Friday, March 30, 2007

End of psych

Psych is now over. Next up: clinical procedures. I should get to do a lot of intubating and IV starting—I think we’re supposed to learn how to run codes too.

The family meeting w/ the patient and his mother was postponed as the patient went back into depression because he was so nervous about it. So I’m not going to see what his mother is like. He was going to look at an apartment last Wednesday—right before the social worker was going to take him the apartment called and said they had turned him down because of his criminal record. Interestingly, something that has come up is that his depression and acting out has gotten much worse over the last six months—as his mother’s health has declined. The current hypothesis is that all this rage, depression, and wanting to move away from his mom is due to the fact that he’s actually scared sick of losing her. Another psychiatrist on the ward interviewed him to give a second opinion, and she believes that once the mother dies he is going to be at a pretty high suicide risk, which makes sense, because I honestly don’t think that he can function on his own. He has no friends or family aside from his mom, and she currently does everything for him. Very sad.

In outpatient, I saw a thirteen year old boy with severe ADHD, but more interestingly with enuresis (wetting the bed) and encopresis (passing stool in his pants). The encopresis dates back to when the kid was three years old and being toilet-trained. One day (and this story was confirmed by his parents), at the exact moment he was sitting on the toilet, the boiler exploded, all the water rushed out of the system, and the sudden change in pressure created a suction that literally sucked the poor kid into the bowl! He was so badly traumatized that he still avoids the toilet.

Another patient was a teenager with ADHD and Asperger syndrome, which is similar to autism but without intellectual deficits. Before being medicated he apparently could not sit still, and was constantly doing silly things and making ridiculous comments about everything to everybody. When we saw him, he sat and read “Left Behind” as we were talking to him and the social worker, and every once in a while he would make random silly comments without looking up. Here’s part of the interview:

Psych: How is he getting along with the other kids?
Soc Work: He’s fine. Most of the other kids realize he’s just an intrusive guy and they accept it.
Psych: Right, it’s not like he’s ever mean or anything.
Patient: (never looking up from book) No, I’m just annoying.

Thursday, March 22, 2007

More psych

I’m still at the VA—I’m enjoying it more now that I’ve gotten used to the swing of things. The 63 yo man who lives w/his mother was discharged after being instructed (as he has been for a long time by several therapists/psychiatrists) that he needs to move away from his mother—he planned on doing this eventually, and in the mean time planned to go to a movie/get out of the house when he got too frustrated. He was discharged in a good and optimistic mood a week and a half ago. Yesterday he came back. As soon as he got home, he apparently went back into his depressed/enraged state and spent a straight week in bed without eating or drinking. He pushed his 86 yo mother to the ground. Two days later he tried to slit his wrist and failed, then tried to overdose—though these actions were really more of attention seeking gestures than actual attempts—he barely scratched his wrist and he only took four of his regular pills. He decided he needed to be admitted again, so his mother drove him to the hospital. We are going to have a family meeting w/his mother next week which I am kind of looking forward to—I’m very curious to see what his mother is like. When we discharge him this time it will be after he has found housing that he can go to straight from the hospital.

The 69 yo schizophrenic is still here, entertaining as ever. He’s a very nice man, and particularly happy now that he has off ward privileges. You can actually hold a fairly reasonable conversation w/him now that he is back on his meds, though he still has his delusions and hallucinations. He talks a lot about ancient Egypt, and when we asked if he reads a lot he said that he doesn’t need to because he was born there. Centuries ago he worked there as a builder. He also exhibits “clanging” at times, in which his train of thought follows similarly sounding words. Eg: “I accidentally killed King Tut on purpose, because he took me for granted, granite, what the pyramids were made from”.

One morning a week I go to outpatient at a program for boys who are drug abusers, sex offenders, or have ADHD so bad that their local schools can’t handle them. A lot of very sad cases.

A couple nights ago my Bible study group spent 4 hours blowing up 1000 balloons as a welcome home gift to one of our friends. Above are a couple pictures. Quite impressive I think.

Wednesday, March 14, 2007


I've been on my psych rotation for the last week and a half--inpatient ward at the VA. Unfortunately being the VA there is not a lot of variety, the majority of patients are there for alchohol or cocaine detox. Here are some descriptions of the more interesting patients:

1) 63 yo man presenting with suicidal ideation x1wk. History of depression x30yrs, recent episode triggered by anger at overbearing 83 yo mother with whom he lives--she puts toothpaste on his toothbrush, sets out clothes for him, and "doesn't let him have a life of his own". He wants to move, but can't afford to--he only makes $900/mon and half of it goes to pay legal fees for the dozens of times he has impersonated a police officer and asked people to carry each other (he has spent a total of 11 yrs in prison and 10 yrs in mental institutions for this).

2) 65 yo man who cut his wrist the day before. Doesn't know why. Thinks he felt kind of sad. Wants to go home. Very jolly man w/ possible borderline personality disorder. Made comment at the end of interview that maybe now his wife will want to move to different state as he has wanted to for years.

3) 69 yo schizophrenic man brought in by police for disturbing the peace. The Bantu people of Africa apparently believe that he is Amen-Ra, he can see images coming out of electric sockets (due the actual 6 dimensions as opposed to the 4 described by Einstein), and today he had breakfast with Moses and Aaron. He is actually Jewish although he looks black, and people who say they are Jews but aren't are trying to kill him because he has kindness in his heart and kindness, as we all know, kills. In his spare time he builds $50 million battleships. He's a very pleasant man, and the way he talks I think he could easily start his own Eastern-type religion if he could just keep his story straight.

Saturday, March 03, 2007

Saturday Clinic

Neuro is over. Psych on the inpatient wards at the VA will start on Monday.

Today I went to the Saturday Free Clinic since I finally regularly have weekends off. I saw two patients with a first year student, both were diabetic/hypertensive/hyperlipidemia patients. The first just needed refills (he also had depression) but was also complaining of painful swollen fingers since yesterday. None of us could see any swelling whatsoever, so we told him to take tylenol for pain. The second patient was diagnosed with diabetes five years ago (his brother has heart disease and diabetes and his sister died of diabetes when she was 50) but has been off meds for the last two years due to loss of insurance. Today his fasting blood sugar was 375 and his blood pressure was 162/90. The doctor said in her office she would just start someone with sugar that high on insulin, but in this situation (not necessarily a reliable patient) we just started him on metformin.

Afterwards I took the advantage of being in that area of town and visited my favorite grocery store: Trader Joe’s. I also went by Barnes and Noble. I just finished the eleven currently written books in the Wheel of Time series—unfortunately the series is not finished (similar to the Lord of the Rings the books are all one story), and the author is dying of amyloidosis. Naturally I hope his disease progresses very slowly for his sake, but I wouldn’t complain if he also managed to finish the series in the meantime. George R. R. Martin’s books have been recommended to me by several people as being even better than the Wheel of Time series, so I bought the first four currently written books. On the plus side, to the best of my knowledge the author is not dying of a chronically progressive disease.