Friday, January 23, 2009

World Weary

Maybe if I write about this I will be able to get it out of my head. Sometimes the stories I hear in psychiatry are just too much.

One patient came to us after a suicide attempt. He has an MR diagnosis (mental retardation) and has so far spent his adult life in various group homes. This guy was always happy to see us, and would sit down and talk to us about his past. So why did he try to kill himself?

I'll call the guy David. David was living in a group home in a small town when the home's manager (a man) started to rape him. The sexual abuse went on for a while. David started to get quiet when he talked about this. When I asked him if he felt guilty, he said, "Yeah, I feel bad because it was my fault." My heart just dropped as he then said the manager would buy him "really nice clothes from Goodwill and a walkman and stuff like that and I didn't think I could tell anyone. So it's my fault." What do you say to that? This man was a monster, and he preyed on a kid who couldn't protect himself.

David eventually did tell someone at the group home what happened. Then they kicked him out onto the streets. He spent a few weeks in November living on the streets before a local evangelical minister found him and helped him get placed at a state hospital. His parents eventually found him, and he says they are now suing the former group home. He said when he was kicked out that manager was still working there, and that as far as what his dad told him he's still working there now.

David has voices telling him that he's dirty, he's disgusting, nobody loves him, he might as well kill himself because everything is his fault. When I first talked to him, he started crying as he said all he wanted was for the voices to stop.

Now David takes (or tries to, if the nurses let him) several showers a day because he feels disgusting and dirty. He asks us at least twice every time I talk to him if we are going to make sure he has another group home to go to when he gets out because he's afraid he'll end up on the streets again.

I know life isn't fair, but when I'm confronted with such a sad story, for a little bit I actually think my heart might break.

Thursday, January 22, 2009

Super Man=Super Stupid

As I have mentioned before, I am required by the Office of Medical Education to crash two support groups. I attended one successfully, but my other two attempts to ended at happy hour. I have to write a "reflection" on my experiences at these groups, and since I didn't think retelling how I introduced the other med student to good tequila would count, I attended one of the group sessions on the mental health unit.

We have several manly-men on the unit right now. During the session three of the men started talking about how you have to learn to trust that your wife/girlfriend/baby mama wants to know how you are doing. Being of the female persuasion myself, I always find it interesting to listen to men's perspective. I sat in the corner thinking "Of course they need to know how you're doing, you idiots." Guys don't realize the Superman act can't go on forever.

One guy's wife stopped him from killing himself. He talked about how for years he worked to make as much money as possible, and now that the money dried up he could have spent more of those years building his relationship with his family. He tried to shield his wife from his problems, only to have them explode on both of them.

Another man's wife left him when he was at his lowest. He told the first man how much he envied his support, and that he wished he could have had that too, or at least gotten out of his toxic relationship before he lost everything.

A third guy was locked away young and can't control his anger. All he wants is to be close to his children, but he's so afraid of losing his temper that he turns his anger on himself.

I enjoyed listening to these men counsel each other. As trite as it sounds, it reminded me of how hard it can be to communicate with your partner. And of how lucky I am to be marrying an guy who doesn't mind having to remind me to "Use your words".

Sunday, January 18, 2009

Babies everywhere!

Five friends of mine have had babies this year. Four of my cousins are pregnant. It's been a tough year for my grandchildless mother.

You can't really blame me though. I just went through two months of pediatrics where I spent half the time dodging body fluids and the other half trying to keep a straight face while Mrs. So-and-so told me just how misunderstood her little ADD cat-shaving miscreant really he picked his nose and wiped it on the exam table. Throw that in with a few lectures a month on all the things that go wrong in pregnancy and childbirth (given of course by men who do not seem to care that I'm nearly fainting in the classroom while they casually discuss episiotomies) and it's no wonder why I'm a little relucant to procreate. Like my clip art of the baby crying? You should see its mother.

