Showing posts with label psychiatry. Show all posts
Showing posts with label psychiatry. Show all posts

Wednesday, November 25, 2015

Overheard


Patient
Antipsychotics are bullshit!  You know, what happened to people with schizophrenia before antipsychotics were invented? Huh?

Doctor
Well, most of them probably died very young from exposure, malnutrition, violence, suicide, disease, or else were locked up for the rest of their lives.

Patient
Oh.

Thursday, June 26, 2014

The day that you realize you're married to a psychiatrist

[Scene: On the couch, watching an advertisement for the forthcoming movie, Dawn Of The Planet Of The Apes] 
Smaller Half
Why do they keep making the same kind of film over and over? 
PTR
Aheywha? 
Smaller Half
They keep making these films about Man versus the Other, and the Other must be destroyed, but of course in the end it's Man who is the Other. 
PTR
Well thanks for ruining it for me.

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.

Friday, December 21, 2012

Mental state examination

Appearance: Caucasian male, medium height and build, looks of stated age, short brown hair unbrushed, unshaven. Dressed in semi formal office clothes, clothes clean though rumpled.

Behaviour: calm demeanour, good eye contact though prone to reverie, no abnormal movements, gait symmetrical. Cooperative with interview.

Conversation: normal rate, tone, volume, rhythm of speech. Brief answers verbally, more expansive in writing. Some tangentiality and loosening of associations. Occasional inappropriate humour. Themes of anger, being misunderstood, narcissism.

Affect: reactive, engaged. Claims subjective inner turmoil.

Perception: apparently normal. No attendance to internal stimuli.

Cognition: not formally assessed. Grossly intact.

Intelligence: above average though possibly not as high as he asserts.

Insight: good though limited in the context of accepting and integrating criticism.

Judgment: impaired by innate laziness.

Rapport: superficially established.

Impression: ?tormented artist
?selfish prick
?dysthymia
?intern burnout.

Plan: 1. Ship him off to another hospital and let them sort him out.
2. Put him in the scuppers with a hosepipe on him.
3. Encourage writing: entertaining at times.

Tuesday, October 25, 2011

Play it as it lies


The most useful thing I learned in my recent six week stint with the psychiatrists is that psychiatrists are doctors too.  Here's the evidence:
  1. They know all about "Code Brown".
  2. They get really annoyed at inappropriate referrals, such as the person with confusion due to an infection that the ED docs think is bonkers and should get detained and given anti-psychotic medication rather than something more appropriate such as, say, antibiotics.
  3. Their handwriting is illegible.
With regard to point 3, although it's illegible, it does have the benefit of being voluminous.  They write so much that often you are able to get the general vibe of their notes even though the actual words are gibberish.

In contrast, the surgical team I've just joined, while they also have unintelligible writing, don't seem to be able to use sentences in their notes.  To be fair, this is probably because they are scribbling madly, desperately trying to catch up with the surgeon, who conducts the round so fast that windows are shattered by the sonic boom.

It's pretty intimidating getting thrown into the midst of this as a student because it means that anything in the notes is thruply confusing.  Not only is the handwriting terrible, the actual text is just bizarre abbreviations of things that you wouldn't understand even if it was actually written out in full.  On the round this doesn't matter so much because as a student my main tasks seem to be to hold the tongue depressors in case anybody wants to do some Playschool craft projects and to not get trampled underfoot by the aforementioned rampaging surgeon.

Clinics though - clinics are a different story.  Today I was given the job of taking notes, which is fine (in fact, the surgeon told me I was a "born note taker", which may actually be an insult, but anyway) except it means that I'm holding the notes and hence also have the job of flipping around in the previous notes and trying to answer questions about the previous appointments.

The surgeon would turn to me and ask something like, "What was the original plan when Mr Smith first presented last year?".  I'd find the page and see that it would seem to say something like, "P) OPO f/u A/S2 w C+R".  Now if you're roolly smart like me you can mentally adjust for the scrawlings and say, "Outpatient followup up in 1 month with a chest x-ray".  Which is fine. 

But the next line says, "2. FFfFt + ananas - ref/ chok", and what do you do with that?

I can't figure out what it means, nor even what it might mean.  The nihilistic part of me wants to throw caution to the wind by saying, "Klaatu barada nikto", just to see what happens.  However, that is not how you establish credibility on day 2 of a new clinical placement.  It's more suitable for a morning tea in week 5 when everyone already knows you're a bit of a nut.  So I simply say, "It looks like the plan was for fffffft, ananas and ref chok."

The surgeon pauses and stares at me long enough for my heart to skip two beats.  "Hmm, fair enough.  It wouldn't be my approach but I'm pretty conservative", he says, and carries on.

Thursday, October 13, 2011

I wasn't aware until now that I was an apologist for sexual predators

Nurse
There is a well-known case here in this city of a psychiatrist who had sexual relations with no fewer than five of his patients.

PTR
That's terrible.

Nurse
No, it's not.

PTR
?

Nurse
It's unacceptable.

Saturday, September 24, 2011

Not thinking about elephants

Psychiatrist
Well, what would you like to talk about in today's tutorial?

Registrar
Oh, anything at all, as long as it isn't the Oedipus Complex again.

Psychiatrist
It's interesting, isn't it, how the Oedipus Complex often brings out these types of very strong reactions from people.  It just makes you think that Freud must really have been on to something.  I know you don't want to talk about it but there are some fascinating things to consider such as how...

