Clinic: now with 75% less stabby!
My prediction from yesterday didn't come true. I was actually happy after leaving clinic today. And not because I don't have clinic again until January 11. It actually went well, surprising even me.
Oh, and Mike provided me with today's teaching points. Hee!
We had four patients scheduled this morning. Dr. C was already seeing one when I got there and Mike saw the second one. The first one had no-showed. The patient scheduled for 10:00 was a new patient so I hung out for a bit. It was 10:45 and she hadn't showed so I was packing up my crap to head over to the hospital to read for a while before lunch. Mary Lou (Dr. C's nurse) then came in saying that she had been here since 10 but was checked in at the other end instead of our end (UPAC takes up half of the third floor and is C-shaped; the adolescent medicine portion takes up about 1/4 of the C and the end opposite ours is the general peds end, which takes up just over 1/2 of the C and that's where she was checked in...and of course, no one ever told us). We checked to see what we were seeing her for and it was depression/anxiety/anger management. Additionally, she's 18 and technically belongs in the adult clinic downstairs. But since she was here and she had been seen two years ago and we didn't know how serious her issues were, we decided to see her.
Her older sister was with her and when I started the interview, I asked L what was going on. She got about a 1/2 sentence out before her sister chimed in and proceeded to ramble on and on and on for about the next five minutes about absolutely nothing. To boil it down, L has had problems with anger, anxiety and depression for a long time. When she was seen two years ago, we had made referrals for therapy and the like but her mom never followed through because she didn't want her daughter to have a 'label'. Now L is back after having uncontrollable flares of temper - she has been incarcerated for stabbing people, she has thoughts of harming others and when she does get pissed, she literally goes into a blind rage. She'll be arguing with something and the next thing she knows she has a knife in her hand and blood all over her and she doesn't remember how that happened. Yeah. Not cool. And I'm starting to fear for my own safety at this point (she poses no threat 'cause all I have to do is lunge for the door and I'm cool...plus I haven't done anything to piss her off yet...but still...eek). I ask her if she currently has any homicidal thoughts towards others or if she could hurt someone right now. She said no. I asked her if she has ever felt like hurting herself. She started crying unconsollably. She admitted that she has had suicidal thoughts in the past but has no current intention of hurting herself. She continued to be emotionally labile throughout the interview. Her anxiety manifests as frustration; she doesn't have the words to explain her anger (methinks because of lack of adequate coping skills) and when she can't explain how angry she is, she resorts to providing examples: "My niece is 5...she's always saying 'hi' and hugging me and kissing me and it drives me up a wall. I can't stand it. I want to bash her head in whenever she talks to me." You can't reason with her by saying that's what 5-year-olds do because all she sees is red. It also turns out that all the women in her family are bipolar. I have this...thing...where when I talk to manic people, I subconsciously engage in a bit of transference - I always walk away from them breathing fast and with a rapid heart rate and feeling, well, rather manic. It's a bad way to diagnose it in others but that's how I always feel afterwards. We managed to get her an appointment in the adult clinic (even though they're not accepting new patients, which IMHO is bullshit), and an extremely urgent referral to psychiatry. She "pinky swore" with Dr. C that she'd get help if she had the intent to hurt herself or others. Let's hope she does. He'll see her next Thursday just to make sure she got help lined up and has started to see someone.
I went over for journal club this afternoon and ended up running into the NYU med student I did the sports med elective with this summer (she was interviewing today). I didn't think I'd understand much about what was going on, but turns out it was on evidence-based medicine and happened to know a lot. We had a team activity we had to do with going to find an article and answering a clinical question. I was able to find an article to use and answer the question. Not bad, eh?
After lunch I was 'promoted'. Mike had a full schedule at the other end so I was the resident of the afternoon. The slow third year barely spoke to me today, so that was a bonus. I saw a patient I had seen before. She has a history of anxiety/depression, self-mutilation and bulimia. She had a trying weekend - an ex-boyfriend called her to tell her of his suicide attempt (she was the only one he called; her and her mom made a few more calls and he was found home alone and had done what he said...he's ok but in treatment now), her current boyfriend's mom called her to tell her that her and the boyfriend wouldn't be exchanging gifts this year, and then yesterday the boyfriend broke up with her. The second of the three incidents lead to some superficial cutting on her stomach but otherwise, her mom said she did great. She dealt with things appropriate, though S is quick to admit she needs some coping skills. She looks shades better than the last time I saw her. I'm proud of how well she's doing. It gives me hope.
Before I forget, two very big thank yous:
-to wojsvenwoj, for providing me with access to wonderful music. The New Porn put me in a great mood to start the day. "The Bleeding Heart Show" from KCRW is permanently stuck in my head, and that's not a bad thing at all. Thank you very much!
-to warsop for my Christmas gifts. I can't wait to dive in to either of them! Thanks so much!
I'm gonna go put my jammies on and watch a House, MD rerun. Could be worse, I s'pose.
