Pumpkin Whore

So I'm on call tonight, right? And at Big Hospital, one of the things this involves is everybody meeting a 4:30 so the person covering walk-in clinic and the ER during the day can sign out all the patients still in a holding pattern to the overnight call person (not me. Ha!) and the short call person (me. And not just because I'm 5'5" on a good day. Because I get to leave at 10pm when I'm short call, and sign out to the night float person. No, not a complicated system at all. But still way the hell better than having to stay all night. I heart short call. At least until I have to get up at 6 tomorrow and still put in a full day's work. But anyhow, I digress...). So there's one patient in the ER, and this other one who's floating in the "going to come in later" ether.

This is the signout I got on the ether patient: he's a chronic schizophrenic in his early 20s, on meds, but has had an increase in the voices lately. They're not commanding him to do anything, but they are calling him names, like "pumpkin whore."

I......um........really?

So like two hours later the ER calls me and says, hey, this guy is down here. He's a chronic schizophrenic in his early 20s, generally well controlled on meds but he's been hearing more voices lately. They aren't command hallucinations; they're just calling him names, like "punk" and "whore."

At which point I just started cracking up. And then I had to explain to the poor ER resident why I was laughing so hard. Who, to her credit, also thought it was hysterical.

Another random thought from today: we have this family in town who is, like, the local psychiatry dynasty. We'll call them the doctors Ming. So, many, many years ago, the eldest Dr. Ming decided to become a psychiatrist. And he was a good one. He was even the head (the Emperor, if you will) of State Hospital at one point. And so then he had three sons, and all three of his sons became psychiatrists, and then all three of the newly minted Ming psychiatrists decided to practice in the Raleigh-Durham area. And then one of them had a son, or maybe they all had a nephew, I'm really not certain (was there a fourth Ming brother who went another direction with his life? I actually don't know), but anyway, there was a third generation Ming who also decided to become a psychiatrist and is a year ahead of me in my program. Which is very cool. But also makes it hell for difficult when a patient comes in and tells you, "I see Dr. Ming." Uh, thanks, that narrows it down to what, half the psychiatrists in the Triangle area?

Anyway, I called one of the many Mings today to tell him I was sending his patient home tomorrow. And we had this conversation about her, and he says something to the effect of, you know, some people really shouldn't be in therapy. For some people, the goal is just to maintain, not to search and explore and conquer. Some people can't handle that.

This flies in the face of my entire practice philosophy. My whole idea of mental health is confronting and fixing mismatches, and getting in touch with what lies beneath. So my first instinct was to be all, what?! And then I started thinking, what if there's some merit to that?

Thoughts from the peanut gallery?

::sigh:: Incidentally, no phrase has ever gotten me (and possibly all of mankind) in more conundrums than, "what if".

Certainly no phrase like "pumpkin whore."

I still think that's hilarious. I should've told that to the voices. Maybe they'd start calling him that for real. I think that would've been less demoralizing.

Well, anyhow, given my obvious mental state, Mags and I are going to go to bed. In my very own bed. At home. Even if I am only there for 6 hours or so and don't get to leave early tomorrow. So diggin' this short call thing.