My sisters and I had a discussion on what we would do if our babies turned out ugly. As far as I know, giving birth does not make you blind. And you can't say, "oh but she has such a good personality" about a baby. They don't have those yet. I think probably I'll just dress her in something very sparkly so the casual onlooker is dazzled. Anybody closer will just have to cuddle her and keep their mouths shut.

Today I went to a baby shower where, among other supposedly cute but usually pointless games we had to each write a piece of advice on a piece of paper for the mom-to-be. Never mind the fact that I'm childless and crossing my legs at the thought of what this woman was going to go through in two months, the fact was aside from medical advice, I really had no words of wisdom. And I didn't think I could illustrate the baby version of the Heimlich well enough in that tiny card space.

So in the end I just wrote what I thought might eventually help: "Men can breastfeed if they try hard enough." I figured it's something to consider during the 3 am feedings.

Google it. It's legit.

Wednesday, January 14, 2009

Diagnosis: Bat-shit Crazy

It's official: "Bat-shit crazy" is a diagnosis.

It's late and I should be in bed. Bad things happen when I don't get enough sleep and have to answer questions in the morning. Like the time on internal medicine during shift hour number 27 when my preceptor asked me a question and I told him, straight-faced: "I don't know nothin' bout birthin' no babies". Or another time on family medicine when a woman told me she had tried diet and exercise to lose weight, but when she went off the diet she gained weight back. "Ummmm, yeah you would," was not the most tactful way to make my point. Or on pediatrics when someone forgot to bring me lunch (which meant no food from 7am to 7pm) and I locked myself in the bathroom. But that's really a story for another time.

But anyway. I haven't blogged in a while because sometimes the things that affect me most take a friggin' long time to write about. And with psych especially I sometimes don't have the right words.

Sometimes the words I do have are not appropriate. Like "bat-shit crazy". I haven't been doing psychiatry for a long time. I don't have all the technical diagnoses down. So sometimes I just call it like I see it. My roommates thought I made the term up. I didn't think I did, but had no idea where it came from. I thought it was part of our collective vocabularly. Imagine my surprise/vindication when our preceptor spontaneously called someone "bat-shit crazy" this afternoon. Let's just say, it's a happy thought to end the night on. Both because I was right, it is a saying, and because with this doctor I know anything ludicrous I say in the morning will probably endear me to him.

P.s. All bats have rabies (as far as modern medicine is concerned). In case you didn't know. If you ever find out you could have possibly been bitten by a bat, or just in a room with a bat for a little while, I'd get that checked out. Otherwise you really could be bat-shit crazy.

Friday, January 9, 2009

Folie a deux couchez avec mois?

Don't get excited.

Folie a deux is a delusion shared by two people. Usually one person convinces another previously rational person that his/her delusion (such as being followed or stalked) is true. Then good luck trying to figure out what's really going on, because both your patient and his/her main source of additional history are telling you how prostitutes are following them and trying to poison their milk. Eventually you end up giving up milk yourself when you realize the carton you just bought at the cafeteria was already opened somehow. Hmmmm.....

This patient was from a small town and felt like people were following her. She said they were on and off her family property after the family patriarch recently passed away. She said people were watching her. I always wonder a little if the patient is telling the truth and we're the ones making a mistake...I guess I'm not comfortable with the whole "lock people up if they don't act like your concept of normal" thing. My preceptor, a particularly academic fellow, thought the woman was straight up crazy. He didn't seem to see how any of her story could be true.

The woman had mentioned people following her mother too, and that her mother wanted away from them. After we left the interview, the doctor turned to me and said, "It would probably be a good idea to contact the mother. I doubt she feels like people are watching her, " chuckling to himself at the idea. Twenty minutes later a nurse tells me the mother will come to the hospital to talk because people could be listening in on her cell phone. Hmmm. My preceptor's eyebrows nearly jumped off his face when I relayed the message.

As we talked to the mother, she had a similar story as the daughter, minus a few of the more bizarre delusions. The thing was, I grew up in a town the exact same size as the town these women were from. I felt like my preceptor was dismissing their stories because he didn't know what it was like to grow up in. I felt like his judgment of this woman was clouded by his lack of experience.

