This morning we were assigned to go to a mental health court in Dallas to watch a psychiatrist, Dr. G, testify for a patient who was refusing to take her meds. David and I both spent the night at the dorms so we carpooled to Dallas (met some nasty traffic) and arrived about 10 min late. Fortunately the court proceedings hadn't begun yet, and we saw a group of orderlies haul a man about my age in a straightjacket into the waiting room. He looked like he was fighting the orderlies at first, but once he was released he was as polite as could be. Naturally we were interested in why this young man was here, and after Dr. G (who looks like a Marine) presented his case (it was straightforward since the patient wasn't present), he encouraged us to stick around since this case was going to be more interesting if the patient got to testify.
The way the courtroom was set up: the ADA sat at one table, the defendant and his lawyer sat at another table, and the orderlies sat near the defendant in case he acted out. The judge faces everyone, and the "audience" consisting of the defendants parents, some nursing students, and some med students (us) sat along the wall. The defendant (a 25-year-old I'll call JR) was a successful consultant who suddenly "quit" his job around April-May and since then became reclusive from friends and family. The few times he did talk to his mother, he made comments about "wanting to put an end to it" and "being filled with darkness." His parents were concerned, and finally, one day when he was supposed to go to his parents' home, he ran out of their car and locked himself in his apartment, prompting his mother to call the police and put him into protective custody. Throughout the doctor's testimony I was staring at the back of JR's head so I couldn't see his face (but Sital later said he was smirking), and when the ADA asked whether any examples of outbursts could be described, JR suddenly leaped to his feet, let out a scream, and shoved the table over, spilling water on the floor and scaring a whole bunch of people. "There's your example!" he yelled before the orderlies cuffed him and led him out of the court room. "Five minute recess," said the judge. Yikes...
We thought they wouldn't bring JR back into the courtroom, but they did, this time in a straightjacket. By this time the table had been set up again and the judge warned JR not to make any more outbursts. "That was a nervous tic," he said (yeah right). The doctor finished his testimony, and when the judge asked the defense if they had any witnesses, JR requested that his mother be called to testify. His attorney allowed it, but made a point of saying that this was against legal counsel. So JR's mother (who was seen crying after his outburst) took the stand and described her son's downward spiral from the time he quit his job (and apparently lived off his savings for the next 4-5 months b/c he wasn't job hunting), the dark comments he'd made threatening to kill himself, etc. She was calm on the stand and told JR that she was doing this out of love for him, and she and her husband would personally take care of his medical bills even if they had to sell their house to do it (now that is devotion). They wanted to keep him in the mental hospital in Dallas, where they work, instead of sending him to TSH.
Throughout this testimony, JR remained silent except at one point where I wasn't sure if he let out a sob or a snort. When it was his turn to talk, he denied most of the things that his mother said (even though she has nothing to gain from having him hospitalized), and practically bragged that he was able to live comfortably "like a teenager" watching movies and sleeping in the months since he quit his job. At one point he challenged the ADA's question about what he did all summer (he said he was too lazy to find another job), and the judge said he had no right to talk to her like that (he didn't know she was the ADA) It was obvious that he was well educated and had made lots of money before he was diagnosed with bipolar disorder. He insisted that there was nothing wrong with him, that there was no need to hospitalize him, and that he did not want to take medication because he didn't need it. The judge ruled to hospitalize him, and after that there was another medication proceeding in which the doctor described the medications he would like JR to take in the hospital. The ADA asked questions about the drugs' side effects, benefits, and whether or not JR would benefit from taking these drugs, and in the end it was ruled that JR would take whatever drug was given to him.
So yeah...that was a really interesting case, and it had to be so difficult for JR's parents, especially his mother, having to testify against him while he was probably smirking and saying nothing. JR goes against the norm of most psych patients because he had loving parents, a successful yet stressful job, and an excellent education, and yet he still ended up bipolar. The worst part is, this could happen to any of us. Maybe someday halfway through residency, the stress will get to us and make us snap, and then it'll be us in court denying everything that happened while our parents watch us and cry. It's heartbreaking to think about.
This afternoon I stopped by Dr. R's office and she told me (rather analytically; nothing gets past this woman) that I needed to be careful about falling asleep in front of attendings because it's very disrespectful. I apologized and told her that it wasn't the first time, that I've been sleepy ever since rotations started, and after asking me if I had narcolepsy (I was quick to say no), she told me to adjust my sleeping schedule or do something to stay awake. "You got more rotations ahead of you," she said, implying that I can't keep going like this. I really appreciated her honesty and concern; not all attendings will talk to students one on one about things like this. She also said that she just dictated a 44-min letter to Dr. Budd regarding the last group of students who were here; apparently they did some less than stellar things that reflected poorly on them. She listed a few examples of how students in the past have fared badly on their rotation by not taking it seriously, and I said, "I don't intend to be one of those students." Her response. "You won't be." I'm really starting to like Dr. R now.
We had an evening of "mini-call" in which the four of us were split into pairs to interview a patient. I was paired with David since we've been partners all week, and he got to interview a lady about my age who was either paranoid schizo or delusional. She said her babies were 7 months and 10 months old, that men have tried to "whore her and s***" and that she didn't know which teeth was which. She also contraindicated herself a lot to the point where we weren't sure what to think. We also eavesdropped on Kyle and Sital as they interviewed a suicidal alcoholic with possible Cluster B (borderline) disorder, and when she said that her last job was working in a liquor store, we had to try really hard not to laugh (an alcoholic working in a liquor store is asking for trouble). After that the guys had to dictate; David and Kyle started at around the same time but David finished first, so they both agreed that their dictations probably sucked. Tomorrow it'll be my turn, and Sital's, so we'll see how that turns out.
Next update will be on Saturday (hopefully)
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