The Five People You Meet...on-Duty

Sleeping to Dream. February 17,2011. 

I love my job.

It’s quite (by “quite”, I meant VERY) interesting, and every day, I always meet someone new, or learn, discover, or be taught something that I hadn’t known before. (I suppose it has been fairly obvious from the start. My job is not my [whole] life yet, but suffice to say, I’m just terribly glad that I am where I am right now.)

I’ve always wanted to be in a situation where I could 1.) help people, 2.) never be bored because there was always something new to surprise me, and 3.) dress up the way I want.

(J Shallow, but hey, perks are fun once in a while.)

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This piece is not at all related in any way to Mitch Albom’s book, but of course, I have learned something from them at some point or other.

The anti-social

I had finished admitting my first patient for the day, when I noticed the Family Medicine resident interviewing a balding man, dressed in a collared shirt, khaki pants, and leather shoes. He had a green envelope that he kept tucked under his arm. “Is that a referral for me?” I asked the family medicine resident who was on-duty at the ambulatory care unit. “Actually, Ma’am, we’re still trying to figure out if this patient can make do with counseling, which we can do at our out-patient clinic…” he said. He went on to say that the patient said he was “depressed”, and that he had “suicidal ideations” (his own words, take note). I figured, since I was there anyway, and I had a feeling that they were going to refer the patient to me for further evaluation, I went ahead and examined the patient anyway.

When talking to a patient, it is best to keep an open mind, as you never know what you’re going to get. Yet, there was something about this same patient that annoyed me. I couldn’t put my finger on it, but while I did my usual “run” (when I talk to someone, I like to take note of their eyes, their mouths, the facial expressions they are capable of, the way their hands move, the way they move when they talk to me…and if their eyes tell me anything.), and felt…weird

When I talked to him, I felt weird…he wasn’t psychotic (that’s what we first year residents are supposed to handle at the ER), and he talked normally, but I could smell that this was something else…a personality disorder. I noticed that as we were talking and I tried to get his story from him, I had to consciously stop my eyebrows from meeting in the middle. I was annoyed semi-consciously, and yet I knew I had to hear his story through. He came alone, and claimed that he wanted us to admit him, so that his family would see him and do something about it.

He was a pretty bad liar (which was probably why I had an aversion to him).

In the end, he checked out my DSM list for a personality disorder.

“Congratulations, S. you just met your first anti-social, “ my consultant said.

(It wasn’t a very pleasant experience.)

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The family medicine resident

My senior told me one time, about how important it was to properly coach the family medicine resident on-duty at the ambulatory unit in evaluating psych patients so they wouldn’t have to wake us up in the middle of the night for a patient referral which wasn’t emergent anyway and could be seen on an outpatient basis.

(Actually, I don’t mind patient referrals, because I’d go see them anyway.)

The resident (whose name was the same as a guy I used to date, by the way) was ok enough, a bit timid, which amused me, because there was no seniority, supposedly. We were both first year residents.

FamMed and Psych (that’s mine) aren’t really the most popular departments in my hospital (possibly because we’re not as “impressive” as the internists, or the surgeons?), according to Trina, one of my co-residents. Still, I do believe we both have our merits…and it all boils down to it being a lifestyle choice.

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The fresh-faced clerk

That day, I was with a student. He was a junior at the College of Medicine, and on that day, he was up for a 12 hour duty session, and he tagged along. I had him interview the patient I had diagnosed to be anti-social, while I went over to the Blood Bank to do my weekend work there.

When I came back, he had written out his histories, and was endorsing the patient to me (in this context, endorsing is when the resident, moi, would listen intently to what information he reads off his sheet of paper while I point things out, and I ask him questions, or do some teaching.)

He tagged along with me, for most of that day. I didn’t mind at all, because teaching students has always been a fun activity for me (and besides, in my hospital, it is a MUST to teach students, it is a tradition we all are meant to uphold.)

Besides that, he looked like a young Scott Wolf, and happened to be my mentor’s nephew. The most fun thing about him was the fact that he was Ilonggo, and we talked in that dialect. Furthermore, he was from this place in Iloilo called Tigbauan, where they speak an altogether different dialect, called Kinaray-a, a hard, crisp-sounding dialect. (Ahhh, music to my ears, of course.)

(I miss Iloilo and its sounds. It was home for a few years, and I’ll always have fond memories of it. :-)) Anyway, he was a pretty verbose clerk, and an able student, who’s convinced me to look into Stephen Covey.:-p)

The anxious mother

That same day, I had another patient who was brought into the Ambu (yes, another one. When I checked her chart, it said that she was brought in because she wasn’t taking her meds.

My first impression of her was that she was just terribly misunderstood, and people at home got on her nerves. She had temper tantrums at home, but when I talked to her, I found her to be easy enough to talk to. And I had no fear whatsoever of her jumping on me and beating me up…

…which was what her mother’s “painted picture” of her was. “Tie her up now, doc, set her mind properly. Admit her at the psych ward now! She’s a danger to herself and to us!”

Whoa…

(let me say that again…)

Whoa.

I find it easy enough to talk to people, and if I didn’t, I usually have a way of getting to, but this patient’s mother was just impossible. I then understood the principle of counter-transference.

She made my blood boil, to say frankly. I wonder if her daughter feels the same way… This mother had a way of twisting things, and that if you hadn’t talked to her daughter first, you’d say that the kid she talked of was a mad, raving lunatic.

What a pity.

The patient did exactly what I said, she took her meds and gave herself the shots.

She wasn’t primarily a psychiatric referral; I had the family medicine patient refer her to the internists because of her more pressing medical problem and checked up on the pair every two hours.

They left against medical advice later in the day, and I wasn’t informed.

When I inquired later, “Hey, did the patient ever become agitated?” the EMS personnel said, “No, but the mother did.”

(haha.)

What a pity. I feel for her.

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The look of love.

A patient was referred to me that night, for behavioral changes. She had been brought in from the northernmost part of the Philippines (a very long way away). She had been admitted for days at a hospital there, and since she wasn’t getting any better, they brought her here.

She was indeed mentally ill, but it was an early onset case, and we strongly felt that we could do a lot for her. She was quite hard to talk to at first, but it was pretty understandable. She had had typical antipsychotics, and was still feeling the side effects.

I talked to her husband, as well, and he was a knowledgeable enough guy, and knew her symptoms. He was very helpful during the interview.

The memory of him holding his wife, keeping her steady while we were interviewing, his looking at her with so much love…got burned into my memory, in a good way.

Mental illness is no easy matter, and it helps a lot to have people around you who care enough about you to help you go through it.

I knew from the start that this patient was going to get better in more ways than one.

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(I don’t mean to get emotional when talking about my patients, but in the general sense, they all have unique stories. I try to stay as objective as I can, any emotional involvement hampers the work that I do. I lose all "powers", that way. :-p)