Worms

Long time, no see. I guess I must see pretty funny stuff all the time, but by this point, I am immume to it. I have been doing some moonlighting, but in all honesty, it is much less acute than the county hospital where I train. Nevertheless, here are some moonlighting cases.

1. Psychotic older guy comes in because he is watching kids get on the school bus. Not so bad, right? Well, what if he was totally naked. At 8 in the morning. Standing in the street. He walks into the office doing some kind of breakdancing moves. Gyrating his hips. He is looking at my computer monitor like he hears music coming from it. I asked where the music was coming from. He said "From my d!ck." I tried to get some kind of history from him, but to no avail. I finally asked, "Is there anything that we can do to help you?"

"Yeah, prescribe me some pu$$y".

2. A lesson for all the non-psych docs that follow the blog. 30 year old female with history of depression presented from a rural county ER. She was complaining of worms coming out of her head. She had large scratches and excoriations on her forehead and scalp because she was trying to get the worms out. Also, spiders had laid eggs in her neck. She could not walk without holding onto a wall. She kept repeating "10 steps North, 4 steps West." and "Katie is a pretty girl". She was not oriented to person, place, situation. Only psych history was some treatment with Prozac. Further history (provided from transferring hospital) noted that she had been picked up by police 4 days ago for a DWI warrant. Had none of these symptoms until day 3, when she was taken to the ER.

What is the diagnosis?

No, it's not Prozac withdrawal.

Let's try Delirium Tremens.

I sent her to the local ER immediately, they loaded her up with benzos, and she came back 8 hours later.

Mental status exam: perfectly normal.

To all you med students and board eligible docs out there, you're welcome, because if you read this, you just got a question right on some B.S. exam

-Psych Doc