but I am posting it on Tuesday...like everything else in my life, I am a procrastinator...
So Monday, I come in earlier than the residents to make sure I grab all the patients' vitals and medication list. I felt a bit nervous again going back to the hospital because I was afraid that I forgotten everything over the weekend. It was pretty quiet when I first arrived on floor A. Only a couple of patients were meandering around, but in general, really quiet. (Patients are allowed to just walk around outside their rooms. None of the patients have any serious medical condition. They are at this facility only for treatment of their psychiatric condition.) I went over to floor B to grab more patient info, then I came back to floor A to get the rest of the info. And oh my goodness...
I felt swarmed by the psych patients. They all just came back from breakfast, and suddenly I felt like I was in the midst of 15 patients as I was trying to get back to the nurse's desk. I swear all around me patients were saying hi, others were waving, one said I was pretty in a slightly flattering yet creepy way, one I had just found out had scabies the last time he was there (gosh...it still makes me feel itchy all over...)
Anyways, I managed to sneak out of there and to the safety of the residents' room. When my resident and I went back on to the patient floors, the chaos just seemed to grow. A former severely psychotic patient ("Diane") had returned to floor A (the lower functioning floor). She used to be the patient of my resident, but this time she is assigned to another attending. Anyways, apparently last time, she kept filing complaints that the staff was raping her. Of course, these complaints are taken seriously as it's part of the patient's rights. So her claims were then followed up by the judge, she got sent to the ER for a rape kit, etc. etc. It turns out the "reasoning" behind her claims are that "her crotch is torn." Which in fact they were...her pants' crotch. Of course that was only happening because of her weight gain from her lithium.
Anyways, another delusion that Diane had was that she was a psychiatrist. She said that she had so many certificates, "like 20+," for psychiatry. She said that she was the one teaching the residents and students, but wasn't getting paid for it. Ironically, there is some truth to that. She is truly the person who is teaching us, but those "certificates of psychiatry" that she claims are actually "certificates" needed to commit her to inpatient psych treatment.
Now, she is back on the floor, saying she is not crazy like the other patients here. But to get a picture of how poor her insight is on her illness, she is a woman who has the strings of her scrub pants tied up and around her neck, kinda like suspenders, and then a towel wrapped around her head (not dissimilar to my hair drying ways...)
Anyways, Diane's presence stressed some of the patients on the floor. One of our lowest functioning patient ("Tammy") was extremely distraught by her. To describe Tammy's appearance, she is an obese woman in her 30s? that suffers from Trichotillosis (which is pulling out your hair from its roots). She thus has several bald spots, with patchy gray hair growing between. She has a constant tremor due to her antipsychotic medication (EPS), and talks very simply.
I do not know how the events unfolded or if there were any events that actually led up to this, but Tammy started crying/howling/yelling from her room (it's a sound that makes you want to run to help, but it happens so often that it has the "boy who cried wolf" quality). She banged her head so hard against the wall that her blood stained the wall. Tammy has a history of self-harm, she a pretty severe gash down her forward that was healing pretty well until this event occured. I am not exactly sure of her diagnosis or her history as she is not my patient. But this is the kind of craziness that was happening on Monday.
The craziness wasn't just on floor A, but also on floor B (the higher functioning). To get a sense, I will share some tidbits, which are hopefully more amusing and less depressing than Tammy's scenario. In fact, the next two patients that I describe should have been admitted to floor A instead of floor B because of their lower functioning ability. Their presence definitely had a chaotic effect on the usually much tamer floor B.
One is a 19 year old girl who has severe delusions. She believes that she is carrying a "child of God," in fact, this is her 2nd "Child of God." She already delivered one who knows when. And I think over the weekend she tried to give birth to this child... Of course she is not pregnant (her pregnancy test is negative), and she is definitely not carrying a Child of God (or maybe it's just my non-faith that doesn't allow me to accept such ideas. of course I do not tell many of my overly religious patients that I don't believe in God...) She is clasically delusional -- having a fixed, false belief despite contrary evidence. Having a conversation (or even listening to a conversation of hers) is excessively frustrating. I do not know how the attending has that much patience for her.
The other man looks like a sweet old 70+ year old man, with a toothy/gappy smile and speaks in jibberish. He tries to shake hands with everyone. I don't know why I shook his hand, since he looked grimy...and man, how much I wish I hadn't because it felt just as bad as it looked. Then he reached for hair and started petting some of it....yuck..ugh...ick...nasty nasty, creepy creepy. I immediately take a step back away from him. He still has that sweet old man smile and keeps yacking away in his jibberish...but so much more disgusting now.
I got the dish about him after the encounter (I wish I had heard it earlier...) I would have known his hand shaking ways, and how he likes to touch girls' hair. Over the weekend, he apparently went into female patient's room and stole her hot pink hoody and started wearing it around with the hoody only coming down half way across his belly....I don't know if I really want to know more creepy stories about him...
Anyways, the best way to describe how Monday was like, is as my resident eloquently said "it's like the shit hit the fan over the weekend, and we're hear to clean up the mess."
Oh as for our Jane Doe, I never got to see her talk on Friday. Sadly, I had to leave too early before the change occurred. Apparently, she was pretty chatty that afternoon. But when I saw her Monday, my gosh she looked even worse. She stopped talking, she wouldn't even respond by nodding or shaking her head. She was even refusing food and water since Sunday. She was in really bad shape. Her pulse was very weak and bp low. Luckily, this morning (Tuesday) one of the nurses was able to encourage her to eat all her grits and got her to take her meds. I think Jane has a crush on him... Anyways, she was verbal today, but her responses were still terse and she still refuses to answer some questions. We do know her name now (one of the other nurses had seen her before), but she refuses to tell us her birthday or any other demographic info. She still has this smile on her face...but the smirk is much more mischievous and less endearing. I'll let you know if there are anymore breakthroughs...
Other Non-Hospital "News":
1) I made a twitter...who knows why I gave in
and for other tv addicts out there...to find out what shows are renewed/cancelled, you can go here: http://ausiellofiles.ew.com/2009/04/fall-tv-cheat-s.html
3) other TV news...Shawn Johnson won DWTS! which is who I wanted, but Gilles is def. smoldering on the dance floor (I don't even watch DWTS...but because I have no other season finales to watch, I'll find whatever else is on. Oh...if you want to watch the happiest/non-cliff-hanging season, not series, finale...watch One Tree Hill. Gosh...that show made every dream come true. and I still think Chad Michael Murray is really good looking...he's even cuter as a father)
4) I went back to visit my high school, since I found out that several of my fave teachers were retiring (or one of those incentive packages that the state is offering). Yes, I was and still am a nerd. My goodness do I feel old, and wearing professional clothing made the dif even more obvious.
5) I ate at a really good diner called "The Fly Trap." It's like my favorite type of American food. The best way to describe it is through its motto, "it's a finer diner." The ingredients are all just high quality. They have two excellent homemade hot sauces, and their homemade jam changes every day, today it was a nice citrus-y, tangy raspberry jam. I need to find more excuses to go to Ferndale...
Hopefully the entry made sense...I didn't even have the patience to re-read it. So congrats on making it to the bottom. I shouldn't have stayed up this late...considering I'm on short call tomorrow and the day after in the ER, so two 9-11 pm kind of days for me. Gosh...time management has never been my forte.
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