But of course...

What does orientation include at the state NGRI facility...a screening of Shutter Island...what else.

Friday night I spent two hours on a patient who not only attempted to overdose on Xanax and gabapentin, but also required Narcan for heroin intoxication, which the ED missed. While it's easy for me to say...uh, you actually believed her when she said she hadn't used in months? there's so much going on in the ED and the patient wasn't obtunded until I was called that I can easily understand why they missed it. Now, having said that, the patient's spouse said that she had used heroin yesterday, so the key here is that drug users lie and collateral is key--SHOCK AND AWE!!  After having her opioid reversed, only then did the patient admit to snorting a bag of heroin. Still, she lied because her UDS showed cocaine and marijuana, which she had denied. So all-in-all, a very time consuming but simple consult. 

Derp

When you have that sneaking suspicion that your 1pm outpatient substance abuse patient isn't going to show...because he got drunk last night and developed pancreatitis and presented to the ED...

Facepalm

Read In a chart: "very mildly thickened aortic leaflet valves..." ... So, is it very thickened, or mildly thickened? I'm very incredibly amazed at the repetitive redundancy.

Kvetching...

Seen in a note...actually a weeks' worth of notes: "Last heroine use..." I keep wanting to ask did the patient shoot up Wonder Woman?? Or did they mean heroin...the drug.

Somebody just tried to bring a duck onto the psych ward...

Geriatrics...I got a right to sing tha blues...

This month is a month of geriatric psychiatry for me. Frankly, I do not like it. It feels much like an extension of internal medicine, which I've ever-so-affectionately labeled Interminable Medicine, but its in a population that is aging, is in very bad shape, and in general it just saddens me to see people living in such a state. Shoot me please should I ever get like that. Other patients are so angry about their circumstances that they inadvertently get in the way of their own treatment. There's no sunlight where I work with the medical students--and dadgummit I need my Vitamin D!! It's not my cup of tea, and it has made me uncomfortable and feel depressed, and to be honest it's a little boring just sitting around asking people about their mood. I've much preferred consult-liaison work, where I'm constantly busy and working on high-acuity cases.




Also depressing is the situation with a recent foster pup. In July we adopted Freddie, only the best greyhound ever. We wanted two hounds, but they only send first-time adopters home with one at a time, which is fair. We became interested in a second hound, whose story broke my heart. The dog was being kept in a hoarding situation by a whippet breeder in another state, kept outside year-round. It was months before he could be put up for adoption. He came home with us, and the first few days were predictably slow. Then this dog bonded so hard and fast with me that it melted my heart. Unfortunately, the closer he bonded to me, the more hostile he became to others in the house. Given my ever-changing schedule, we cannot have a dog that doesn't respond well to everyone in the home. Which is a real shame because he could be a very sweet hound. So, there's that.


The long and short of it is I'm having a bad week, and I'm kvetching.