Tuesday, August 6

i woke up this morning, with that familiar didn't-get-enough-sleep painful sqeeze in my head, in a panic, because i needed to get to work early this morning. then i remembered. chick died last night.

then, i didn't care so much about getting to work on time, but i went thru the motions, half-asleep, and i did get there.

sat through early morning torture. this random doc had called this early unscheduled mtg so that he could dispense his wisdom to us, the medical students and residents. and basically came with nothing. he proceeded to boast, in a slightly veiled manner, of his accomplishments, his publications, the famous people he knew, under the pretense of answering questions. i don't think he answered a single question directly. in psychiatry, we call that tangential thought process, when he goes off on whatever thought seizes him. he was also circumstantial, in that he would boast and drop names before finally answering a question in an unsatisfactory manner.

i couldn't help but think: you called this mtg to boast to us?! how high can you get on yourself?!!

if he had come with a lecture prepared, or to really teach us something, i would have grumbled but accepted it. this, this...this was really unbearable. i could not believe the extent that a human ego needed to be stroked and fed. if i EVER become this way, friends, let me know. PLEASE. i would not be able to bear it and can not condone that sort of behavior, and especially if it reared it's ugly head in myself.

(perhaps it didn't help that i didn't get enough sleep, that i had to prepare yet another presentation, and do another write-up. plus, i have my shelf exam coming this fri. i am not a stressing type of person, i'm generally laid back, but third year might be slowly changing me)

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during rounds today, an interesting patient was discussed:
this patient had been generally low and somewhat depressed for most of his life. he was a shy, antisocial person, and that was the general picture friends and family had of him. he also had some possible manic episodes, thus acquring the diagnosis of bipolar disorder.

then, he somehow got his hands on some anti-depressants without a prescription.

now, taking drugs without prescriptions is generally not a good idea. for this patient, the anti-depressants swung him into mania.

he was feeling GREAT. he felt like he was on top of the world, that he could do anything. he felt bold and made lots of new friends. he was accomplishing things. he was also scaring his family and his close friends. this was a totally different person that they saw. he was unfamiliar and just so very different.

the problem arose when those close to him advised him to see a psychiatrist. which infuriated the patient. you see, he LIKED his new self. he LIKED the state that he was in. he was being productive, social, amiable, and was generally feeling good. and he was upset that those close to him wanted him to go back to the way he was.

as i was listening to this presentation, this story, i became terribly confused. as always, i inevitably begin to take the side of the patient, and see from his perspective (don't say, aww~~. this is not necessarily a good thing). and i saw how maddening his situation might be.

it's like growing up with one leg chopped off, everyone knowing you as "that cripple." and then someday, somehow, you find a way to miraculously grow that leg until you feel that you are normal, and you are so happy about it! except that your family and friends are like, "that's not you. you're too happy. get that leg chopped off. you are not acting normal."

can you imagine? i'm sure i exaggerate, but that is something like what this patient is experiencing. he is not acting bizarrely. he is inappropriate sometimes, but mostly, he is no longer that down, depressed, shy character that he had always been. he's happy that he is like other people now, and upset that he is not accepted in this new state.

this field of medicine is driving me nuts. i can't help but have this overweight uneasy feeling always sitting on my chest, as i work, because i can't shake the thought that we are restricting the mental states of patients. it's my fear of mental claustrophobia. i can't imagine anything more frustrating.

yakob at 5:53 PM

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