Showing posts with label bear. Show all posts
Showing posts with label bear. Show all posts

Friday, December 20, 2013

Psychiatry for toddlers


This week I've been working as a locum in the emergency department, with the psychiatry team.  Here is the transcript of a conversation I just had with the Hatchling about it:

Hatchling
Dada, did you work today?

PTR
Yes, I did.

Hatchling
Were there lots of people and animals?

PTR
There were lots of people, yes, but no animals.

Hatchling
Were you friendly?

PTR
I was.  That's what my job is all about. When people are feeling really sad, they come to the hospital and I am friendly and nice to them, and then they aren't so sad anymore.

Hatchling
Did you give them a cuddle?

PTR
No, I just talk.  The only people I give cuddles to are you and Mama.

Hatchling
Thank you Dada.

In reality, of course, it's not quite so simple.  Psychosis, attempted suicide, substance abuse, people with really tragic histories of childhood abuse, pain, and deprivation.  But I think the details can wait until the Hatchling is a bit older than 3.  Until then I'll just continue counting my lucky stars and trying to be the best Dada I can be.  And being as friendly as I can to people who need a friend.

Wednesday, April 21, 2010

Crisis

First, let me say that I know perfectly well that the plural of "crisis" is "crises", pronounced "cry-seez".  But let's face it - you sound like a knob if you say that.  So I'm going to say "crisises", pronounced "cry-siss-ez".  Okay?  Just live with it.

Also, I know that the Chinese word for "crisis" consists of two characters - one represents "bear", while the other represents "being bitten in the face".  So there's no point posting a comment to that effect.  We've all done those management courses where you learn that kind of guff. 

If you look up the word crisis in a medical textbook, you'll find that there are lots of different types of crisises.  For example, there's the Addisonian crisis, where your adrenal glands just aren't doing their thing.  Or the oculogyric crisis, where your eyes roll uncontrollably whenever someone uses long Greek words that you don't know the meaning of.  Or the cholinergic crisis induced by nerve gas, where you poop your pants but can't do anything about it because you're lying dead on the floor.  Or even the carcinoid crisis which can cause a deficiency of tryptophan, an essential precursor of serotonin, which is best remedied by eating chocolate-coated corn chips.

But the one crisis you won't find, despite it being intimately familiar to all medical students, is the academic crisis.  The academic crisis can be triggered by a wide range of different stimuli yet the symptoms are always the same.  The sufferer will:
  • exhibit a prodromal attitude of apparent relaxation and whimsy in relation to their learning,
  • progress to a stern self-admonishment that "I will start tonight!", often accompanied by sincere promises to bewildered partners and friends,
  • become tense, agitated, and uncommunicative,
  • pace back and forth in front of their usual place of study yet be unable/unwilling to actually begin work,
  • acquire a fixed delusion that other medical students do not suffer these same crisises,
  • decide to "just start on topic X", then suddenly switch to topic Y, then topic Z etc, at an ever-accelerating rate,
  • conclude that they should try to learn everything at once and actually attempt to do so,
  • insist that "this time it's different", despite the fact that the same thing happened just last week,
  • eventually realize that they are learning nothing so they might as well do nothing, and settle in front of the TV with a big bowl of chocolate-coated corn chips.
The duration of the academic crisis is inversely related to its intensity.  Indeed, some sufferers endure an ongoing chronic nagging crisis for years at a time, characterized mainly by low-level guilt.  Truly serious cases can go for months without an attack, then suffer continual short crisises which are so intense that they are quickly followed by a cholinergic crisis, leaving them dead on the floor with poopy pants.

If you know a medical student and see them undergoing an academic crisis, your immediate priority is self-preservation.  Stand well clear in case they unexpectedly explode.  Under no circumstances should you attempt to minimize their distress.  What they are going through is part of the circle of life.  From time to time, the tree of medicine must be refreshed with the blood of students.

The only treatment for the crisis is group therapy.  Get a bunch of students together in a room with a cake and hope that one of them confesses to a recent attack.  This may take a while, as they have extraordinarily strong and deceptive ego defence mechanisms, but eventually someone will crack.  When they do, there will be a moment of solemn silence and then everyone else will sigh and say, "I thought I was the only one who did that".

It's not a cure, but it will stave off the next attack for a week or so.