Maybe my crazy is showing

I'm sitting here importing a bunch of my old CDs into iTunes (this is no small feat, because I own well over 300 CDs). The title? Is a line from a very old Bryan White song (Between Now and Forever, if you were wondering), which I'd totally forgotten about and still think that line is just funny as hell. Now, perhaps more so than I did back when I was a freshman in college. Which was a disturbingly long time ago.

There are an awful lot of bad CDs I didn't even remember I owned. Still importing them, because every now and again you still get a craving for some really corny old song, knaamean?

So, today, this woman...well, let me start this story with a little neurology lesson. There are two types of things that sometimes get called seizures. The epileptic sort, where a group of neurons in the brain misfires, and then more and more neurons around them get electrically rerouted, and sometimes the whole brain gets involved. There are lots of different ways that epileptic, or electrical, seizures manifest, from "zoning out" or tapping your foot to the thing that most people think of classically as a seizure, the big, arms and legs jerking, thrashing around, foaming at the mouth, biting your tongue sort of event.

And then, there are non-electrical seizures, which are sometimes called psuedoseizures, or psychogenic seizures. Which are different from epileptic seizures because the brain actually still works fine, it's the mind that gets in the way. Now, unresolved emotional baggage can cause a lot of medical problems. And it has that stigma of being factitious - something you're intentionally doing for attention. Which, yes, there are people that do that. My patient that I FINALLY discharged last week after TWENTY FIVE FREAKIN' DAYS IN THE HOSPITAL? She did that. You could tell, because sometimes the phone ringing, or, like, threatening not to feed her dinner would miraculously bring her out of a four hour "seizure". Conversion disorder, pseudoseizures, that sort of stuff? Not voluntary. But it still carries that stigma of being "all in your head," which is really difficult for people to handle when you tell them their seizures aren't "real", because they are really, generally, they're just not an electrical storm in the brain.

Okay.

I have this patient, right, who came in while I was on call in "status epilepticus." Which, for those of you who've made the silly choice to pursue a career in something other than medicine, is a state where you have either one really long intractable seizure, or many in a row so fast that you don't have time to return back to normal. And we give drugs like valium to break this. But, she, clearly, clearly has non-electrical events. Even you non-medical types can figure this one out: she has seizures every month when she menstruates, which started after she had a miscarriage.

Um...as we sometimes like to say in psychiatry....duh.

And so when she has these things, her vital signs are normal, she's physically safe, whatever. Yet, they still gave her EIGHT MILLIGRAMS OF VERSED in the ER. Which, if you know what that means, dude! I know! And if you don't, well, if you walked over and injected that into me? I'd probably stop breathing. Dumb, dumb shit, for, clearly not status epilepticus, because, not epileptic! But, whatever. So this woman, right? Has clear axis II stuff going on, obviously having pseudoseizures, etc, comes in for EEG monitoring. And her epileptologist goes in yesterday and tells her, these aren't electrical. And then the psych consultants go in, and completely piss her off (and, off the record, left me one of the worst consult notes I've gotten from any service all month). So today, I tried to calm her down, and promised to come back and do a little therapy on this topic (which isn't quite how I pitched it to her, but, you know). And I do, and she keeps interrupting me, right, and asking me stuff about myself. Like, am I married, do I have kids, etc. And I basically answered her briefly and then redirected her back to her stuff, because it wasn't anything too personal, and she was saying a lot of other things to indicate that she was clearly identifying with me, which is a useful therapeutic tool. And then she says, "How old are you?" And I told her, and she was all, "Really? Really?? You're actually 29?" And then she says:

"I thought you were like, 40."

.........?

Forty?

I mean...what?

Now, if I were forty, then it would be okay (it's kind of like, if I were a nurse, it'd been cool when people ask me if I'm their nurse. Because it would be okay for me to be a nurse, but I'm not, so it irritates the crap out of me that people assume that because I'm female I'm the nurse, not the doctor, despite the fact that I'm wearing a long white coat and...well...doctoring them. Because if I were their nurse I'd have a lot less debt and wouldn't have had to work my ass off in medical school and right now would be making a lot more than $8/h and working a lot less than I do. But, I digress). But I have eleven years to go before I'm 40! And, she explained it away by saying that she thought I looked young, but, assumed that to be a doctor I had to be much older.

Not helping.

On a related note, I'm wondering if I made a big political faux pas this morning. My attending, who's kind of a cocky bastard, and is also a behavioral neurologist, went in this morning and gave her a very good talk about pseudoseizures and why that doesn't mean we think she's crazy (we think that for other, unrelated reasons), that these are very real events, etc. Now, I'd warned him that she was pissed at psych and offended that "we all thought she was making it up", and I'd talked to her a little already, but, he just did a very good job with it. And a lot of people don't, as my psych colleague clearly demonstrated. And so when we walked out, I said to him, I think very genuinely, "That was a good explanation." And he says, "Yeah? Well, I've given it a few times." And I couldn't quite tell if he was being, um, coy (for serious lack of a better term), or really sarcastic. And it occurred to me later that my comment could've come off as being sort of condescending and a little insubordinate. Because, well, I'm an intern. He was interviewed by the New York Times yesterday as an expert on dementia.

And back at the Emerald Palace I used to get criticized a lot for "not knowing my place." Which, I concede, I usually don't.

I dunno. I figure I'm probably okay, because I've also noticed that recently he assumes every patient is mine and has started wearing cologne to rounds.

Damn, this post got awfully long. Nice of you to still be reading it!