TSH: The Cluster II Adolescent

Our scheduled "hell week" started out all right since Dr. M will be gone this week (at most we'll get him on Thursday), so we reported to the admissions center at 4:00 p.m. David and I didn't have a chance to grab dinner since the local Chuckwagon (the canteen) was closed, so my dinner consisted of two granola bars. We were supposed to get six admits today, but they didn't arrive b/c their judge didn't sign their OPCs (order of protective custody) that would send them to TSH. Instead, we only got one voluntary admission: an eighteen-year-old with "depression."

This guy told us that he's been feeling suicidal ever since his girlfriend of 1.5 months dumped him, saying that last night he was planning to OD on HTN pills but changed his mind at the last minute. He told us that he's been depressed ever since he was 11 or 12 and that his ex-girlfriend keeps playing "mind games" with him. He also said he'd gotten in trouble in the past and doesn't get along well with authority figures (doesn't like people telling him what to do), and despite being a high school dropout who hasn't gotten his GED, he loves to read and wants to be a doctor and help people "like him." He also had a tendency to rant about his ex and then forget the original question that we asked him. He said he was over her, but a few minutes later he'd say that he can't stop thinking about her. He was hoping that TSH would be able to do something for the negative thoughts in his mind b/c he knows something isn't right and wants to fix it before he does something he really regrets.

This went on for about 90 minutes but it was hard to pinpoint exactly what he had. He had a little bit of every Cluster II personality disorder: borderline (he has a history of falling in love with girls too quickly and they end up hurting him), narcissistic (he bragged about being an avid reader and writer of science fiction stories), histrionic (he wants full attention paid to him and his problems), and antisocial (he's been in trouble with the law and hates authority figures). On top of all that, he smokes MJ and cocaine and has tried almost every drug on the street. Heck, he claimed he "picked up some Vicodin" in Dallas just by saying his arm hurt. Maybe I'm naive when it comes to drugs, but how do you just "pick up" any drug? At any rate, the four of us talked to Dr. EW and we all agreed that he wasn't a good candidate to admit to TSH. He was not suicidal at the moment, and he could benefit from outpatient care.

When we told the kid that we were referring him to a Dallas clinic, he became upset. First he said that he was glad that he wouldn't have to be admitted, but then he said that he felt he would improve more at TSH with doctors around to guide him every minute of the day and tell him what to do. It doesn't work that way, but he didn't believe that. And yet, he doesn't know how to deal with his anger issues. "If I knew that, I wouldn't be here," he said. David put it best when he said later that the kid expected to be spoonfed, as was the case here. He claimed that if we sent him to outpatient therapy, he would forget about it and not go. So...we sent him over to Dr. EW, and they spent over an hour in his office just talking. Sital and I went to eavesdrop for a few seconds and heard him ranting yet again about how he can't stop thinking about his ex. In the end, he was sent home, but Dr. EW said that after some psychotherapy, he and the kid had come to a "mutual understanding" about what the kid had to do to improve his life. Whew. Who knew that one patient would take up 5-6 hrs of our time?