how do i seem to attract the psych cases.....

well, so far this rotation has definitely been able to live up to the reports from previous students...the pathology is AMAZING and i have been told i will learn a lot during the two months and be more than prepared to deal with most situations i will encounter during my intern year....

it seems i am already getting that experience even on my 3rd day. Each day we get a new patient, so if we can transfer, or discharge the patient we will have less patients to see the next day. My counterparts ended Friday afternoon with 1 each, i on the other hand have 3. I spent four hours on the phone trying to 'turf' one of my patients unsuccessfully. Let me give you a quick recap about the patient (inmate)..

it all started on thursday when my attending looked with a smirk in my direction, and mentioned he has a great case for me - a chronic swallower!

yep thats right, you read that correctly - he gave me an inmate that swallows foreign bodies, and will sometimes require surgery to remove the items. He has been doing this for the past 40 years and knows a lot about the medical system and the correctional system (he is serving what is effectively a life sentence - 165 years without parole). I refused to give him pain medications, so he can have tylenol and motrin. He swallowed 6-7 metal objects 5 days ago, has not passed any gas or had a bowel movement since that time. I can visualize them on XRAY. In the past he has had 78 abdominal surgeries for similar episodes and the surgeon that normally operates on him is in italy for the next two weeks. The partner refuses to take him, and told me to manage him until he gets worse, there are no other surgeons willing to take the case. The inmate gets frustrated because i am not providing him with medical care so he swallows a spring loaded object and shoves a spring into his abdomen so its protruding about 2inches from the skin (and is about 5 inches into the abdominal cavity). Of course he does this at 4pm on a friday. Seriously.... why does this happen when i am trying to leave for the weekend?!?!

i removed the object, gave him some pain medication that in reality is more of a placebo than a narcotic, started to feed him with the idea of pushing some of the objects along and adding some bowel prep for fun....if he wants to be difficult, two can play that game. I also had all the furniture removed from his room and left him wit a blanket, mattress on the floor and a shroud to wear. I am hoping he doesnt find any more objects to swallow over the weekend and i have arranged to have him transferred to another facility monday for a scope to try and remove some of the objects.....

my other cases just make me feel like House. They are a constellation of symptoms without a clear cut diagnosis because of the multiple underlying diseases....

this is def going to be an interesting two months....

not to mention i live in a trailer and florida is gearing up for a major hurricane to strike next week...i hope i will be ok and not have to evacuate....stay tuned to hurricane Ike, it is going to get interesting.