Monday, August 31, 2009
Friday, August 28, 2009
I am a "green" R.N and just pulled a 36 hour shift in a very understaffed hospital. I was tired, emotionally spent and considering my career choice. After reading your blog and seeing the way you use humor to deal with the day to day happenings it rekindled my faith and reminded me that I wasn't alone. Thank you.
Wednesday, August 26, 2009
Here is a direct copy of a chart I saw when looking up a patient's past history:
Patient presents with
- "My Cat's Burning"
HPI: Patient very difficult to interview and giving strange inappropriate responses to questions. Shouts, "AIDS!" long pause "Gonorrhea!" long pause "you want to see my penis?" long pause "My cat's burning and I need someone to look up under me." Finally interpreted to mean that she has burning when urinating for several days. Also complaining of vaginal pain and burning. Unsure if she's had any discharge. No abdominal pain, nausea, or vomiting.
-You can't make this stuff up!
Friday, August 21, 2009
I was at the mechanic the other day. I knew I needed some work done on my brakes, and I was getting a quote. Meanwhile, I made small talk with the brake guy while he was telling me all that I needed. Of course, I felt like he was trying to sell me more than I needed. I went with the minimum service. He said something like, "I bet that your psychiatry training helps you out with negotiations like this," implying that somehow I knew that he was trying to scam me. I did, but it had nothing to do with my psych training.
Another example is when someone recently mentioned that a way to keep guns out of the hands of suicidal/homocidal people is to make them undergo a psychiatric evaluation. Of course there would be a lot of logistic concerns (which psychiatrists would do it, who would pay, etc.) But what I want to make clear is that Psychiatrists can NOT read minds. I can only help you if you want help. If you are lying to me, maybe I can figure it out, but I probably can't. Sure, I may be able to tell if you're depressed or hearing voices. I can obviously tell if you're manic. But I can't tell if you're going to kill unless:
1. You tell me you're going to or
2. Your family/friends/police heard you make those statements or
3. Other aspects of your personal history (which you can lie about anyway) send up a red flag.
The third aspect of all this is what really hits home. I recently found out that the father of one of my daughter's classmates died. It made me confront my own mortality; I had seen him a few days before. He was fairly young and appeared happy and healthy. He did NOT look depressed. I figured he had a heart attack or car accident. Then I checked the medical examiner's website. He committed suicide. This was a person who on the surface had a loving family, a successful career, wealth, you name it. These are all protective factors for suicide that almost none of the patients that I treat at a county hospital possess. Who knows what his own personal demons were. But the point is: I'm sure nobody saw this coming.
I can't stop thinking about the hole that he left for his wife, kids, and friends. My initial sympathy turned to anger due to the selfishness of this action. That night, I told my family I loved all of them and promised to never do such a thing. It has been haunting me for a week now. Even though I didn't really know him, it touched me deeply. I am a mental health professional. I am supposed to help people like him.
Please, if you are having thoughts of suicide, or know someone who may be, please get them the help they need.
Sometimes they don't seek help on their own.
And don't expect a random psychiatrist walking down the street to read their mind.
Anyone can fake it.
Anyone can lie.
And I wouldn't know.
Thursday, August 20, 2009
Monday, August 17, 2009
Sunday, August 16, 2009
After we stablized him, three sets of parents arrived and were put into the family waiting room. I called the chaplain because none of the parents knew about the fatalities. We had no way to identify our patient besides his personal belongings. Our patient, the last alive and barely holding on, had a unique belt on.
I went into the family room to talk to the parents. I said "I am sorry to break the bad news but we had two deaths at the scene. The one survivor is here and is in very critical condition."
All I could hear was screaming and sadness. One family member asked, "Who is the young man alive?" I said, "Sir, we have no way to identify him except that he has a unique belt on." Then one hopeful set of parents started crying and said "Does it have a nickname and silver trim?" I said, "Yes." The parents then shouted "That's out son!"
The other parents were crying in agony. It was probably the worst night of my medical career. Trying to maintain composureI said, "You can come back to see him in 5 minutes, but he is in critical conditon with a serious brain injury."
The parents soon came back and identified him. Unfortunately the CT Scan illustrated irreversible brain injury with a cervical spine fracture. Again, I had to break the sad news to the family.
With more strength and courage than I could ever imagine, the mother said "I want to donate his organs so someone else can live. He wouldn't want to live like this." I was shocked b/c so far in my career, I've seen most make end of life decisions that maintain someone on a ventilator, prolonging the inevitable. I made the call to the transplant center and he became an organ donor. I left the hospital that day with a wall around my heart to seperate my emotions from reality.
I eventually forgot about Alpha until I received a letter in the mail one day from the transplant center. It said the following: "Dear Dr. Sensitive, Although Alpha died on June 1, 2008, we were able to harvest his liver, eyes, kidneys, & tendons. Because of your referral, 12 people were either saved or helped by Alpha's tissues. We are extremely grateful, and on behalf of our patients we thank you."
My wall came down and my emotions came back. Thus far I dealt with that night by building a wall, but now Alpha was a real person to me. I went home that night and googled his name. I found out that he was 2 minutes from his house, his girlfriend was following behind him, and she saw the entire accident. I discovered that he had a My Space Page and looked through it. It was strange to see him as a person, and I was saddened that his life was cut so short. However, through his death and his courageous mother, he saved the lives of 12 others.
Friday, August 14, 2009
Monday, August 10, 2009
Wednesday, August 5, 2009
We all scratched our heads because this young man looked healthy, clean cut, and didn't appear to be an IV drug user. We went to the family waiting room and broke the bad news. It was tragic to all, including the nurses and doctors because its always hard to have a young person die.
Later in the evening, the hospital chaplin spoke with the girlfriend regarding their last moments. The girlfriend stated : "He had been looking at girls all night long and pissing me off. When we went to leave the bar he did it again, and I punched him in the chest and he took two steps and fell over."
When I heard the story I was shocked because I didn't believe someone could die from one punch! After some research, however, the condition is called "commotio cordis," results in V-tach, and can cause immediate death. Everyone should think twice before checking out girls in a bar!!!!
Monday, August 3, 2009
Like a good little intern, I had already reviewed his med list. This seemed easy enough. "Sir, you're already prescribed Nexium. That should take care of everything."
"But I really think I need Mylanta," he said.
"Okay, if you really want it, I can't stop you. If your reflux acts up, feel free to buy some over the counter," I replied.
"But Doc, you don't understand. I have a new lady friend who's 20 years younger than me. I don't have the ability to give it to her as much as she wants."
"Oh, you must mean Viagra."
- Psych Doc
Sunday, August 2, 2009