TSH: Aggressive Patients

This morning David and I were back in the treatment room interviewing the male patients (we interviewed females yesterday). They were a fairly interesting bunch. One guy was manic and rather incoherent, but at one point he took my hand and Dr. R asked, "Are you flirting with my med students again?" At least he was harmless. There was another patient who mumbled and spoke so softly that it was hard to understand him; he denied ever killing anyone, yet his chart says he's guilty of jabbing a pen into a person's skull (that's why you are careful about giving pens to psych patients), so that was an eye-opener. Another patient had an obvious case of tardive dyskinesia; he couldn't stop grinding his teeth and had obvious tremors. There were two notable patients, BB and RS, who each stood out in their own way.

BB was a schizo who was prone to violent tantrums, and he kept asking Dr. R for a weekend pass so he could go home to his parents. Dr. R explained (not for the first time) that in order to get a weekend pass, his parents had to call the social worker by Monday, and today was Wednesday so it was too late. Not to mention his parents haven't called the hospital because they obviously don't want to take him home on the weekends, which is a bit sad. Then BB said he wanted to live with his brother, which was a bad idea b/c his brother has been in and out of TSH himself. Then he got angry and said he was doing everything right with his meds and stuff (except going to classes), so Dr. R should "make him happy." Dr. R got annoyed and said, "I've been here since 6:30 this morning! Why don't you make me happy!" One thing about Dr. R, she tells it like it is and is not afraid to argue with the patients.

RS was the last patient we saw, and he was the scariest patient I've seen to date b/c he was so loud and aggressive. I was the one who interviewed him, and here's how some of it went:

Me: Can you please look at me, Mr. RS? (I could only see his side)
RS: I am looking at you! (no he's not)
Me: How has your appetite been?
RS: I don't care how your appetite's been!
Dr. R: RS, that's not nice!
Me: Do you know your doctor's name? (Dr. R)
RS: (yelling) I am my own doctor! (he also keeps pointing furiously at something on the ground that we can't see)
Me: Do you know the name of the hospital you're in?
RS: This is not a hospital!
Dr. R: Then what would you call it?
Me: Have you ever had thoughts of hurting yourself or other people? (I'm pretty sure I knew the answer to the last part of the question)

At this point RS just gets totally pissed and is looking at me like he wants to kill me, but I didn't back down. I wasn't afraid of him because he hadn't moved from his seat yet, but mentally I was getting myself ready in case he should lash out. Fortunately Dr. R said it was obvious we weren't going to get anything out of him when he was pissed like this, so he was allowed to leave. Whew. Afterwards, however, when David and I had to walk through the common area to the exit, I thought I saw him glaring at me and walked a little faster (David's observation, not mine).

A group of drug reps for Seroquel took David, me, and other doctors to lunch at a Cajun restaurant called Fat Catz that had some pretty good food for a decent price. Then all the med students sat down for an afternoon with Dr. R. It was pretty interesting. She gave us all a placebo pill of a oral disentigrating pill (a form of pill given to patients) so we could see what it was like. Then she told us to put on earphones (with loud voices talking in the background) and answer some questions while wearing the earphones, and the rest of us were to watch each other's reactions. There were times when the voices were loud, and other times when the voices were soft; this was so we could see what it was like to be schizo. David talked louder when the voices were louder. Sital started giggling more when the voices got louder. Dr. R said that I was more relaxed and had a more positive affect when I had voices in my head, but without the voices I was more calm, reserved. Does this mean I'd make a good schizo? I asked her what that means, and she said, "You tell me." Among the questions I was asked: my history, my favorite subject in school (I couldn't think of one and said MOD, and Dr. R agreed that Dr. SLP was an excellent professor), and what I do for fun. When I said I play the violin, she strongly suggested that I bring my violin to one of their music classes and play for the patients. I think I'll do it =)

It took us two hours to run through a full psych evaluation with Dr. R, which consists of many many questions to ask the patient to gauge just how bad off they were. We have a mini-night call tomorrow evening and an overnight call on Friday. It turns out that Dr. M, the prof who normally makes students' lives hell during a week of nights, will not be with us next week b/c his brother passed away, so my classmates and I will not get the same night experience as everyone else. On one hand I'm relieved, but on the other hand I'm disappointed not to get the Dr. M treatment that everyone else who's been here did. But who knows...Dr. M just might come back for our last night. By them hopefully we'll all be able to impress him.

I'm typing this from Dr. R's office; she has a computer that med students are allowed to use. Fortunately it doesn't block me from blogging. I don't know when I'll have time to come in here for the rest of the week, but rest assured there'll be lots of stories to tell when I do =)