Psych!

2nd rotation of 12. Psychiatry. I'm working on the adolescent inpatient unit this week and have been very fascinated and saddened by the mentally disabling illnesses out there that affect our youth. One girl in particular was a well functioning, straight A 15 year old with only a history of bipolar in her family to be her downfall. So the combination of faulty genes and large amounts of cortisol building up in her brain from stress (she just broke up with her boyfriend) causes her to have her first "break". A "break" in bipolar disorder means a manic phase of this disease. (Bipolar being the combination of depression and mania). So after a few days of not eating or sleeping because of the heartbreak she begins to become hyperactive and hypertalkative. Her parents realize something is different with their daughter so they put her in the car to go to the ER. On the way to the hospital the girl gets out of the moving vehicle and precedes to remove all her clothing while walking out into traffic. (She has now "broken") At the hospital, the girl tells the nurse that she is 4 years old and has no orientation to where she is at or what day it is. From the hospital she is admitted to the unit I'm working on. She is now my patient. The doctor and I go in to talk with her. She is still undressing herself and so she is kept in an isolated room. She is wrapped in a blanket sitting on her bed. It is obvious that she is "checked out". She can't answer our questions. She can't remember anything past 1st grade and when we sit in silence she will space out and then be surprised to see the doctor sitting next to her. She reaches out to touch his shoulder to see if he is real. She can't delineate between reality and the hallucinations she's seeing. Thankfully this is bipolar and not schizophrenia. Bipolar is treatable with meds and people can function normally if they are compliant with taking them. My heart aches for her and her family. These few weeks will be some of the hardest for them. But there is hope. Hope that she will improve. Hope that our Father will come soon and restore us all with new minds.

embarrassment

So the past 2 weeks have been the start of my clinical rotations. I'm currently doing "family medicine" which means I go between the urgent care and the family clinic. Most days, it's pretty mellow. I've had the opportunity to incise and drain several MRSA abscesses from peoples underarms and inner thighs. Those days, I go home feeling like I need to jump in a bath of bleach water. Other times I come home rather amused by the patient encounters I've had.

One of my first days in the urgent care, I was asked by one of the PAs if I would like to come watch an incision and drainage of a cyst. I happily accepted and followed her blindly into a room with a closed door. To my surprise and more to the patient's surprise was that I recognized him. The look on his face when he realized he knew me was one of mild horror. The first thought through my head was, "Where is the cyst?". At that point I could have chosen to turn around and leave out of respect for him but I made a quick decision to act professional and stay. This was a good learning experience and good practice for future encounters with patients I might personally know. Within seconds the PA had him on his belly with his shorts half way down his bum. The cyst happened to be nestled in the superior portion of his butt cheeks. I think at this point, both the patient and I were probably blushing but neither of us could see the others' face. So we chatted as if were sitting in a cafe' having coffee together, all the while I'm helping to hold his cheeks apart while the PA performed the procedure.

Another day, at the Family clinic, I was helping out a resident by seeing some of his patients. I picked up a chart on the outside of a room. On the line where it says why the patient is there, it read, "Suppression Therapy." Not really sure what that meant, I walked confidently into the room to find a 30 something, good looking gentleman with a very nervous look on his face. He was expecting to see a male doctor but instead a young female student walks in and shakes his hand. As a I sat down with my clipboard and asked him why he was there, he crossed his legs, and his arms, and with hesitation told me he was there for suppression therapy for his Herpes. Once again, I practiced my "non shocked, this happens all the time" demeanor. I asked him questions about the history of his disease as if it were a common cold. His body language opened up over a few minutes but when I went to listen his heart and lungs, I could see that he was sweating profusely. That was the extent of my exam. I didn't ask to see the herpes. I believed him and I think he appreciated that.