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The Details Matter

In clinic today I saw one of Dr. B’s patients. I grabbed the chart, went to see the patient, and came back to present to Dr. B.

After 3 weeks at my site I have managed to avoid seeing any of Dr. B’s patients. Let’s just say that Dr. B is rough around the edges and his vocal chords have a propensity to produce very loud noise when speaking to people. He is also over 60 years old and looks like he could be your grandfather.

Anyways, while presenting my patient to him, I mentioned that my patient had experienced dark red blood in her stool for “months.” The conversation then continued like this:

Dr B: Months? What do you mean months?!? Is it 2 months or 200 months? It matters!

Me: Right (while nodding my head. He is right, after all. I have nothing about which to argue.)

Dr. B: In medicine, the details matter. Are you married?

Me: No

Dr. B: Do you have a girlfriend?

Me: Not at the moment.

Dr. B: Well when you get a girlfriend you ask, “Do you have a lot of money?” She says yes, and then your next question is, “How much?” See? The details matter!

Me: (Nodding my head)

Point taken. The details matter. Got it, coach!

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Words With Patients

Let me set up the scene. I had just met my patient and examined her in her room. She was an older woman. She was an inpatient (meaning she was staying at the hospital). We were discussing a possible trip to the OR that day. I wasn’t sure if she would go that day or if the surgery would have to wait.

Nevertheless, our conversation was pleasant and I felt that we had fairly good rapport. We laughed and smiled throughout the conversation even though she was obviously anxious about surgery. And then this conversation happened:

Me: Well, it was good meeting you. I’ll probably see you later today. If you’re here tomorrow, then I’ll see you then too.
Her: If I’m here? Where would I go?

I sensed the panic in her voice. She sounded like I had just casually mentioned that her future existence was in question.

My only thought was that she could have gone home after surgery since I didn’t think the procedure was too serious. But poor, lady. She was thinking more negatively than I anticipated.

And once again, I was reminded how important communication really is. And seemingly innocent remarks can be understood in a completely different light that it was originally intended.

Oh, and I did clarify what I meant as soon as I heard her reaction. And we laughed again.

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A minor said he doesn’t need to take his medication because he is “grown up like the Kardashian sisters.” Talk about choosing role models.

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Phone Calls, Puppies, & Babies

I don’t mind talking on the phone. That is, of course, as long as the person on the other end actually has something to say. But phone calls have been one of my least favorite parts of this week on Adolescent Psychiatry.

Whenever we have a new patient, the we are supposed to learn everything about the patient that we can. For these new patients, there are three sources of information: 1) the nursing admission note, 2) the patient, and 3) the parent/guardian.

Usually, by the time the patient becomes “ours,” the patient is already situated in the unit. The nursing note has already been done. Our job, then, is to read the nursing note to get a sense of what happened, and then find out what the story is from the patient and their parent/guardian.

The patient/guardian is a phone call away. And these phone calls often take quite a while. I suppose it is expected, though, with situations that often involve seriously disturbing relationships and circumstances. We have to discuss the current situation and the events that led up to the hospitalization. And then we discuss the patient’s history in detail.

But what I find much worse than the phone calls is what I learn from them, and what I learn as I get to know the patient more each day. As the story unfolds, I have to watch myself. I sometimes get so mad and frustrated. I find myself in disbelief at the atrocities that “my” kid has had to endure. There are stories of 7 year olds who get started on drugs and alcohol. Seven year olds! Who gives a kid drugs and alcohol?!? We have to hear about kids who were abused in every way imaginable by people who were supposed to help protect them. We talk to kids who tell us they see and hear things. We have to daily ask them if they are thinking about hurting themselves or other people — because it is a very real issue for many of them.

And I find myself disgusted that it is harder to adopt a puppy than it is for a person to become a parent. It’s ridiculous. And it sucks.

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Addiction Week

I have been on the Psychiatry service for almost 3 weeks now. This week I was assigned to the Addictions unit. It has been quite the eye-opener. It has been filled with meeting people at various stages of recovery. I have sat in on Al-Anon , AA, NA, and other group meetings.

They have been filled with stories. Sad stories. Tearful stories. Stories filled with despair. And stories filled with hope and inspiration.

The biggest thing about this week is the realization that addiction is a disease that does not discriminate. There were successful professionals. There were homeless members. There were women and men. There were people like me. And that scared me. Because I realized that if I could be sitting in one of those chairs and telling one of those stories.

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Three Weeks

A 3 week stint at a county hospital isn’t very long. Three weeks, with one day off per week, is 18 days of coming in every day.

But a lot can happen in 18 days. Three weeks is long enough for me to admit a patient, follow the patient for three weeks and watch the patient deteriorate right in front of my eyes.

The patient is not even 30. Young children at home. I doubt the patient will be alive in a week’s time.

Three weeks.

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Overheard In The ED

I remember one time when my team was on-call. It was late at night and the ED was packed. There were beds and chairs lined up in the hallway with makeshift dividers separating patients.

There was one particular patient at the end of the hallway that I had noticed after walking back and forth. He was a scruffy older man who was lying in a gurney, sunglasses in place. He looked like he was resting comfortably enough.

On one of my trips through the hallway, I had just passed him when a nurse walked up to him and asked, “What’s your name, sir?”

Though my back was turned to them I heard him reply in a deep, rough, scratchy voice, “Wolverine.”

“Wolverine?” the nurse asked.

“Yes,” he replied.

I about died with laughter. I never got to meet this character. He wasn’t admitted to our team. But I’m sure it would’ve been fun to treat a superhero.