Quote of the Week

Me: Mary*, you seem happier today. How are you?

Mary (smiling toothlessly) : Oh, I am better. I see the devil on your body.

Me: Excuse me? You see the devil on me?

Mary: Oh yes. I see the devil on your body.

[Pause]

Me: I like your new sweater.

Mary: Oh thank you!

*Patient name changed.
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If you're going to be crazy, you have to get paid for it or else you're going to be locked up.
Hunter S. Thompson

Questionable

This is a practice question I did the other day.

A 19-year-old man is evaluated for depression of 6 weeks duration. He enrolled in college as a freshman 5 months ago and began participating in intramural basketball, football, and soccer in addition to carrying a full academic load and having a part-time job. He smokes cigarettes and marijuana and consumes more than 12 alcoholic drinks on the weekends at parties. He is sexually active with four different partners. However, during the last 6 weeks he has seldom left his room and has stopped attending classes because he cannot concentrate; he is in danger of failing all of his classes. He feels restless, cannot sleep, has a poor appetite, and feels depressed. He can identify no precipitating event related to his change in mood, although he had a similar episode once before at age 16 years. There is no family history of mood disorders.

Which of the following is the most likely diagnosis?

(a) Bipolar disorder
(b) Dysthymia
(c) Major depressive disorder
(d) Seasonal affective disorder
(e) Situational adjustment reaction with depressed mood

(Question from MKSAP for students 4, American College of Physicians)

The answer I gave: Major Depressive Disorder
The one they said was right: Bipolar Disorder

They thought his behavior when starting college was "hypomanic".
Seriously??
I would just label that at "college freshman". No??

Interesting how much depends on your perspective.

So I've been studying lately, and sweating, and packing up my car wearing a dress, and sweating through the dress, and planning stuff for this weekend.
Fun things to post about coming up ...
a 30th birthday, a wedding, time in Vermont, and Buckfest.
And that's just the next 4 days!

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"A question that sometimes drives me hazy: am I or are the others crazy? "
-Albert Einstein

A Day in the Life

Someone call a psych consult on me STAT because I'm paying for this shit.
In other news, I got a haircut, Mom!

I got a text from my poor classmate who was on call last night at 2am.

"The list [of patients] is really long. [My Favorite Resident*] wants to start rounds at 5:30. Get here as early as you can."
*Heavy sarcasm

Usually we get in each morning around 5am and start the progress notes that the residents will fill out for each patient after we round on them at 6am.
This includes name, date, vital signs, ins & outs, medications, etc.
Basically glorified secretarial work.

I got this text message when I woke up at 4:30, threw on clothes and scarfed down an apple (all I would eat for the next 6 hours) on the way to the hospital.
We furiously filled out the progress notes and also transferred the vitals to a list of all the patients, which we made copies of for all the residents on the team.

Yesterday, My Favorite Resident had requested that we not make copies of the vitals list on pieces of paper that are 3-hole punched.

This morning we frantically looked all over the nurses' station for paper that wasn't pre-hole punched.
No luck.
Instead we raced up the stairs to meet the residents, stack of prepared progress notes in hand.

I handed My Favorite Resident the vitals list and saw him pause and his shoulders drop as he looked at it.

Preempting him I said, "Sorry, we couldn't find any paper that didn't have holes in it."

"I'm disappointed."

"I'm sorry you feel that way."

"I'm serious."

"I know you are."

"Did you check downstairs [6 flights] in the printer in the residents' lounge?"

"No, we ran out of time this morning because the list was so long."

"I'm not hearing anything you're saying. All I'm hearing is no, you didn't,"
and he walks away.

All this before 5:30am.

As happens at many points during my day, I was torn between the desire to laugh at the ridiculousness of his behavior and cry because someone like him is dictating my day.

Luckily, my day could only get better from there.

*I wore some new gold, happy shoes I got with my so far most flamboyant interpretation of a "professional" outfit.

Didn't know my face would be in this one...sorry for the creepiness...heh heh.

*I'm following the best attending this week, who is funny and kind and wonderful with patients and asks me how I'm doing [might not seem like a big deal, but common courtesy has been rare around these parts]. He told me he liked my shoes [I could've cried from the kindness] and that they reminded him of the Wizard of Oz, the book, not the movie because in the book her shoes were silver. Who knew?


*And he finished early, so I got to leave after only 10 hours at the hospital.
*Bliss*
Which was good, because those new gold shoes might need some more breaking in...