SPOOOOOOKKKKYYYY

My favorite holiday of the year!!!!


HAPPY HALLOWEEN!!!!

ransacked

Yesterday after studying for 4 hours I decided I needed to release some energy. I got ready and left to go to the gym when I noticed my driver side door was prompt open. I opened the door completely and saw my car was ransacked. The glove box was left open, the center console opened and contents were thrown about, old gym clothes that were on the ground were thrown everywhere. Luckily few items were stolen---my ipod, a few old already expired credit cards, a few bucks that were hidden in my ashtray and my insurance card. No damage was done, well, to the vehicle.

I, on the other hand, was pretty upset. I've never had anyone steal or break into anything of mine before. I felt violated. The car was parked right in front of my house, in my driveway, literally 20 feet from my bed. There was a huge knot in my stomach, pretty much all day. And I know that I was lucky and it could have been A LOT worse, but the upset feeling was still there. I wondered why this person or people needed to break into my car---did they need money for rent? for drugs? or did they do it just for fun??? A lot of the kids I work with now have stolen to keep their habits up. I wondered if this was a future child psych patient. And I wondered how many times they will commit these types of crimes before they actually get help.

ROOOOAARR!!

So tomorrow when I meet with my 15 year old female patient with suicide ideation I am supposed to be mean. My resident says that its time to push her buttons and get a response out of her, otherwise she'll stay in the facility forever. She really enjoys the psych ward and isn't interested in leaving (possibly a borderline personality disorder) so the resident told me we've got to make her slightly uncomfortable. I have a problem with this.

I suck at being mean. I may think of mean things to say after a fight or during a situation but they never actually come out of my mouth to the person. I can rant and rave about being pissed off at something, but thats as far as it will go. I even have a hard time writing mean things on here! So I've decided that this will probably be more therapeutic for me than for my patient. I've got to push her buttons while hiding my feelings of feeling bad for doing it.

this is not going to be easy........

OCD

OCD: Stands for Obsessive Compulsive Disorder
Obsessions are:
recurrent and persistent thoughts, impulses, or images that are intrusive and inappropriate and that cause marked anxiety or distress
Compulsions are:
repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly

The worst patient my doc has ever seen: the guy counted how many breaths he took each day. That is all that he could do--day in and day out. Breath (1), Breath (2) Breath (3)....Now that's commitment!

I gave it my best shot, counted one breath, got bored, and quit.

thinking thru the kid crisis.......

I love kids. Ask anyone. I was a nanny in Denver during undergrad. I spent a lot of my free time taking the kids to Chuck E Cheese or to the movies or taking them swimming or to the science museum. It was always a blast. They ask great questions, have great imaginations, and laugh at words like poop and fart (lol i said fart...). So although I whined like a little kid my last blog I was actually looking forward to hanging out with the 3'9 clientele. That was until I realized that these are sick kids.

Sick not as in physically ill (although a couple had the flu), I mean psychologically and socially. The cute 12 year old girl told me how much cocaine she snorted. The 15 year old girl old me about how her 23 year old boyfriend was going to be mad at her once she got out. The 9 year old girl told me how she attacked her stepmom in the car while she was driving...for no reason. And these are just the girls.

I know I'm not going to personally "save" anyone, but looking around the room and hearing these stories, I start to lose hope that anyone will. I would say that usually I'm a positive person. But these situations suck the positive thoughts right out of me. These are the kids that grow up and become the adults that I saw the past 4 weeks. These are the kids that my mom sees in juvenile court--time after time.

How do I go back every morning with such a grim outlook? Each day I go into work hoping that someone will be given a chance to make a good choice and actually choose it. Unfortunately the real test is not while these kids are in the safe inpatient facility---its when they are surrounded by temptation or pissed off at the world, but at least they get some practice in a safe environment.

resistance

i dont want to go. I don't WANT to go. I DONT WANT TO GO!!!!!!!!!!

ok now that I have whined like a little kid, I'll go start my child psych rotation.

ugh.

the hospital

Yesterday I completed my two weeks for psych consults and this next week I start outpatient child psych. Although I am ready for a change, I am sad about leaving the hospital.

The past few weeks I realized how much I love being there. I look forward to chatting with the caf workers---they have become my friends because I eat there so often. As I roam the hospital halls I run into people I know who stop to say hello---other medical students, surgeons that I worked with last rotation, and even a couple of patients. When I descend to the basement and I walk into the emergency department, I feel at ease. Not only do I know the docs there, but I get excited about what cases could be there---anyone need stitches? an ABG? any traumas come in today???

Psych has gotten better over the past two weeks, but its definitely not for me.....I think I would be too invested and unable to separate my life from theirs. Which is why I think surgery or Emergency might be better for me---there is a degree of separation already built in.

After my psych test, I am moving to a different city to do my OB rotation. I guess new scenery will be good for me, but I'm definitely going to miss the hospital.

you did what??

Last week when I was on call, we were consulted for a patient on the floor who had a small bowel obstruction leading to surgery. During surgery they found a condom full of water. We were consulted to assess his suicide thoughts and see if he needed some psychiatric help.

When I questioned him how a condom full of water ended up in his small bowel, he explained how it was a complete accident. Just when I was about to press the issue about how a condom filled with water was in his mouth, he states that he didn't mean to swallow it. Apparently he was having sex with his girlfriend, thought it would be hot to deep throat a condom, it got stuck, he choked and had to swallow it. He thought his stomach acids would digest it. He woke up at 3am with severe abdomen pain and vomiting that he couldn't explain so he came into the hospital.

I love these patients.

quote of the week

When asked if a kid was intentionally doing bad in school to passive-aggressively show up his parents he replied:

"No way! That's like shitting my pants just so someone else will have to smell it. I mean, come on, you still have to sit in your shit."

the child experience

Last week I spent a morning in child psych. The doc specialized in kiddos with substance abuse problems----all the kids live at a ranch in a near by town for a year and they take online high school classes, do gym, and then help out with chores on the ranch.

The first kiddo was really outgoing and friendly. I realized I could be totally manipulated by this kid if the had the brains. He then started telling me what he did before the ranch.

"My first choice was alcohol. I drank A LOT! Then we did cough syrup. Which was great because the only screening test for it costs about a thousand bucks"
-- how much cough syrup did you drink?
"At first it was just a bottle. I quickly developed a tolerance and had to drink almost a liter."
--a liter??(!) how did you purchase all that cough syrup??
"Well, I'm a good writer. I wrote to the nearest cough syrup production company and told them I worked in a lab and that I was doing research on the CNS effects of cough syrup by testing lab rats.....they sent me a shit load."
---oh my god.

(OK I didn't say that- but it was clearly what I was thinking. I am sure my face expressed it and the kid probably totally read me. I am so screwed with the wicked genius kids!)

what i think about

Going in everyday to the psych ward makes me feel like I'm part of the movie Girl, Interrupted.

It all started my first week--all the patients really got along well and they would talk about one another during our therapy sessions. It reminded me of the part when Susanna (Winona Ryder) and Lisa (Angelina Jolie) all got together in the basement and did their own "therapy" thing.

Everyday I wonder who will be the patient with the baked chickens rotting underneath their bed.....