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"Just don't dare the suicidal patients to kill themselves..." - Nobody wears a white coat any more... — LiveJournal
...a tribute to becoming a doctor.
"Just don't dare the suicidal patients to kill themselves..."
Saturday: Weigh day at Curves. 208; down another 4 pounds. That's a total of 11 lbs and 21 inches from last April, more from last July when we're going to reset my start date to as I had ballooned to 228 because of a broken arm. A triumph.

I said I'd tell you a story, O Best Beloved, about doing something Good.

And I did do something Good on Friday. I picked up a chart and I read through the notes and Megan and I went to talk to a very nice paranoid schizophrenic who had such a charming story. It seems that he hears voices from the TV and the radio, but they only talk to him when they're lonely or when he wants them to.
Why would you want them to talk to you? He smiles, displaying teeth that are rotting at the corners of his mouth and missing in the front. "Boring TV shows."

The trouble all started when his Zyprexa was discontinued a few months ago, and the voices suddenly turned mean.

"They told me to do bad things. Hurt people. Kill myself." He didn't sound distressed as he spoke; the schizophrenic has an odd affect about him. Flat, we call it. He heard the voices whenever he was near a TV or radio, every day, for a couple of months.
There is a question we must ask those who have made a suicidal gesture, particularly those who have a history of ideation. It's a question that has always seemed strange to me, and must be carefully worded. I asked it, feeling as strange as always.
Why did you do it today? Why not yesterday or tomorrow or next week? It always feels to me like I am asking "Why did you try to kill yourself on my shift?"

"I don't know," he says to me with another smile, frighteningly casual about this matter. "I just got tired of them bothering me."
He got tired of them turning mean, so he took a whole lot of his lithium tablets. About sixty, from my best guess, and my best guess was what ruled the day. Sixty 300mg lithium tablets. That's a lot of lithium, which is a drug with a narrow therapeutic range and a 10% mortality in overdosing. And then he called the paramedics. I thought of you, pharmboy and mama0807 and fyrfitrmedic, and what you would have said.
He came in, they drew a blood lithium level and called for a CIU consult. That's us. An hour or two after that Megan and I showed up. We checked the labs, we walked back to the CIU, we talked to the resident. "What's his lithium level?" 1.0. Within therapeutic levels. No need to worry. In fact, suddenly we began to doubt whether he'd taken the lithium tablets at all. But he was sure he had.
Resident was not so concerned. I believed the patient. I went back and checked the time on the lab draw. Less than an hour after ingestion. We'd done a quick read-up on lithium toxicity and knew that blood levels peaked between 2 and 4 hours after ingestion. The time was now 3 hours post-ingestion. "Dr. E," I said, tapping him on the arm. "We need another lithium level."
We found the Medicine intern for the team he'd been admitted to. She hadn't seen the patient yet. We filled her in. "We need a lithium level now." She turned a little pale. Busy woman. "I'll get that order in."
Then we went back to the CIU and waited. 45 minutes later we had our lithium level. 3.6. 3.6 is not good.

He was still awake and alert and talking to us, but he was getting nauseated and threw up quite a bit. We found the medicine intern again. "Did you see the lithium level?"
No, she says, but Toxicology was just here 10 minutes ago and left a note. Dr. E looks at me.
"Your lithium level's 3.6. They didn't have it when they left their note. Better call Renal, Tox says approaching 4 is cause to consider dialysis."

If it hadn't been for two medical students with nothing better to do on a Friday afternoon, O Best Beloved, the intern wouldn't have gotten to him for another hour or so. Nobody was worried, because the lithium level was so low. They were going to check it after admission, sometime later that evening. If it hadn't been for us being so thorough (Megan laughs, and points to me. "She wins the prize for that.") he wouldn't've been on monitoring later on, when he went to the shock room after we'd left for the weekend.
We checked this morning. He's still alive, lithium levels peaked at 3.7 that evening and came down by Saturday evening. And I will always remember Dr. E, the PGY-3 resident, looking at us at 5:30 on a Friday and saying:
"Go home, guys. Enjoy your weekend. You really made a difference today."

I am a medical student, O Best Beloved. I cannot write prescriptions and I am clumsy at intubation and when I try to start an IV or draw blood my hands still tremble with nervousness. I have to go home and read about my patients' common diseases to understand what medications have been started and why. The school pays for my malpractice insurance and I am glad, because I am afraid still that my inexperience will inadvertently injure someone. But once in a while, being a medical student means that I have a little more time than the doctor, that I am not afraid to spend extra minutes flipping through charts and writing down labs and double-checking results so that I can look polished in front of a resident. Once in a while, being a medical student gives me twenty minutes with a patient instead of ten.
Once in a while, O Best Beloved, it doesn't matter what class or rank or grade I claim, because what I am makes the difference.

now feeling:: good blessed

13 whispers echo . o O ( ... ) O o . whisper a word
chemta From: chemta Date: May 18th, 2004 01:01 pm (UTC) (etched in stone)

Good job!

I really liked that story. It made me feel that good is being done somewhere.

I was unaware that lithium was used in the treatment of schizophrenia. I thought that it was just the anticonvulsant mood stabilizers that we bipolars share with them...

