Friday, July 30, 2010
The Picture Album
I love doing psych consults so much that I just did an extra elective. Something cool about hanging out with "real doctors" and seeing all the medical/psychiatric interactions. Or something. Anyway, I find that most consults are pretty interesting, and I've seen every imaginable kind of delirium, suicide attempt, drug withdrawal, etc. Or so I think. It's those stories outside of my normal comfort zone that make it to this blog.
Warning: Those with kids, especially moms, especially if you're a pregnant mom, be forewarned. You may not want to read this one.
Getting a psych consult to the Labor and Delivery floor can never be good. Usually it's some case of post-partum depression/psychosis, usually requiring a report to be filed with appropriate child welfare agencies, moms with 10 kids and no way to care for them, etc. Today, it got dialed up to an 11 for me.
A G6P3 21 y.o. female presented 2 days ago with acute pelvic pain. She was at 34 weeks' gestation. Sono showed intrauterine demise of the fetus. While waiting to spontaneously deliver, she got very labile, asking to go to a different hospital, etc. Basically, she was angry that the primary team didn't just surgically remove it. Seems reasonable to me, but damned if someone shows some normal human emotion in a hospital or else psych gets called in.
I saw this lady the day after she delivered. She is understandibly sad, tearful, and grieving. Her life had not gone according to plan, as evident in her age, 6 pregnancies, and 3 total miscarriages now. She reported her prenatal care, psych history, support network, etc., as I obtained a complete history and mental status exam. I gave her referrals to several different grief counselors and recommendations for meds and follow-up.
As I was wrapping up the interview, she asked me if I wanted to see pictures of her baby. I felt this twinge in my gut, telling me to say no. No human part of me wanted to see a dead baby. However, I knew it would be better for her therapeutically to show interest in her plight in this way. The patient needed her doctor to do this. To connect with her. It was going to be hard.
She brought out a small album. Her and her mom had put a new little red dress with a matching cap on the baby. They took 6 or 8 pics. Different poses. Closeups of face, hands, feet included. At first glance, it looked like a normal newborn album. But the reality of it all could be seen in the skin color and turgor. I was able to manage "She's beautiful" or somesuch, quickly tied up any loose ends, and left her room.
I just hope I helped her in some way. Because those pictures are gonna stay with me for a while.
Posted by SerenityNow at 8:08 PM