Moment of Burrito: "I saved a life. I deserve a shirt." - my patient S to her mom on getting help for her ex-boyfriend (she got a new shirt from Abercrombie; Dr. C told her to go for the whole outfit the next time)
Oh, and Mike provided me with today's teaching points. Hee!
We had four patients scheduled this morning. Dr. C was already seeing one when I got there and Mike saw the second one. The first one had no-showed. The patient scheduled for 10:00 was a new patient so I hung out for a bit. It was 10:45 and she hadn't showed so I was packing up my crap to head over to the hospital to read for a while before lunch. Mary Lou (Dr. C's nurse) then came in saying that she had been here since 10 but was checked in at the other end instead of our end (UPAC takes up half of the third floor and is C-shaped; the adolescent medicine portion takes up about 1/4 of the C and the end opposite ours is the general peds end, which takes up just over 1/2 of the C and that's where she was checked in...and of course, no one ever told us). We checked to see what we were seeing her for and it was depression/anxiety/anger management. Additionally, she's 18 and technically belongs in the adult clinic downstairs. But since she was here and she had been seen two years ago and we didn't know how serious her issues were, we decided to see her.
Her older sister was with her and when I started the interview, I asked L what was going on. She got about a 1/2 sentence out before her sister chimed in and proceeded to ramble on and on and on for about the next five minutes about absolutely nothing. To boil it down, L has had problems with anger, anxiety and depression for a long time. When she was seen two years ago, we had made referrals for therapy and the like but her mom never followed through because she didn't want her daughter to have a 'label'. Now L is back after having uncontrollable flares of temper - she has been incarcerated for stabbing people, she has thoughts of harming others and when she does get pissed, she literally goes into a blind rage. She'll be arguing with something and the next thing she knows she has a knife in her hand and blood all over her and she doesn't remember how that happened. Yeah. Not cool. And I'm starting to fear for my own safety at this point (she poses no threat 'cause all I have to do is lunge for the door and I'm cool...plus I haven't done anything to piss her off yet...but still...eek). I ask her if she currently has any homicidal thoughts towards others or if she could hurt someone right now. She said no. I asked her if she has ever felt like hurting herself. She started crying unconsollably. She admitted that she has had suicidal thoughts in the past but has no current intention of hurting herself. She continued to be emotionally labile throughout the interview. Her anxiety manifests as frustration; she doesn't have the words to explain her anger (methinks because of lack of adequate coping skills) and when she can't explain how angry she is, she resorts to providing examples: "My niece is 5...she's always saying 'hi' and hugging me and kissing me and it drives me up a wall. I can't stand it. I want to bash her head in whenever she talks to me." You can't reason with her by saying that's what 5-year-olds do because all she sees is red. It also turns out that all the women in her family are bipolar. I have this...thing...where when I talk to manic people, I subconsciously engage in a bit of transference - I always walk away from them breathing fast and with a rapid heart rate and feeling, well, rather manic. It's a bad way to diagnose it in others but that's how I always feel afterwards. We managed to get her an appointment in the adult clinic (even though they're not accepting new patients, which IMHO is bullshit), and an extremely urgent referral to psychiatry. She "pinky swore" with Dr. C that she'd get help if she had the intent to hurt herself or others. Let's hope she does. He'll see her next Thursday just to make sure she got help lined up and has started to see someone.
I went over for journal club this afternoon and ended up running into the NYU med student I did the sports med elective with this summer (she was interviewing today). I didn't think I'd understand much about what was going on, but turns out it was on evidence-based medicine and happened to know a lot. We had a team activity we had to do with going to find an article and answering a clinical question. I was able to find an article to use and answer the question. Not bad, eh?
After lunch I was 'promoted'. Mike had a full schedule at the other end so I was the resident of the afternoon. The slow third year barely spoke to me today, so that was a bonus. I saw a patient I had seen before. She has a history of anxiety/depression, self-mutilation and bulimia. She had a trying weekend - an ex-boyfriend called her to tell her of his suicide attempt (she was the only one he called; her and her mom made a few more calls and he was found home alone and had done what he said...he's ok but in treatment now), her current boyfriend's mom called her to tell her that her and the boyfriend wouldn't be exchanging gifts this year, and then yesterday the boyfriend broke up with her. The second of the three incidents lead to some superficial cutting on her stomach but otherwise, her mom said she did great. She dealt with things appropriate, though S is quick to admit she needs some coping skills. She looks shades better than the last time I saw her. I'm proud of how well she's doing. It gives me hope.
Before I forget, two very big thank yous:
-to wojsvenwoj, for providing me with access to wonderful music. The New Porn put me in a great mood to start the day. "The Bleeding Heart Show" from KCRW is permanently stuck in my head, and that's not a bad thing at all. Thank you very much!
-to warsop for my Christmas gifts. I can't wait to dive in to either of them! Thanks so much!
I'm gonna go put my jammies on and watch a House, MD rerun. Could be worse, I s'pose.
Moment of Burrito: "I saved a life. I deserve a shirt." - my patient S to her mom on getting help for her ex-boyfriend (she got a new shirt from Abercrombie; Dr. C told her to go for the whole outfit the next time)