more hours per day. Because I have a knee injury on the leg that doesn't have broken bones attached to it, and because the knee will not heal if I don't spend more time off it than on it, I will be limited to eight-hour workdays for at least the reminder of this month. 


As I waited for my friend to drive me home following my appointment with the dean, a third-year medical student consulted with my friend who was transporting me. The subject of their consultation was a patient the two of them had seen earlier in the day in their emergency medicine rotation. The patient had been given instructions on how to care for a wound at home. The third-year student expressed concern that the patient may lack the competence to follow the discharge instructions. My friend, a fourth-year medical school student, was less concerned. My friend explained to the third-year student that while the patient seemed a bit nutty, she clearly was not stupid.

"Stupid, crazy . . . What's the difference?" the third-year student said, throwing up his hands. 

There is actually a rather large difference. I told the third-year student the story that I've told here one before. I copied it from another person's blog tonight because I'm too lazy either to find my own version in my blog or to re-type it from scratch. Here it is.

A truck driver was doing his usual delivery to the Mental Hospital. He discovered a flat tire when he was about to leave. He jacked up the truck and took the flat tire off. When he was about to replace the flat tire with the spare tire, he accidentally dropped all the nuts into a storm drain. Realizing he can't fish the nuts out, he starts to panic.

A patient walking by asks him what happened. The driver told him his problem.

And the patient said, "Here's what you can do: take one nut each from the other 3 tires and then tighten them onto the spare. Then replace the missing ones as soon as is practical. It's as easy as that!"

The driver was very impressed and asked: "You're so smart . Why are you here in a Mental Hospital?"

Patient replied:  "Hello, I am here because I'm CRAZY, not STUPID!!"

Source: cook'n & eat'n http://www.dvo.com/newsletter/weekly/2016/2-19-957/jest1.html

My friend asked which is worse: stupidity or insanity. The answer would depend on the situation, the degree of either stupidity or insanity present, and the particular form of insanity.  If a person suffer from a form of mental illness that causes him or her to  hear voices that tell him to harm himself or others, that's probably the worst-case scenario, and in that case, insanity is probably worse than any form of stupidity could ever be. If, on the other hand, a person merely operates under the assumption that he or she is Emperor Hirohito, his or her insanity is probably less an impediment to following discharge instructions than stupidity would be.

I've seen some crackerjack cases of stupidity when it came to complying with medical instructions or even with living in general.  One patient was putting her inhaler up to her nose when using it. She thought all of the inhalers were defective, as she continued to wheeze after using them. Another was taking rectal suppositories orally.  Another patient had her boyfriend take her birth control pills because they caused her to gain weight. Perhaps they did cause her to gain weight, but not even close to as much weight as the resulting pregnancy caused her to gain. One guy used his ringworm medicine for hemorrhoids. The medications for both hemorrhoids and ringworm should be the same thing because both hemorrhoids and ringworms are basically round. (?!?!?!?!) An overweight patient who was consuming the nutritional shakes in addition to meals (and dessert) instead of in place of them. She thought the shakes contained an ingredient that would magically cause her to lose weight. In each case the instructions were stated explicitly.

Whatever anyone does to himself or herself because of stupidity is at least fair. What's unfair is when a child suffers because a parent is too stupid to comply with medical instructions.  We had a parent who put her child's ear drops in his mouth. Another patient didn't fill the prescription for topical ointment for her kid's yeast diaper rash and instead used leftover medication from her own yeast infection. (A topical medication that is to be used for an external infection would have to be much stronger than would one for an internal infection. I wouldn't necessarily expect the woman to know this, but I would expect her to at least ask before using the wrong medication on her baby.) Another parent for some reason thought all of her children were protected from chickenpox if just one of them was immunized. (I can't understand how she even came up with that.) A child with a known peanut allergy was brought to the E.R. for anaphylaxis from eating peanuts M & M's. The parents thought the peanuts in peanut M & Ms were fake peanuts.  A six-month-old baby came for a well child exam with Dr. pepper in his bottle. We knew it was Dr. Pepper because the mother admitted it. The doctor was far more patient than I would have been in thoroughly detailing all the reasons why babies should not have Dr. Pepper or other soft drinks. The child came to the office about three weeks later for an ear infection. The mother proudly showed us her baby's bottle and told us that she was following the doctor's orders. Instead of Dr. Pepper, his bottle was full of Mr. Pibb. The doctor actually walked over to the wall and banged his head against it.

Unless a parent is so far gone that voices in his or her head are telling the parent to drown a child in a bathtub or elsewhere, stupid is usually far more dangerous to a child than is crazy.