Yeah...I've only been in residency for three months...

The other night I was doing my usual short call, and I got a phone call from the primary service regarding a patient with (what else) suicidal ideation...but there's a twist. This individual also happens to be a doctor. Oh goody. And wait!! she's also a borderline, a group of patients I find particularly challenging. None of this makes makes me feel good. Long story short, the patient denied any active suicidal ideation, what was said was "who wouldn't have thoughts of killing themselves if they had pain like this." So, a gray area. But there was a past suicide attempt. I wanted this patient in the hospital, because there was a pattern that looked like it was about to be repeated, but the patient did not meet requirements for committment. And then the patient eloped prior to discharge...security was called and

Here's where things hit the fan like a steamy cowpie in June, the patient goes home, sends an email to her outpatient psychiatrist saying that I was right, that I should've kept her. Doctor calls the police. Patient leaves her house, and shows up on the floor after I've signed out to the night resident. Then the patient codes. What has the patient done...taken over 100 pills of oxycodone, percocet, and valium...

I cannot even begin to put into words what I felt in that moment. Anger, at myself and my inexperience, frustration with the patient, anger at the patient. It completely ruined my day. I kept asking myself over and over again what I could've done. What trick of the trade did I not know regarding how to commit her....because doesn't every psych resident deal with a borderline who's also a physician who knows exactly what to say and has been planning a suicide attempt for two weeks....
One of my attendings stated that "it's ok to feel that way. First year residents are constantly afraid that they'll be exposed as a sham and not knowing anything. But it's ok, because first years really don't." While that didn't exactly make me feel great, it is an accurate representation of how I feel at the moment. I've been told by several people in the crew that I did everything I could, and that I did everything right...but at this point I don't know how much of that is avoiding a problem with me going off the deep end, or if I really did do everything I could do.

People in my program have been very nice about it, stating that more or less "it happens, and sometimes there's nothing you can do." Pardon me if that's comforting, yet not.

People keep calling me Doctor...

...and I don't think they're being sarcastic.

I've been taking solo call now. It's crazy it's hectic, it's long. And I love it. 

 

My new rotation for the past two weeks has been to manage the psych calls from the emergency room. The hours are nice (11-4:30), but it can be a bit zany. I get called for just about every drunk guy in the ED, because apparently every drunk guy that comes into the ED also endorses suicidal ideation. Lovely. After 4:30 I put away the dedicated psych admit phone (that of course I get to carry...). And then transfer my pager over to the system wide psych pager and hold that until 8pm, when the night resident takes over. Some days it's been zany, and other days not at all.

I've seen a transgener patient with psychogenic seizures, borderline personality disorder, and (because the rest wasn't enought) hereditary blindness.

I've (twice) seen a rapid cycling bipolar patient whose cycle is so rapid that she's floridly manic in the morning, but slides into a depressive state in the evening. When the regular hours C/L team seems her in the morning/afternoon she's (again) floridly manic. For some reason two days running she asked to speak with psychiatry (which after 4:30 is me). By the time I get there she's anything but manic.

More often than not, after hours I get the typical calls -- suicidal patients in the ED who may or may not actually be suicidal. Once in a while a patient will plotz somewhere on the floor and it's my job to make sure that they don't leave without being fully evaluated. Sometimes they ask for something to help calm them down, sometimes it's obvious they're about to threaten the staff.

All in all, it's been a pretty cool rotation.

I Dreamed a Dream

I dreamed that during my call last night I got paged to see a suicidal patient...in my dream not only did I forget to see the patient, I forgot to sign him out to the night resident. I woke up so freaked out I didn't fall asleep again for three hours. 

...I think it's the adrenaline. I also find myself not needing/wanting to eat much when I'm on call. 

Gee...thanks

My one admission today was a turnkey. The consult doc and the unit doc arranged it. Then both left without putting orders in or alerting the poor schmuck who is on call (that would be me...) who gets the call from an angry nurse saying PATIENT NEEDS ADMIT ORDERS!! WHY DIDN'T YOU PUT THEM IN....uhhhh because this is the first I'm hearing of it

QOTD

I go down to HR (a never-ending conundrum) to get some special ID card I need. 

The guy at the desk looks up and goes "What's up doc?....damn, I should just get a carrot I say that so many times a day."

New Rotation

Done (for now) are the dog days of internal medicine. I have another month coming up in November, and I doubt I'll see the sun at all that month, but enough about that. Now I'm "managing" the intake for psych patients in the ED during the day, and until 8pm I'm on call. It has been hectic, a bit chaotic as one would expect, but actually a bit fun. This week, I seemed to get patient's who came in packs, all with the same problem. While it made dispo relatively straightforward, keeping the patient's and their individual problems straight was more of a challenge!!