18 posts tagged “work”
He's had ten heart attacks. He is thirty eight years old.
The first one hit when he was twenty six. It changed the happy-go-lucky guy with a cannabis tattoo into a depressed loner.
His mother died in her twenties of the heart attack. His sister, in her thirties. His two children have also had them. He worries about them at night. Sometimes, he smokes.
Three years ago, he was told he had a month to live, maybe less.
'I'm still here.' He grins at me.
His heart is mostly gone now. He's been admitted, but no surgeon will touch him.
He and I sit and trade jokes while the specter of death stands between us. How do I offer this guy an anti-depressant? Instead, I shake his hand. He thanks me for my time. I walk outside and move on to the next consult.
Some days, I don't like medicine that much anymore.
Yesterday was the call from hell. I discharged two patients, saw seven in the ER, admitted five. Everything from drug-induced psychosis to schizophrenia to a stroke. ( The patient had a stroke. Call a neurologist. Do NOT call a psychiatrist to make your diagnosis for you, ER people.)
I worked non-stop for twenty hours straight. Then I went to bed.
And woke up three hours later to sign out to today's team.
Tomorrow, I have another twenty four hour call. Then I do house call for consults all next week, and consult call all through next weekend. Gah.
Hubby is on call today. I plan to sleep all day if I can.
I miss Vox...read all the neighborhood posts earlier this morning but could not think of decent comments to write.
Time to recharge my brain.
Running late for the morning research seminar, I have twenty minutes to see the new patient on the floor. Time enough, I think, as I walk in the door.
'Hi, I'm Dr. P, I'll be taking care of you while you're here on our unit.'
She asks for my credentials. I hand her my ID card.
'So, you're a resident.' She might have said vermin.
Uh oh. 'You'll be meeting a senior attending physician later. May I ask you a few questions?'
'Let me tell you something first. You are supposed to be a professional, but your behavior is not. You need to make better eye contact like I am making with you. You also need to stop jerking your head.'
So much for 'empathic' nodding. She goes on for the next five minutes, hard to interrupt.
I already have a diagnosis. Which is good, because she'd rather see a more professional doctor. Later, she tries to incite other patients to a non-compliance strike. Fortunately, her abrasive manner pushes them away. She plays the piano all day long and sings in the hallways. We spend a lot of time calming down other patients.
My attending offers to transfer her to another resident's care, but I can't let this one go. I go back the next day.
'You can be my doctor. I come from a good family. I can see that you are a genius, too. Amen.'
We bargain over medicines. She refuses the sedative she takes at home but agrees to take the mood stabilizer. I couldn't care less about the sedative; the battle is won.
Three days later, she's still grandiose and demanding. But its getting better.
[printed with permission, identifying details changed]
I took this for the staff on the floor today. It was a hit. They loved the fact that I'd replaced half the fat in this recipe with applesauce. Less guilt all around.
Also saw a couple of patients who stayed with me long after the interview was over. Countertransference of either kind can be a bitch; wonder why they quit offering mandatory therapy to trainee psychiatrists. Now my husband must do the job with little compensation. :)
Hi. I'm a psychiatrist. Your doctors asked me to come by and see you.
Why? Do they think I'm crazy?
No..well, they wanted to see if we could talk about your alcohol use, and if we could help you in any way.
Hm.
So why are you here?
Pancreatitis.
And do you know what's causing the pancreatitis?
The drinking.
Hm..so what would you like to do about it?
Nothing.
Do you think quitting might help?
Yes, I guess.
Would you like to get better? Or is that something that doesn't matter right now?
Oh, hell yeah, I want to get better.
So, in order to get better..would you like to quit?
Not this time.
[ I'm so tired.]
Some have known a likely lad
That had a sound fly-fisher's wrist
Turn to a drunken journalist;
A girl that knew all Dante once
Live to bear children to a dunce;
A Helen of social welfare dream,
Climb on a wagonette to scream.
Some think it a matter of course that chance
Should starve good men and bad advance,
That if their neighbours figured plain,
As though upon a lighted screen,
No single story would they find
Of an unbroken happy mind,
A finish worthy of the start.
Young men know nothing of this sort,
Observant old men know it well;
And when they know what old books tell
And that no better can be had,
Know why an old man should be mad.
-Yeats
Often, I see elderly folks who come into the hospital for medical reasons, and we are consulted either for depression or capacity, because their family or physicians think they need to go into a nursing home.
There was the 91 year old lady who sat with a straight back and her legs neatly together. She was often confused, but always formal and pleasant. She called me 'my dear', and would always say, 'come back and see me.' She had beautiful, paper thin, translucent skin.
There was the 76 year old man who said he was just lonely, and not depressed. I held his hand and he had an amazing grip. When I commented on his clasp being stronger than mine, he said, 'This is how it should be. You're a lady.'
I find myself going beyond the rules of my training and just spending time with these patients, talking to them, and yes, holding hands at times. They are such survivors, so much smarter than we give them credit for, have so much to share. Sometimes my affection comes through when we present, and somebody will joke, 'Why don't you take them home?'