(First floor Wagoner hall, I was a junior and you were a senior)
ayradyss From: ayradyss Date: May 18th, 2004 06:29 pm (UTC) (etched in stone)

Re: Good job!

!!! Ruthie as in the Ruthie I was just flashing prom pictures of the other day :)

He's potentially schizotypal with bipolar qualities, getting seriously huge doses of a bunch of other meds, 20+-year history of all this. I think they use anything that works.
xarkos From: xarkos Date: May 18th, 2004 08:09 pm (UTC) (etched in stone)

Re: Good job!

Wow, been so long since I've heard from/of any Academites outside the 4-5 I've always kept contact with. That reminds me, I should write the Joshes at some point...
reynardo From: reynardo Date: May 18th, 2004 02:10 pm (UTC) (etched in stone)
And is this not, my dear, part of why you are becoming a doctor - to use your brain and your reasoning to save someone?
From: silmaril Date: May 18th, 2004 02:26 pm (UTC) (etched in stone)
I think your mood indicator says it all.
From: sepuki Date: May 18th, 2004 05:02 pm (UTC) (etched in stone)
I'm glad that you feel blessed, but here I think you were more the blessing itself than anything else. ^_^
ayradyss From: ayradyss Date: May 19th, 2004 04:03 pm (UTC) (etched in stone)
God does great things in this world. Sometimes, I am the tool by which they are accomplished.
turnberryknkn From: turnberryknkn Date: May 19th, 2004 02:13 am (UTC) (etched in stone)
(smile) I'm going to remember that story. And I'm going to tell that story, to every student I ever mentor someday. That story deserves to be told, and you deserve the credit for the catch. Well done.

It's amazing what the Lord can do through us, no? :-)
ayradyss From: ayradyss Date: May 19th, 2004 04:03 pm (UTC) (etched in stone)
Pass on the word. We really do make a difference sometimes.
From: feldspaar Date: May 21st, 2004 04:51 pm (UTC) (etched in stone)
Hang in there with the weight loss. It takes a godly amount of patience - so keep leaning on Him.

I wasn't doing so well with weight and health out of college, but finally began to address it these few years as preparation for a lasting career. He has been super-supportive, providing ways to self-discipline, patience and willingness to do right by Him. So, hang in there.
ayradyss From: ayradyss Date: May 21st, 2004 05:27 pm (UTC) (etched in stone)
And since my own self-control is practically nil, I have to depend on Someone else.
Thanks for the encouragement.
From: thomas_erskine Date: May 23rd, 2004 08:17 pm (UTC) (etched in stone)

Reconsidered Actions

You know suicide always seemed funny to me because it's completely pointless. The thing I don't get is why the hell these kids want to take their life in the first place? It's not like they have it worse than any one else in the world. They need to stop dramatizing their lives and get over their ignorant depression. I know some of you will be like, "You dumb ass depression is an illness. You can't just get over it." Depression is NOT a fucking illness; it's a Goddamn emotion that can be controlled just like your hormones.

God I really hate fucking people today, especially the suicidal ones. They take any feeling they have and use it as a crutch for attention, or a way to "escape." These fucking morons need to wake up, if people are making fun of you, picking on you, or doing other shit you don't like, then get out of the fucking situation. It's not hard. It's called walking away, and focusing your energy on something useful that will help man kind, not burden it with your stupid suicidal bullshit. Every person in this whole fucking globe has the opportunity to make it a better place, and it's ass holes like that kid, that keep fucking every thing up.

So my question for you is, now that you saved that kids life and all, what is he going to do now? You know once you release him back into society the tormenting is just going to be worse, and maybe this time he wont take the pain out on him self, maybe he will kill the kids who are pushing him to the "brink of suicide."

I believe that you have free will, and choice. You choose to want to kill your self, and you choose to be depressed. This kid is just making the wrong choices. Did you ever try to tell him how to be happy, or what he is good at and how he can apply it to become much more successful than most of his peers? Probably fucking not. So what? You helped him breathe some more. Obviously his whish to cease living was not granted.
Man, you medical doctors are funny, you're so concerned about saving the body, but you don't give a shit about saving the boys life.

What I don’t get is how selfish these suicidal ass holes are. There are millions of people worldwide that are dying from real illnesses and diseases, and this piece of shit has to attempt to kill him self and take time away from the people that really needed it. God this just irritates the hell out of me. I am going to go think about something less painful like burning holes in my eyelids.
ayradyss From: ayradyss Date: May 23rd, 2004 08:57 pm (UTC) (etched in stone)

Re: Reconsidered Actions

The nearly-fifty-year-old gentleman in question is a schizophrenic, prone to doing things at the prompting of his hallucinations even when he doesn't really want to do them.
He had no interest in dying, and never did, he said as much to us. But the voices of a schizophrenic can be overwhelming.

Refute for me the evidence on PET and functional MRI scans that shows a deficit of neurotransmitters - a chemical alteration - in individuals with clinical depression; the evidence that shows that the brain itself processes differently in a depressed individual. If you'd like citations, I can provide them.

What, after all, is psychiatry if not concerned with saving someone's life?
13 whispers echo . o O ( ... ) O o . whisper a word