Tuesday, December 29, 2009

A day in the life...

I will admit that sometimes I forget about this blog. Maybe it's because I think I have nothing to share. Thank goodness ER doc keeps updating this thing. I've had a pretty good couple of days to report, so here is a report from one day at the county clinic.

1. Overheard this discussion betweeen a new patient and the nurse (I didn't see this patient, the other resident did).

Patient: "My mom kicked me out. I am staying at Motel 6. I spent Christmas at ***** hotel - it's for dealers and whores!"

Nurse: "Why did she kick you out?"

Patient: "She says I've been neglecting my son. How can I neglect him if I'm not even there?"

2. New patient presents with anxiety. No psych treatment history. Anxiety problem started a couple of weeks ago. The only situation that makes him anxious? Urinating into a cup in front of his probation officer.

I'm sure it had nothing to do with having a possibly dirty UA. Especially after you've already been in prison. You should be pretty used to performing bodily functions in front of peers.

3. New patient, 20 year old kid. Chief complaint "I think I'm addicted to Adderall."
Me: "What can we do to help you?"
"I need a prescription for Adderall."
Right away, I have decided I won't be prescribing any schedule IIs to this dude. I went through the interview, and he just kept on giving me reasons not to. Uses ecstasy, meth, LSD, cannabis on a regular basis. Has purchased Rx stimulants from friends and off the street. No job. Dropped out in 9th greade. His goals are: 1) Record some of my music 2) videotape myself skateboarding, burn it onto DVDs, and sell them on the internet. Arrested x1 for possession of weed. Denies any history of violence/suicidality.

I let him go on and on, way longer than scheduled 30 minutes because I was documenting like crazy. He had some anxiety, no mood component or psychosis. I offered medical treatment that did not include stimulants (or benzos), and he started to get pissed. "I need to go out and get some fresh air. Can I leave my stuff here?" I told him that the interview was over and to please take the stuff (new patient forms) and complete them in the waiting room.

Next thing I know, Granny comes back and starts advocating for placing him on stimulants. "He's been clean for 2 weeks."
"Really? How do you know? He told me he did meth and weed last night."
"No he's been in jail for 2 weeks for possession of methamphetamine."
So now I know that he's lying to me about jail.
She also says she has to sleep with a deadbolt on the door because he assaults her.
Lying about assault history.
All this and she wants me to prescribe a med that he admittedly abuses, and will likely increase aggression.

After I let Granny vent all of her anger toward her worthless grandson out onto me, I gave her a referral to Al-Anon.

Just a day in the life. Check back later about a 12 hour shift in the psych ER.

-Psych Doc


StorytellERdoc said...

As I said before, you simply can't make this stuff up! Too good. Merry Christmas from Motel 6 to your house! LOL

Funny post.

Doctor D said...

Don't be so hard on the young man. I'm sure those skateboarding videos will be the beginning of a great and productive career!

It really is amazing how some people think all of life's problems can be fixed with controlled substances.