Friday, July 10, 2009

Clinic Fun

Okay, I know I've been slacking off lately. Maybe it's because I'm in clinic now, so there's not quite as many crazy ER stories. In clinic, the craziness and irrationality is still present, but on a smaller scale. Just thought I would provide some anecdotes from one week of working in an outpatient psych clinic for the county.

One day a week is child/adolescent clinic. Every other patient is a photocopy of this one. 7-10 year old boy comes in with mom. Mom complains that kid is acting up in school, getting into fights, suspended, etc. At home, he throws telephones and potted plants while calling mom the "C"- word. Dad has been in prison all the kids life. Mom never re-married but has had some boyfriends. Mom wants to throw some mind - altering drugs down the kid's throat and hope everything gets better.

Last week, I'm seeing a followup. 50-ish white female with anxiety after a near fatal car wreck that put her in a coma for a few weeks. She had on a T-shirt that said "pimpjuice" and that's all I could think of during the entire visit. I didn't know until today when I was looking for a graphic that it is an energy drink, a Nelly song, etc. If you have anxiety/depression and you think your life sucks, then take life seriously and throw away the dumb t-shirts. Just my opinion.

Yesterday, I was reading through a lady's new-patient questionnaire. She mentioned that she had trouble controlling her "dietbetes". I asked her what that meant and she said, "It's because of the insulin. If I don't eat, I feel bad. So I have to eat more than I should so the insulin doesn't make me crash. I've gained 50 pounds since I got diabetes." I guess she never thought of just taking less insulin. Or she has a crappy doctor (in addition to me).

Also yesterday, a 400+ pound guy comes in for a pain management referral. Basically the pain management docs want a psychiatrist's "street smart" opinion as to whether the person might have potential for narcotic abuse or addiction. On this guy's self-reported review of systems, he wrote down "can't masturbate". I understand that this is a quality of life issue but I asked what that has to do with chronic pain and he said, "Oh nothing to do with pain, I just can't reach down there anymore. Also, I can't wipe my own ass." The guy lives with his 80 year old mother and no one else. I did not ask him who actually does the wiping.

-Psych Doc


Andrea said...

Sounds like he needs a Bottom Buddy:

Anonymous said...

And now I am feeling like a paragon of sanity.


C. said...

Perhaps instead of narcs he could use a diet.

Anonymous said...

Is there a pill or potion, magic spell or seminar that could possibly keep idiots from breeding? I am so sick and tired of helpless children being thrown into hell-holes of "homes" because Momma got druck and f***'ed some dood who looked hot in his tight tee-shirt. These kids are practically feral, and we wonder why they have problems???? And in five to seven years these boys will go impregnate someone themselves before they go to prison. What a waste of human life and potential. Maybe state-run orphanages could do better...they'd be had pressed to do much worse than some of these "families".

Pattie, RM

Nick Dupree said...

What'd you do for kids who throw telephones and potted plants?

Did you clear the obese guy for narcs? I bet 400 lbs is excruciating on the joints, but narcs could stimulate the appetite EVEN MORE!


Mark p.s./Mark p.s.2 said...

Not being able to wipe yourself must be a built in failsafe- divine warning one is too fat, no? (joke)
He/she 400 pounder must be trapped in a life where [eating] is all they know how to live, so it is all they can do. Same as an alcoholic or compulsive gambler.

The answer: 1)person has to see/perceive the problem and want to change.
It is easy to lose hope during the change of behaviour.
2)Then they need a virtual parent to encourage and guide them back to "normal".
Try finding a parent for a grown up adult.