[One hour and fifteen minutes pass]

... ending in the destruction of civil society and the slow rebuilding up again which is, of course, the tragedy of man's inability to process or work through the Oedipus Complex.

Friday, May 20, 2011

Crazy horse

Being a parent sometimes seems to be a kind of benign psychosis.  You get so caught up in it that you lose track of reality.

The Hatchling really laughs and smiles when I bounce her up and down on my knee.  While I do this I sing an amazingly tuneful song that I made up about riding horses.  It goes:
Doo da doo doo doo-da-doo,
Doo da doo,
Doo doo doo-da-da-doo!
Riding on a horsey,
Riding on a horsey,
Doo doo doo-da-da-doo!
I've been doing this several times per day for the last two weeks and it only just occurred to me tonight, for the first time, that she has no idea what a horse is.  She doesn't understand a word I'm saying.  She just likes being bounced around.

It isn't her pretending that she's riding a horse, it's me.

Tuesday, October 19, 2010

Give me malaria or give me death!

Goya knew a thing or two about medical education.
This haiku thing is really catching on.  Today a psychiatrist started speaking to me in verse.

He was a pretty odd guy but I really enjoyed his company.  The conversation began by him asking me, "What's your claim to fame?"  I claimed to have no claim to fame but gave him the short version of my life story ("I'm spending 3rd year in Hometown, I used to be an engineer").  He sat staring down at his desk, deep in thought. 

"1940", he said.  And he wrote "1940" on his pad of paper.  "Was the year I was born".

"1949", he said, and again he wrote "1949" on his pad of paper, and he drew a box around it.  And then another box around "1940".  "Was the year I first thought to become a psychiatrist".  He would leave long pauses

in the middle of his sentences

so his speech sounded

quite poetic.

He continued to tell me his life story, accompanied by little illustrations of what he was talking about.  For example, when he was talking about the hypothalamic-pituitary-adrenal axis, he drew some little adrenal glands.  And when he used the phrase, "Following on from that", he would draw an arrow to a different part of the page and begin anew.  The whole page got filled up with a crazily complex flow diagram illustrating his professional life.

And much more!  For example, he asked me who won the first Nobel Prize related to psychiatry and I guessed that it was the guy who invented the frontal lobotomy, but he said it was much earlier than that.  Apparently it was given to a guy who was able to treat General Paralysis of the Insane, which was actually caused by cerebral syphilis, by deliberately giving people malaria.  The diagrams for that got a bit confusing, let me tell you.  We talked like that for more than 45 minutes because his first patient didn't turn up and he didn't realize that next patient was waiting already.

Anyway, the whole time there was this enormous blowfly careening drunkenly around the room, smacking into the light fittings and dipping distractingly in and out of our line of sight.  And that was when he spoke to me in haiku:
If we were at home
I would catch that fly and feed
It to my turtle.
It was really striking stuff.  So much so that at the end of the afternoon, after I'd seen him run through his list of patients and it was time to go to home, I thanked him for his time and said, "I hope you catch lots of flies for your turtle".  He let out a great bark of a laugh, like a seal, and waved me out the door.

I think I want to be a psychiatrist.

Friday, April 16, 2010

Dangermouse

I spent the day with a psychiatrist yesterday.  It was great.  I enjoy psychiatry a lot.  I don't really enjoy psych consults with GPs very much since they typically run like this: "Still feeling okay?", "Not so great", "Okay, try taking the tablets 3 times per day instead of twice and come back in a month", "Okay, see you then".  Not very inspiring stuff.

Psychiatrists get to spend longer with their patients because, presumably, the patients have a more serious need of them.  Its the conversations in these long consults that I like, when the patient isn't just trying to avoid getting pushed out the door.

But the most exciting bit about yesterday was that there was a mouse loose in the consulting room.  Halfway through one of the appointments, I noticed that the mental health nurse was twitching her foot in a funny way and staring at the floor.  I thought I might have to ask her switch seats with the patient, but it turns out she had spotted the mouse right by the patient's chair and was trying to persuade it to go back behind the desk without alerting anyone by doing this little minimalistic haka.  It didn't work.  The mouse came charging out right through us all, heading for the door.

The patient screamed.  We all jumped.  The mouse realized it was trapped because the door was shut.  I leaped up, announcing that I could catch it because I was from the country.  (I get that from my mother - the belief that any eccentric behaviour will be tolerated if you loudly announce that you're from the country.)  Of course, I failed to catch the mouse but succeeded in making myself look like an idiot.  The mouse ran back bahind the desk and vanished.  We all had a laugh and carried on.

The mouse made two other appearances in the afternoon.  The first time it bolted for the open door, running over the psychiatrist's shoe to get there, and then disappeared down the hall towards the lunch room.  About an hour later, once it had had some lunch I suppose, it sprinted back into our room and ran between my feet, under my chair and back behind the desk.  The patient we had then really jumped but the psychiatrist and I were quite relaxed about it by that stage, and laughed it off with an insouciant wave of our hands, as if it happens all the time. 

I noticed that each time after the mouse appeared, the patient was more relaxed and open with the psychiatrist.  There were more fearful glances over their shoulder towards where the mouse was seen last, of course, but it didn't seem to inhibit the consult.  Perhaps they had the right idea in the olden days by sending people out to asylums in the country where they could reconnect with nature.  Yes, most if not all of the therapies were a bit inappropriate and ineffective, not to mention downright dangerous or harmful.  But I think the prescription of a mouse to chase around the house might be just the thing to really pep people up and give them the change they've been looking for.  Who'd like to be a co-author?