As he was getting excited over the possibility of a folie a deux, I took it upon myself to educate him a little about small town life, meanwhile validating kernels of the women's story along the way. Case(s) in point:

1. The mother's house was robbed after the funeral.

In a small town you know to lock your guns and carry-able items, or just have someone sit in your house during the funeral. You should do that in big towns too. Thieves can read an obituary section (I guess in a small town they're just more likely to know where the deceased lived). That would make anyone paranoid about people trying to take stuff from her.

2. Strange people were going on and off some remote farmland and tried to run them off the road when she entered.

Umm, this man deals with meth heads on a regular basis. Farms, especially remote ones, are a good place for people to go squat with their meth labs. We found one on my grandpa's farm in a hundred year old barn. You can't tell me there weren't people going on and off the land.

3. People on ATVs and trucks were trying to run them off the road.

Do you know what people on meth act like?

4. People listen in on cell phones.

The woman actually knew how it was done b/c her family had done it. Delusion schmelusion!

5. The cops didn't do anything useful.

Not to insult the county's finest, but who hasn't felt like this at some point? No one? Just me? You people didn't have enough excitement in college.

6. Neighbors acted suspicious and watched them through their windows.

I know a girl who actually met her first college boyfriend by changing in front of an open window. People are watching.

7. The whole town was in on it.

Look, when there are only 1,000 people in your town, it doesn't take too many to feel like they're all in on it. And most of them are related anyway, so it's probably closer to the truth.

In short, I was in the unfortunate position of disagreeing with the man who gives me a grade in two weeks. And I was in the even more unfortunate position of having a big mouth. Luckily the psychiatry department has given us all sorts of sensitively worded assignments-one of them being a "cultural awareness assessment" or something like that. I happened to have the form in my white coat so I waved it around a little, talked about "good-learning experience" and "needs independent research" and pretty soon I was on my way back to my computer for a snack and a little reading.

Wednesday, January 7, 2009

My trip to Al Anon

As part of my psychiatry rotation, I've been tasked to attend two support groups: Bereaved Parents and Alcoholics Anonymous. A regular barrel of fun.

Another med student and I planned to go to the AA meeting tonight. I wondered how one prepares herself to go to an AA meeting so that she blends in. Yes, I know all people of all types are alcoholics, but what if the group and night we chose was more over-50 biker than WASPy white girl? How was I gonna blend in?

I took a shower after working out and saw that my mascara had smudged all over my lower lid. I left it thinking maybe it would look like dark, tired, can't sleep because I'm out partying circles. I didn't know what clothes one wore to fit in, so I just dressed like I usually do in the evenings. Which is to say I found things on the floor that I thought had come out of the clean pile rather than the not-so-clean pile.

Another problem was the fact that I am not actually an alcoholic. I'm just a medical student sent to Observe. How arrogant is that? "No, no, I'm not one of you people. Just keep acting like you usually do while I make mental notes about your kind." I didn't feel like getting thrown out of my first AA meeting. I needed a cover story. Luckily, "I'm just a student who occasionally drinks too much; my doctor suggested I come to a meeting" was both truthful and adequate. Never mind that too much for me is two beers and the doctor who suggested it is two hundred miles away in the Office of Medical Education.

Finally we were off. Unfortunately, we were not off with directions or a GPS. Thirty minutes later we were in a bad part of town cursing Chaplain Bob for suggesting this particular meeting. I told my buddy I'd rather be an alcoholic than get out of the car in the neighborhood, so he started the car back up. That's when the lights shined on what I'm pretty sure was a drug deal going down in front of us. Spotlighted. Fifteen feet away.

After that I figured the only way to salvage the night was to stop at the Irish bar on the way home. A Boulevard Wheat later, I was feeling a little guilty (and light-headed) but promised I'd go to the next meeting.

As my penance, here's a link to the effects of alcohol. Link