When you've spent all your life taking care of your family, being strong, caring, you shouldn't have the spend the last years on your own. Sometimes, the family simply can't pitch in, they have their own problems, or the patient is too sick to be cared for at home. There is a reason, and that makes it easy for me to explain to the patient. But sometimes, its not as simple.
Thats when I feel stuck. And sad.
I'm doing grand rounds this week. For some strange reason, I picked personality disorders as a topic, and for some stranger reason, I decided to depict each personality with..shudder..a lolcat.
Yes. So for the past couple of days, I have surfed through hundreds of cat images, looking for the perfect paranoid look, the arrogant narcissistic tilt of the head, the well-timed histrionic paw flick.
I wish I had picked dogs.
On a cheerier note, we have perfected our recipe for the perfect focaccia, and here it is.
Ingredients-
2 cups all-purpose flour
1 cup whole-wheat flour
2 tbsp + 1 tbsp olive oil
1 tsp salt
1 tsp dried rosemary
1/2 tsp pepper flakes
1 packet dried active yeast
1 and 1/4 cup warm water
1 pinch sugar
sea salt for sprinkling on top
- Dissolve yeast in lukewarm water with the sugar and let it rest for a minute, until it foams. If it does not foam, the water was too hot/too cold.
- Mix flours, salt, pepper, 2 tbsp oil, rosemary in a mixing bowl.
- Add the yeasty water and knead for five minutes. Add a drop or two of oil to the top of formed dough and roll it around, so it doesn't stick to the bowl.
- Cover the bowl with a towel and let the dough rise for an hour.
- Gently punch the dough down, and knead for another minute.
- Roll it out into a flat disc about half an inch thick, on parchment or silicone sheet laid on a baking sheet.
- Cover with the towel again and let it rise for thirty minutes. Pre-heat oven to 350 degrees.
- With your fingers, make depressions in the disc. Do not go all the way through.
- Brush with 1 tbsp oil and sprinkle the salt on top.
- Bake for 35 minutes, or until bread browns a little on top and sounds hollow.
- Let it cool before slicing. Serve with soup, or make sandwiches.
This morning, I woke up feeling grumpy. A had already left for work; I had several new consults lined up and they were all rough cases. Feeling sorry for myself and angry at everybody else, I dashed off a whine-y post on Vox. I even had a mini-breakfast-binge on last night's pizza. Then I got ready, still grumbling, and left.
It was snowing outside. Beautiful, fluffy, pretty snowflakes, gently floating down, almost as if carried on invisible wings. Distracted by the snowflakes, I decided to make the best of today.
It worked. My empathy returned. It was a long day, but I survived, and so did my patients. Some of them might actually benefit from what we did today.
It was still snowing when I came back. The first thing I did was delete the whine-y post.
The good thing about blogs, they have a delete button.
..to be a chronobiologist, and use phrases like 'rhythmic human' and words like 'zeitstorer'?
In case you really are wondering, read this.
For some odd reason, we ended up talking about hypothetical psycho-surgery today at work. What if we could make a diagnosis, point a little laser pen at a particular spot on the brain, zap a few cells, cure Bipolar, and go home for tea. Would psychiatry still be fun? Probably not..
In a separate incident, I discover this after a month of nightfloat. Nightshifts are carcinogenic, or so they think. Good thing OTC melatonin is cheap. I like that line at the end of the article, though..'Just get a dark night's sleep.'
Amen.
A couple of days ago, I saw this middle aged lady on consults. She has end stage renal disease, and was getting dialysis at an outpatient dialysis unit. She also has bipolar disorder, and is very prone to angry outbursts, verbal aggression and threatening people verbally. One fine day, she ripped off her IV and threatened to 'kill everybody with Hep C'. Her treatment was terminated and she was asked not to return.
Since then, she has been coming to the ER, gets admitted and dialysed, discharged, and then back again in a couple of days. This time she again pulled off her IV and got extremely upset while in the ER, and we were consulted for 'history of schizophrenia, bipolar, and mood disturbances.' She was started on a low potency mood stabilizer (thats the only one she could tolerate, apparently) and she refused Risperdal consta (long-term antipsychotic) shots.
When I went in to see her, she was eating beef jerky, talking on the phone, crying, and immediately told the person at the other end, 'Well, here's another Angel of Mercy to see me. I better see what they want.' She knew she would die without treatment, and that 'the bitterness in my head and my mouth are going to kill me.' The staff up on the floor have already suffered some of her outbursts, and don't want anything to do with her. She had huge gift bags by her bed, full of lotions, perfumes and gifts she had bought for the family who 'don't want anything to do with me because I burnt my bridges.'
I couldn't help feeling sorry for her. She has a creatinine of 14.9 and desperately wants to live. How much of the anger is Bipolar and how much is just her? I don't know. But she deserves a chance at life. The hospital is now going to draw a behavioral contract after which she might get treatment again as an outpatient. I hope.
