Monday, January 30, 2006

Water Boy

Although I have been on an outpatient rotation, I am still covering the wards and consults for the weekends. It's been a bit more call than I usually do in a month--still not too bad--but seeing everyone on the weekends has allowed me snapshots into their lives.

We have one man who will not stop drinking. He drinks and drinks and drinks and drinks. He has had seizures because his sodium is too low. He is essentially diluting himself, thinning out the concentration of his protoplasm full of saline, which is all of our inner state. He doesn't have a tumor, he doesn't have an imbalance in his kidney, he doesn't have a problem with his sugar. He is just sick.

He is one of "my" people, the mentally ill.

He has no understanding that his drinking is causing him problems, or even that it might be related to him being in the hospital. "I know I had a seizure once, but that was years ago! Why do you have to keep TALKING about it?" On admission, his sodium was 109, when the normal level is around 130. With sodium levels that low, free water flows across membranes to areas of higher concentration--like body tissues. Like the brain. More water means swelling in an organ, and a swollen brain means more pressure inside the head, which means seizure, herniation, death.

I saw him last weekend, carring around a larg, 24 ounce Dunkin Doughnuts cup. "My wife brought it for me!" he bayed. He held onto it and kept wandering into the dayroom to refill it with caffeine free Diet Coke from the machine. He never let it go. The nurses couldn't take it from him.

I checked his sodium. 123. Trending down. I asked the nurses if there was any way for us to steal the cup away. They said they'd try. And they did.

This past weekend, there he was again, standing at the nurses' station, bleating for a doctor. He had been out on a pass the day before, where he had drank the largest bottle of Snapple that he could find. He's not gotten any better in the month that he's been with us. Maybe the meds will eventually gain a foothold. Maybe his irritability and mania will soften, cool down. Maybe he will be able to restrain his thirst.

But somehow, I can't see that happening. His thirst is unending, cannot be quenched. I fear the day he is discharged, and wonder how long it will be before he is brought into the ED, flailing madly, intubated, and scanned...and then gone. His mind destroying his body, in the most essential sense of the phrase.

Meanwhile, he stands at the nurses station, wondering why he is here, posing problems that we cannot solve. And so we wait.

And he drinks.

Wednesday, January 11, 2006

Dena's scarf

Dena's scarf
Originally uploaded by emtkatydid.
Dena's Christmas scarf. It's red. It's short-rowed. It's from MagKnits.

I worked on it while I was at the movies.

It's a knitting doctor's dream. And now, it's the knitted property of another doctor!

The Loot

The Loot
Originally uploaded by DrEtak.
These are the wonderful knitting books I got from my wonderful mom. They are, from left to right: Candy Blankies (crocheted baby blankets, nice color groupings and adorable patterns); Knitter's Book of Finishing Techniques; Ann Budd's Knitter's Handy Book of Patterns; the classic Knitting Without Tears by Elizabeth Zimmerman, Alterknits; and Handknit Holidays.

In medical land, I got a book on behavioral treatments for explosive (irritable, dysregulated, "uncontrollable") kids; and a hand puppet in a white coat named Dr. Moody.


I haven't published here in forever. I could pretend that I've been busy, but mostly I've forgotten about it. I didn't think I had that much to say, either.

However, I found a bunch of medical blogs, and that's inspired me. Our C/L attending sent me the URL of a resident psychiatrist in Seattle. She writes the way I wish I could, a "literary blog," one might say. I have many nights during which I lie in bed, waiting to fall asleep, and imagine the things I'd like to write. There's so many patient stories to tell. In the past six months, I've seen and done things that have made me cry, made me laugh, made me hate everyone, everywhere--and sometimes, it's made me feel like a doctor.

And then I screw up again and can't believe anyone lets me even talk to patients.

I presented a journal club today on the treatment of depression in teenagers. It was an actual controlled, randomized clinical trial, which is hard to find in child psychiatry. It also had real statistics, which was difficult, I am sure, for some of our residents. We seem to be somewhat split between the biologicall-minded, science-background folks and the therapy and psychosocial understanding and treatment kind of folks.

Therapy people don't like statistics.

I like statistics. Or, at least, the kind of studies that you need statistics for. I like the idea that there's some evidence to support what I'm about to do. Otherwise, why did I go to medical school? I can say things to people because "it seemed like the right thing to do," but who knows if I'm helping them? Of course, I know very little about therapy, so I'm not familiar with the literature and the supports for doing certain things. I'll learn.

I've been knitting some. I got spoiled with a bunch of knitting books for Christmas, so I'm trying to rush and finish the current projects so I can start on some new ones. I also got a bag of yarn odd-balls from my grandmother. Maybe I'll knit a stethoscope cozy. Or I'll get some tinfoil and knit my patients some protective hats.

The possibilites are endless.