Tuesday, March 20, 2012

A Cure for Nausea... and Music

Nausea- A word I've always had trouble spelling. And I've only had to use the word a million times in medical charts. This is an 'in case I forget later' post. I've had nausea for only about 4 or 5 days now, and the ONLY thing that takes it away is CrossFit. I'm serious. There's no time to feel nausous. There is only time to stay focused and work hard. Another 'in case I forget later' thing to write is that I have found that music does far more for me these days then it ever has. I'm trying really hard to not make this sound completely corney, but instead of music just getting under my skin it now just flows right through me. This sounds absurd. Whatever :)

Thursday, March 15, 2012

Thought Disorder

(I introduce myself and ask what's wrong.)
Can I have coffee?
My mother likes coffee.
I can't be having those people coming and sleeping at my mother's house.
All I got is this cup and my mother.
I got an infection of my hands.
I'm holding somethin' wif nuffin'.
They built in a school.
(I ask the patient to go urinate in the cup. Patient goes to the bathroom and comes out a minute later.)
I can't urinate I'm sorry.
I don't have no brothers and sisters.
(I have the patient sit back down and ask how the patient's mood has been lately.)
I can't be happy after what they did to me (shows me an old scar, I inquire about timing and event).
They did it to me the same night I got shot.
I'm not superman.
I'm not gonna keep doin' this for ya'all to tear me to pieces.
My mother's still there, what we gonna do with her.
My mother, she needs to lie down.
Ain't no computer out there for her.
She wants to see the world.
I don't understand why.
That's why I go to the club, cuz when we together we argue.
They got destruction going on at the club.
(I ask: construction?)
No, destruction.
I ain't gonna give no piss like that to the doctor.
I got a house trying to sell out to a school.
I'd rather have a purpose then destruction.
Saving everybody, not one against another.
I got to find these people.
(I ask: Do you do drugs?)
(Response): I don't supposed to.
I drink Pepsi, I drink coffee.
I take pills.
I keep hair out my nose.
I got tired of cutting my hair everyday.
This is the only way I can talk to a woman, if I come to the hospital.

This post is written as an illustration of thought disorder. It is the exact dialogue between myself and a patient. Here we have flight of ideas and loosening of associations. The patient is actually not anywhere as ill as many others I've cared for. Sadly schizophrenia can be devistatingly disabling. The most disabling feature is not exactly the symptoms but the absense of insight. Nearly all patient's who suffer from schizophrenia do not believe they are sick. It's like their mind's wiring of reality is so distorted that they cannot comprehend the mind they used to have. They do not realize they are sick because the sick mind is the new mind. It is the only mind. But the person there is still the same person. And that is what has been one of the greatest challenges and rewards of what I do, connecting to and helping that person lost within the ill mind.

Wednesday, March 14, 2012

Assuming Responsibility

There are too many directions I could take this post, so I may babble a bit... I'll try to keep it tight and will just write again later/tomorrow when I have more time.

So here it goes. 15 minutes of writing. No editting. (Need to go to bed STAT).

This post was originally inspired by the doofus that was trying to send a violent patient from one area of the hospital to my ED (psychiatric ED). The patient was being extremely violent, and the staff responsible for him were 100% trained in what to do. But you know, some people will always try to go the easier route. When the person with the least amount of information came to my ED and asked the person with the least clinical training if the patient could be transferred over, my associate rightly consulted our 'rules, blah, blah, blah book' and was unsure. I was of course there and became involved right away. There are far too many opportunities here to insert my commentary, and details of the case as always will be 100% left out to ensure patient confidentiality, which is something I am a big stickler about. Long story short, I ensured that the patient was not transferred and gave recommendations of what to do to ensure the patient's and other's safety. Twenty minutes later, no joke, it is all over the security officer's walkie talkie that this patient became far more violent and, again I need to leave out details, there was something like a dozen officers on the scene to contain the situation. So, I, heatedly and obsurdly authoritarian-like ask, what in the hell gives people the right to NOT assume responsibility. I could go on, but I only have 5 minutes left. Apparently I type slower than I think, or I think too slow... not!

Then today I ask an attending to please put his final one-liner on a patient's electronic chart so that I could send the patient to his destination and the attending tells me he has never heard anything about the patient, that he has no knowledge of the case, and that he would need the case to be presented to him. Sure, okay, problem is this attending signed an involuntary commitment form for this same patient one hour before my shift began. So I showed him this very serious legal document with his signature and the patient's name on it and he STILL insisted that he didn't know anything about the case. And he adds 'you know, people bring me forms all the time that I just have to sign...'. Okay, fine, well this form just happens to be one of the absolute most important forms in the ED. It's as important as a DNR/DNI form. Because yes, for patients who are involuntarily committed it is most often due to a matter of life and death.

