I...uh...don't know what to say

"My wants go further than a hairy vagina. I need some green!!"

Patient QOTD

Patient: "Oh god have you seen how big my ass is?? Do NOT give me Abilify!!!"

Can't say I noticed ma'am, but thanks for letting me know. How about Saphris??

Am I high or stoned? I can't really tell.

In the last two weeks in Chicago the temperature has fluctuated approximately 40 degrees. It finally caught up with my sinuses, and last night I could feel the drip drip clog clog gunky feeling in the back of my throat that sure enough, I was going to feel lousy the next day. Sure enough, this morning I couldn't breathe through my nose at all and my throat felt like it was in a sling. I had some decongestant medication in the cabinet and I took one. Later in the day I was having all the trouble in the world concentrating. My head felt like it was on the ground floor, but my brain was definitely a level or two higher. It was definitely a medication side effect, and I just sat there thinking, as a schizophrenic lady was muttering to the elephants she couldn't help but see, People take this for enjoyment??

Miss Thang

We had a patient come to the outpatient substance abuse clinic. From the moment this girl walked into she had "Hot.Mess.Express" written all over her. She barely wasted a minute. She had relapsed on her alcohol abuse, didn't want to go to meetings because she didn't want every one (at an AA meeting...) to judge her for relapsing, she was constantly having problems that weren't hers at work, and on and on and on. At one point she was so adamant about not going to her meetings because she would be judged the doctor interrupted her and said "That's bullshit. You're making excuses."  All the while she is basically lounging in a chair meant for sitting (say hello to your inevitable back problems in fifteen years) and wore enormous sunglasses, and would not take them off. It was somewhat difficult for me to concentrate on what she was saying because these sunglasses were each the size of Montana. All I could think of was Miss Thang, you aren't Anna Wintour, please take off those giant shades.

After she walked out, I looked over to the doctor and mouthed "Borderline." 

"Yup. Any time a patient pisses me off, there's a good chance they're borderline. Don't get sucked into that."

Awesome day of outpatient

Psychiatry is proving to be a real riot.

We had an autistic patient in his twenties. We heard him coming well before we saw him. Apparently one of his few means of communication is to scream. The doctor had to have him wait in the car with his handler in order not to agitate the rest of his patients. Totally understandable web one considers that half the patients are schizophrenic and bipolar. When it came time to see him, he again began to holler before settling down. His handler mentioned that he frequently liked to drop his pants, at which the patient began to laughingly mutter "Pull down da pants pull down da pants pull down da pants." To which the doctor replied, "No, you will keep your pants on." Then he started to do this crazy dance involving gyrating his hips, which he thought was the funniest thing in the world.

Afterward, another patient came in with what is termed IED, Intermittent Explosive Disorder. This patient was also clearly autistic, but had very little language impairment. He did, however, have significant cognizant and behavioral problems. His nurse told us that he had had his shoulder and wrist dislocated by the patient, and that the patient also bit his father's hand in a tantrum. He talked with us for a while, and he could clearly quote just about every Disney movie ever made. It was impressive. And a good day at the outpatient clinic. We were even provided lunch by a drug rep (always a plus to save a few bucks!).

Psychiatry PEARLS

So far I am really enjoying psychiatry. The psychiatrist I'm working with is the head psychiatrist at Chicago Hope Hospital, and is frankly a much better teacher than the other doctor we had the option of working with. Word-of-mouth led me and my partners to choose accordingly.

While in between patients yesterday, he went over a few "basics."

1. If a patient who is acting crazy says otherwise, care should be taken.
2. A person claiming they feel crazy is most likely extremely anxious.
3. A person whose associates say they're crazy or psychotic is most likely actually psychotic. The patient will usually be unaware of their psychosis.

Yeah I'm on psych...but...

While pre-rounding this morning, my partner and I stumbled across the fact that one of our patients has dextrocardia. For the non Doctorese speakers, this means the heart is reversed, and found in the right side of the chest as opposed to the left. Totally unrelated to psych, but cool nonetheless.