Found out another patient I grew close to committed suicide on New Year's. He was my first psych patient ever. I took care of him for almost an entire month. He was the one who made local headlines, having had a SWAT team tear gas his home and haul him in to the VA. Given previous violent behavior, he was placed on "red dot" precautions, meaning staff should never see him unaccompanied.
I hated the way he always smirked at me in the mornings when I'd bumble through rounds. His anger and sarcasm made me nervous. He was one of those high-maintenance patients who always seemed to know when I was drowning in other paperwork, and demand to speak with me. I always dropped what I was doing because back then, I didn't know any better about drawing boundaries. Luckily, he grew to appreciate this and started cooperating with me. By the time he left, he was smiling and joking with me each morning, even looking out for me when I had to deal with a bigger and physically threatening patient.
Anyway, he was taking massive doses of oxycontin and vicodin, which I had tapered down and eventually discontinued. I switched him to gabapentin (which I'm still not entirely convinced does any bit of good - it's like fairy dust for psychiatrists - very expensive fairy dust). The plan was for him to get suboxone in our substance abuse clinic. Because he overdosed in the past in a suicide attempt, no other doctor in Michigan would write prescriptions for opiates. He had to go 400 miles away to get these meds. They found his body in a hotel a few weeks ago, next to several empty pill bottles.
Later in the day, I ran into three more of my former patients running around in the VA, two employed there now and one there for a med refill. They all said hello, shook my hand, etc. Weird mixture of emotions to see them doing better, but thinking of Mr. B's death all the while.
It's hard for me to process patient suicide, particularly when I felt we had a good therapeutic alliance. In a sense, it feels like a betrayal. I know it's stupid to go on about how I feel betrayed when someone died, but it's the best way I know how to describe how it feels.
This is the second of my high risk OIF/OEF veterans who have overdosed shortly after I worked with them. Both had seen other physicians between discharge from inpatient psych and their deaths, and even started rehab programs. More experienced psychiatrists tell me it's not really my fault then because I've done all I could inpatient, but with high risk suicide patients, it's more like a game of hot potato isn't it? Who will see him before he finally manages to kill himself?
I know you can't save everyone, that it's useless to wonder what I could have done differently, but I can't help but dwell on this tonight. I'm so grateful that I ran into the other three today, and got the chance to see them doing well. They have no idea of the impact they've had on me. Not every day is getting shiny red toothbrushes as Christmas gifts, or being asked to stand in at a delusional patient's wedding. Still, I love doing what I do.
Ann Arbor is super-duper. I am still working on the new friends part, but it's tricky when the only people you regularly hang out with are colleagues and patients. For what it's worth, I do enjoy spending time with my cohort. And today, one of my patients invited me to her kennel up north for a ride in her dog sled when she gets out of here. (She was a med patient, not psych, which might have given me pause.) I'm more interested in going to see if this tiny old lady will really yell, "MUSH!" or whatever it is they yell in the Iditarod.
Anyway, I survived long call #2. My scattered-brained night senior paged me x6 on the same patient in the space of one hour. (Day senior is cupcakes and sunshine, tells me I'm a good intern when I'm being a dumbass, brings us coffee sometimes, and most importantly, actually teaches us stuff.) Whatever, I didn't need that sleep or anything. What really irks is the indignity of doing an unnecessary fecal occult at 3 AM (to heparin gtt or not?). I would have vomited had I eaten anything prior. What made me really want to cry was the attending telling me the next morning that the patient would have gotten a heparin drip regardless of guaiac outcome. FML
Why does ACLS training take two days? I wish I would have remembered to take the recertification course (4 hrs) instead of letting my certification lapse and having to take this stupid-long one. Anyway, when the psychiatrist is running a code, you know you're in trouble. On the plus side, I learned two cool things about the UM hospital today. 1) track lights on the ceiling guide you to the code (so, try to casually saunter in the opposite direction) and 2) the elevators ding twice when going down, once when going up (no more rushing an elevator going the wrong direction).
I really like all my colleagues so far. When I interviewed, the program director specifically stated that things like AOA (medical honors society) or a 4.0 GPA were *potential* red flags - possibly rabid gunners or prima donnas. Guess we'll see how that works out soon enough. Anyway, I've organized a dinner on Saturday (Ethiopian food). Wonder how many people will show up! There are some serious foodies in the group, so I'm hoping we can have occasional dinner parties when I get my apartment fixed up.
Visited the Planet Rock gym! Seriously, this gym makes my old one look like a kid's playground. There's this cool-looking stalactite in the corner, but I don't know how to lead-climb (or belay) yet. I love it, but I probably won't have much time to go climbing these first few months. They keep us pretty busy at the VA, where I'm starting on Wednesday. Wish me luck. :)
I'm really just goofing off here, not trying to see any of the usual touristy sights this time since I've been to most of them already, but there are a few worth a revisit (British Museum, Covent Garden, Regent Park Inner Circle). This week has mostly been about relaxing and spa treatments. Went to the Turkish baths yesterday where I did the hot, hotter, hottest rooms, then jump-out-of-your-skin icy pool cycle several times before a body scrub and falling asleep for a couple hours in one of their comfy beds.
Today I continued being totally useless (unless being decorative counts) and had an eyebrow threading (best arches ever for only five pounds), a haircut, and my first leg waxing ever. The leg waxing didn't hurt like the threading, but the attendant swore I didn't need it because my leg hairs are so fine. Hm. That would explain why it feels like the hairs were just broken off, because it still feels slightly stubbly. I get much better results from shaving. Oh well. At least the haircut looks GREAT.
Watched a dude in pink hotshorts juggle a chainsaw on a unicycle in Covent Garden. That guy was a riot. "Kids, if your parents don't give you at least a tenner to give the crazy man in the pink shorts, they don't really love you. Just kidding. You know that's a joke right? It means you're really adopted. . . And I'm your real father."
I'm so ready to go home and hear familiar Okie accents again.
just peeled off the remnants of a large slug which had been smeared under my shoe. UGH. If there's anything that squicks me out more than cylindrical, limbless creatures, it's *slimy* cylindrical, limbless creatures. :(
GAH!! Freaked out by Manu's story of the spontaneously exploding slug. Bizarre wildlife in Clermont-Ferrand, I tell you.
via Wikipedia: Freak of Nature fact #1: Most slugs will on occasion also eat carrion, including dead of their own kind.
Freak of Nature fact #2: A commonly seen practice among many slugs is apophallation. The penis of these species is curled like a cork-screw and often becomes entangled in their mate's genitalia in the process of exchanging sperm. When all else fails, apophallation allows the slugs to separate themselves by one or both of the slugs chewing off the other's penis. Once its penis has been removed, a slug is still able to mate subsequently, but using only the female parts of its reproductive system.
Folk medicine from rural Italy: The garden slug Arion hortensis is used to treat gastritis or stomach ulcer by swallowing it whole and alive. A clear mucous produced by the slug is used to treat various skin conditions including dermatitis, warts, inflammations, calluses, acne and wounds.
Oh hellllll no. I'll keep suffering through that ulcer if it means I don't have to swallow a live slug. Or you know. . . try H2 antagonists/antacids.