Well, I'm one minute over but would like to continue for a few...

There are other responsibilities I'd like to call on at this time.
As you know from the last post I am pregnant. I'm about 5 weeks right now and right now is when all of the baby's organs begin to develop. The nuchal cord is about to close if it has not already. The next 7 weeks are pretty intense for the baby's development. I read that right now, more than any other time in pregnancy, I've got to be really aware of what I expose the baby to. So, last night I decided to check out the ingredients of the whole wheat graham crackers which are individually wrapped and located in a bucket next to the water where I am currently working. Most nights I might eat one or two. Don't ask me why. Frustration, stress, tiredness, hunger, who knows. So, the ingredients include high fructose corn syrup, TBHQ, and some other three letter acronym for a preservative. I hate preservatives. So, no more graham crackers for me. Next week I'm back in my office where there is a huge jar of M&M's next to the water source at that location, NO NO NO NO NO!!!!! I keep telling myself to start making juice everyday again, flood the body with the love of a high-greens, non-processed balanced diet. It is my responsibility. Green love for the baby on the way. Last week I ate a ton of collard greens, brocolli, bell pepper, spinach, carrots with other food... this week I have been a little more lazy. I read today that mom's who eat hot dogs (barf) during pregnancy have babies with more brain issues- the article blamed it on the nitrites... more interesting research to do I suppose....

Other responsibilities to remind you of-
Practice daily maintenance on not just your body but also your mind. Check in with yourself. Give yourself a break by going easy on yourself when you need to. Talk things out with your loved ones. Let your loved ones know how much they mean to you. And if you cannot express it fully in words show them. I do believe actions speak louder than words. Smile often. Be joyous. Be limitless. You are an endless supply of love and wonder. Internalize what you learn as often as you can. What I mean by internalize is to simply acknowledge with great respect what it is that you felt/thought/learned and move on. Rest assured it will be stored away where you will be able to retrieve it; do not dwell on things.

Ah, it's that time, I need to sleep if I'm gonna go to CrossFit tonight before work. Two more night shifts then I'm back to a semi-normal schedule again for a few months :) Hope to have some wild dreams right now (I often do, I just don't remember them for more than about 10 minutes after I wake up...). GN!

Monday, March 5, 2012


Sarah: "I might regret this, but I'm gonna go confirm this guy's social security number..." as she leaves the room to approach the irritable manic patient in the room next door. He is doing his best to be polite and pleasant, but can't help himself from trying to convince any staff that will entertain him that he will be the next *insert grandiose position of power here*.

I am pregnant.


He is mumbling something about Atlantic City now. He is quite the talker. Oh yes, he's manic. I said that already.


I said that already too.

I am still a little shocked, but I don't really have a reason to be. I'm shocked that it happened so fast, although Cami said she was pregnant after only 2 and a half weeks of trying. And I believe Mandi gave me 2 months tops. I'm shocked that Cain knew last week, days before I took a pregnancy test. The exact conversation:
Cain: I think you are pregnant.
Me: Why, because I've gained a little weight?
Cain: No, because you smell like 'baby'?
Me: Oh, well I have not showered today.

I believe that was Wednesday or Thursday of last week.
The next day he asked if I took a pregnancy test yet. I had not. He said I still smelled like 'baby'.

I finally took a pregnancy test Sunday morning. One pink line and one faint pink line. Asked Cain if there was one line or two. He said one and a half. Posted that on facebook so our friends and family could get a good little chuckle.

The manic guy is silent now.

They all got more than a chuckle. They got word that I was pregnant. Now everyone knew before me.

So I went to Tae-bo. It's a party, it's a party, it's a party, ay!... No, seriously, Sunday mornings is straight-up a Tae-bo 'party'. Before I went to Tae-bo Cain said, "you can't go to the gym, you have to eat now, you have to GET FAT". Is HE insane? He believes I am obsessed with food and exercise. But really I'm obsessed with being fit and healthy; I wouldn't really say obsessed I'd say pre-occupied, or rather it is one of my very top priorities. Anyway, I went, and when I came home there were nearly 30 comments on my facebook post. I love you all so much :) Went and got the 'yes' or 'no' test, and it said 'yes'.

So here I am, preggo, or as Lindsay says, preggers.

And now I finally have a reason to blog! Hip hip hurray! I don't know, something about just blogging for the hell of it didn't seem so meaningful to me. Well, not so much that it was not meaningful, it just felt too exposing, too self-serving, too 'obsessed'. But now there is a little peanut who can one day read all of my verbal diarrhea and hopefully appreciate a little chronicle of his life in the womb...

Sarah's great comment a moment ago: "You know you're in trouble when the patient walks in with The Harvard Dictionary of Medicine."