crazy crazy Monday...

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

2) Chuck is RENEWED! http://ausiellofiles.ew.com/2009/05/its-official-nb.html

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.

maybe psych really is medicine...

I've never really been interested in psych or the brain for that matter...I find the subject matter a bit too amorphous with too many unknowns.  I always felt like it was a field of long drawn-out sessions in the outpatient setting, where people just need someone to listen to them because they don't have supportive friends (ok...that's an exaggeration, I don't really believe that.)  And in the inpatient setting, it just seems like doctors are just loading them up with haldol and tons of other sedating drugs so that they won't cause trouble.  But today, I feel like we really did help out the patients, and maybe there is some science behind all these Axis I disorders.

Today, I (or more like my resident and attending) discharged a patient with depression and anxiety.  I've been interviewing her for the past few days, and honestly she's a pretty easy patient to talk to.  She voluntarily committed herself to the psych ward because her anxiety was incapacitating her.  Honestly, she sounds like a pretty normal person with normal concerns, like trying to get back together with her boyfriend, what other people think of her, her weight,her boss, etc...things that we've all dealt with, except just to an obsessive degree.  Sometimes I just really wanted to say "stop being so dependent on others, be responsible, take care of yourself and child, and stop obsessing over things".  Of course, I can't really say such things...nor did I really want to give her advice that may actually be counterproductive in an unstable patient.  

Anyways, we changed her medication--we added klonopin (clonazepam, a benzo) and trazadone and omg, what a change just overnight.  She wasn't anxious anymore, kind of excited about going home (when yesterday she kept say she is def. not ready to go home).  She was like a totally different person.  She still had her concerns, but she was no longer obsessed about them.  She made a list of goals, about eating less, working out, doing laundry, helping around the house...(gosh...her list sounds vaguely familiar)... Anyways, it was pretty rewarding when she left saying "thank you" (I know cliche...but v. true)

The guy who talked me to death yesterday is getting discharged tomorrow.  And gosh, he was so much better today too, you can tell within the first minute of talking.  He didn't give me a headache today!  I actually told my resident pretty colloquially (I really should start practicing the art of presenting patient's histories) that "the patient is doing much better today.  He didn't annoy me today."  Hahaha...she started laughing at me saying..."we actually try to refrain from that term."  Oops.

Oh...and more laughing at me (of course in good fun, at least I hope). At the end of the day (actually 5 pm, and my resident was anxious to get out), I had to find this new patient, a Jane Doe.  So I quickly scan the floor, and I'm pretty sure I found her, but of course the patient doesn't talk.  I look at her wristband and saw no name, so assumed it was her...brought her to the nurse's desk, apparently looking confused and saying "I think I found her..."  Apparently it was very amusing to the residents.

Anyways, my resident was very happy that our last admit of the day was a 5 min interview.  Jane actually had a really pleasant demeanor.  She wore this sweet soft smile on her face, and just politely nodded and shook her head at questions.  She could only whisper one word answers, like "fine."  My resident asked her the question, "do you have racing thoughts?"  And Jane nodded yes.  Then my resident said we have drugs that will help you.  Anyways, it was a very short interview...we had no history, name, meds, etc.  But my resident assured me that risperdal or any antipsychotic will quiet her thoughts down.  She told me that this was a classic example of extreme psychosis.  A psychosis so severe and overwhelming that the patient has way too many thoughts that she can't even verbalize her thoughts and answer questions.  Apparently, after the drugs, our Jane Doe will be Ms. Chatty-Mc-Chatterson.  I really hope I'll be able to see this dramatic transformation... I'll only be at the hospital for 2 hours before heading for 5 hours of lecture...hoorah!

Gosh...I didn't mean to ramble this much.  Now no one will read it, if they have my kind of attention span.  But other non-hospital highlights:

-eating tasty Thai food with other med students...playing pseudo-hooky after morning lectures, going to the hospital a bit later in the afternoon (I think I always mention food in these posts...)

-watching Rachel Getting Married (only half way through)...I feel like I can't escape psychiatry

-getting my pants tailored

....what an exciting life I live!

less lovin' and more yellin'

So no patients saying "I love you" to me today.  In fact, lots of scary yelling coming from the "scary" ward.  I heard lots of door slammings by patients, screaming in various rooms as I walked by, and a whispered "hi" from a Hagrid-sized guy who uses his size to intimidate ppl.  Yea...I'm making it sound scarier than it is... 

I didn't see my favorite Hispanic manic today.  I forgot to tell you that she loves to swear at people in Spanish while wearing a smile and sucks her thumb at the end of her statements like a punctuation mark before walking away.  But I did see my other fave patient with the pink beret, except she somehow lost it and stuck a black comb in her fro.  I am sure I am meeting some of the most unique people I'll ever see in my clincal years and beyond.

Today I lasted through my first whole shift: a staggering 8:30-5 pm.  I am still feeling completely lost.  But I am glad I am starting on psych because...

1) Staff, residents, and attending are extremely nice and understanding and helpful and everything you could wish for on a first rotation (including more free deserts, this time chocolate cake)

2) I can make an utter fool of myself when I interview patients because for the most part the people who are on the "higher functioning" ward (e.g. bipolar, mood disorders NOS) just want someone that will listen to them (I actually got a headache from listening to one of them); and the "lower functioning" pts. (e.g. the schizophrenics) make no sense whatsoever that I really could say anything to them.  (I have yet to do a one-on-one interview with the scarier folk...I won't lie, it's kinda scary to be with them one-on-one.  I feel like their mood can change on a whim.)

Best thing I saw on the wards today:

Antisocial patient's (a person who defies rules and laws, not a person who is "anti-social") chief complaint - "I want conjugal visits with dim lighting and candles at least once every other day."

On my very non-productive home time:

I should have not signed on to my computer immediately when I got home, so I could have prolonged my ignorant bliss of not finding out my board scores.  Ugh...I was much happier not knowing than knowing.  I guess scores can always be worse and I never felt like standardized tests were my strong point (though I don't think my clinical grades will be any better...)

So as always, I turned to food and tv for happiness :D (gosh I love living at home home).  I watched the season finales of House, an episode of Cupid (yes I watch everything on ABC) and series finale of Scrubs.  Is it sad...that I draw parallels to my "friends" on tv?  Anyways, I came to the cliched conclusion that my scores really don't matter that much, and it's really all about love...(and yes I am sucker for the chessy messages on tv.)

Sorry for the disjointedness...maybe it's a pathological thought process - flight of ideas or something.  I really do need to read or study, but I really don't know how to...any pointers? (besides not wasting time on tv, blogging, and reading Red Sox news...)

first real day - say hello to the crazies

after a full day of psych orientation and 2.5 hours of driving on monday...i arrived on the inpatient psych ward at a pleasant 9:30 am and learned that:

1) patients apparently love me...i've already gotten two "i love you." granted one was a hispanic manic (like the rhyme?), with heavy makeup and a winter jacket from the 80s and insisted that I looked like her sister (maybe I got too much of a tan...); the other was a schizophrenic who had a fro with a pink beret and toilet paper stuffed in her ears

2) the sound of "dr. chi" is pretty pleasant, yet so far away and def. frightening to have that responsibility.  i also love that my first "dr. chi" in the hospital came from my attending

3) free banana splits are tasty

and beyond:

3) my sports med doc told me that my MRI showed a strained PCL and thinks that physical therapy would be good.  lucky for me, i have such a flexible schedule (sarcasm...psych isn't THAT easy)

4) i watch WAY too much tv at home, but it feels so good...