So I woke up this morning just feeling like crap. Crap-tastic, even. I had a weird migraine-y thing going on. So I snoozed for half an hour whining in my aching head about how awful I felt and how my tummy was unhappy and how I got kind of dizzy whenever I picked my head up...but I got up, and I got dressed, and I slumped down the stairs...and then had a conversation with my mom, who was like, are you nuts? Be a real person. Take care of yourself and go back to bed.
Wise, my mom.
And wouldn't you know it, a couple hours' sleep in a dark room helped a heck of a lot more than six hours of distracted therapy and two lectures would have. And as guilty as I felt about cancelling, my mom also pointed out that for the hourly rate they charge for me (which is, what, about $180 an hour more than I make), my patients deserved to have a doctor who was actually paying attention and not trying not to throw up on them.
I did get paged twice, though, out of my quiet, dark little den. One was Magical Corrina the All-Knowing, who needed my parking application (why do they create all this paperwork? I had parking. I'm still employed here. I want to keep my parking. Done. Is that so hard? Magical Corrina and I have other things we could be doing with our time), which was fine, because Peng was already on it and forging my signature on the paperwork I left on my desk and forgot to sign. The second page was this woman from the medicine service. It went something like this...
Medicine: Hey, I just had a few questions about this guy.
Me: Um, yeah, so, I think I only saw him, like, once. Remind me who he is?
Her: He's the guy with CF.
Me (amazed that that description actually did the trick, because, you know, like there's only one patient in the whole world with cystic fibrosis): Oh, yeah. What's up?
Her: Well, he's in the hospital.
Me: ...with a CF exacerbation?
Me: Okay. So...
Her: Well, you know, there's a significant psychological component to it, too.
Me: Um...can he breathe?
Her: Oh, it's getting better.
Me: So...um...how can I help you?
Her: Well, I was wondering if you wanted to do anything.
Me: Uh, you know, I only saw him once, in the intake clinic, like a week ago.
Her: Right. And he's been taking the medication you prescribed, and went up to the full dose about two days ago, and seems to be doing pretty well on it.
Me: So, psychologically, he's doing better?
Me: And...um...he can breathe?
Me: (pause) Okay.
Her: So we were just wondering if you wanted to do anything else, you know, while he was in.
Me (trying to think of a way to put this tactfully): I...um...no.
Me: I mean, I guess if you feel like his medicine needs to be increased, you could go up another 5mg, but I think the thing he really needs is therapy. And we've discussed that, but if you could reiterate that, it'd be great.
Her (clearly frustrated that I just prescribed "therapy" for a "psychological problem"): Yeah, okay, whatever. Thanks.
Me: Well, glad I could help.
Here's a tip, for all of you consultants of psychiatry or future consultants of psychiatry or people upon whom others may consult psychiatry... Corrina aside, we're not magic. As our chairman is fond of saying, "We heal minds, we don't read them."
I still have no idea what she wanted me to do. The real reason they sent the guy to me was because they want him to stop coming into the hospital. I failed to do that with one 30 minute visit (he was 30 minutes late for his intake appointment) and ten days worth of homeopathic doses of an adjunct medication.
I got a consult this weekend to come "talk" to a kid in the ICU who drank himself into alcohol poisoning because the team was too busy to find out "what was really going on." Yeah, like this kid's going to tell me. Surely they must realize that "Hi, I'm Dr. Kate, I'm one of the psychiatrists on call" translates, in the patient's head, into "Hi, I'm another random doctor. Clearly the team thinks you're crazy, which is why they called psych to come talk to your crazy ass." And when I balked a little at the consult, the resident call it in was like, "okay, and, so this is the second kid in two weeks we've had from his peer group with the same problem. We need to you to find out what's going on with them, see if there's like some abuse issues or something."
I? Am neither Colombo, Kreskin, nor DSS. And I do not speak the mythical language that makes teenagers give polysyllabic answers (I, too, still get "fine," "yeah," and "stuff"). But I couldn't actually seem to get out of doing the consult, and I figured (like so many of the ones that we do) it would actually be better for the patient to talk to me about it than the crazy Pedes lady who was overestimating my ESP, so I went and saw the kid. And discovered that, a, he'd already figured out this alcohol poisoning nonsense was a stupid thing to do, and 2, the other person from his peer group who'd had the "same problem"? Was a kid on our unit who tried to overdose to kill himself, not one with a raging case of bad judgment.
Sometimes I really have to wonder...what is it that everyone else in the hospital thinks we do?