The magical mystery land of community health

I don't make this stuff up!…but I do change identifying information.

Quotes of the day May 26, 2010

Filed under: Uncategorized — lesbonurse @ 10:52 pm

Me, to older man scheduled for appointment to discuss results of his cholesterol testing: “Well, I’m just taking a look at your labs.”

Patient: “Why do you want to look at my abs? I’m fat!”

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Me, to 40-something single male: “Hi, how are you today?”

Patient, winking: “Blessed to be in your presence!”

(note to self: use that pickup line on someone in the future…just not at work)

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Scary stuff May 24, 2010

Filed under: Uncategorized — lesbonurse @ 2:22 am

I saw a patient with post-partum psychosis this week.  Wow…this was the first case I’ve seen in primary care, and it was intense.  The patient had a history of depression, including post-partum depression with her first child, but had been feeling well for the past few years.  She gave birth to her most recent child 2 months ago, and had been feeling just a tad depressed over the past couple of weeks.  Then suddenly, she was overcome by a wave of suicidal depression which developed quickly over the course of a few days.  Worse still, she developed auditory hallucinations of voices telling her to kill herself.  She came to the clinic at the urging of her family members, who had advised her to seek help (good call, family!).  She had already made a suicidal gesture the day before, and could not assure me that she would be safe if allowed to go home.  In fact, she told me she was pretty sure that she would try to kill herself if we sent her home.  Ok then…this was one patient who was not going home.  We do have a crisis evaluation team for our city, but when we called they told us that the wait would be several hours before they could have someone come out and evaluate the patient.  At 4pm on a Friday, this was not ideal.  We called EMS and sent the patient to the ER, keeping our fingers crossed that she would get a sympathetic provider and an official evaluation by a psychiatrist.  I’ll have to look at her record when I get in to work tomorrow…I hope that she was at least admitted for a 72-hour hold.

Perhaps this was more scary to me because I’m currently pregnant, but geez…how awful to descend so quickly into a severe depression (with psychotic features).  I can add this to the mental list of “Stuff I Hope Doesn’t Happen to Me During Pregnancy/Birth/Postpartum.”

 

This is how it happens May 11, 2010

Filed under: Uncategorized — lesbonurse @ 12:46 am

I grew up near a huge coastal city, with a big population of homeless teens.  When I was in high school, their life seemed a bit glamorous, but as I got older I realized how truly difficult the life of a runaway teen is.  Drugs, sex work, rape…very little ends well for a teen on the streets.  I remember reading somewhere that the majority of runaway teens are never reported missing–a fact that has always made me sad.

Last week I saw a patient that I know pretty well.   About 6 months ago she started having problems with her 16 year old daughter.  It was no surprise–my patient has many issues (including a difficult personality) and is not likely to be a candidate for mother of the year.  I doubt that living with her is easy.  2 months ago she told me that her daughter had dropped out of school.  Last week she told me that her daughter had run away from home.  I asked if she knew where her daughter was and she said “I don’t know…but I heard she was going down South with her boyfriend.”  Oh? I asked, Do you know her boyfriend?  “No,” said the patient, “but I heard that he’s trouble.  My son saw him and my daughter fighting in the street once, and he was grabbing her arm and pushing her.  I told her, ‘A man who grabs you like that is going to end up hitting you one day’ but she didn’t listen.”  And are you worried about her?  Did you report her missing? “No…she wants to think she’s grown, she can be on her own then.  I don’t care.  I still have one at home.”

Wow.  Just wow.  Your 16-year old daughter leaves the state with her abusive boyfriend and you do nothing?  No wonder she feels unwanted.  If nothing else, please report your daughter missing so that they can identify her body when they find her as a Jane Doe, ok?

Sad.