That Thing

It was the last day of clinicals on the psych unit today. I stopped at Starbucks on the way in and bought two "travelers" of coffee--one for the adult unit, one for the child unit--and a gift card for the clinical instructor. (We traditionally give cards and bring food to thank the staff who have put up with us.)

When we got to the site, I got stuck down in the poorly run children and adolescent unit, a fitting end to this particular rotation.

The kids unit gets moving slowly. Unlike the adult patients, who start getting up and about around 7 a.m., wandering out to seek out coffee to kick-start their day (little do they know that they're getting decaf), the kids are slower to get moving. They sleep until 7:30 or 8:00, take showers, and meet for breakfast around 8:30 or 8:45. So there's not a lot to do between the time we get there around 6:45 and the time the kids come out for breakfast at 8:30.

Since there was nothing else to do, I sat in on the shift report from the night to the day shift and then I lingered behind looking at patient histories. Sometimes I look at patient histories just to confirm my suspicions. Sometimes I do it because I'm curious about the consistency of the patient's story over time. Sometimes it's just to see what kind of people I'm dealing with every day. (We're encouraged to look at as many patient charts as we can on the psych unit--a clear difference from being on a med-surg unit, where we are only allowed to access the charts of the patients we are directly caring for--since the bulk of psychiatric care in an acute setting consists of observing patients and documenting behavior, and the patients are therefore basically "treated" en masse.)

Anyway, in my last blog I described: Two patients--one a child, one barely not--who I suspect have been profoundly, horrifically sexually abused. They have never met, but they could be twins, both devastatingly beautiful and both nightmarishly passive, sweetly blank-faced, and terrifyingly psychotic. 

One of those patients was brought in last week, literally an hour before my clinical group left for the day. The only interaction I had with her was to exchange greetings and bring her a lunch tray since the tech who would normally do it was busy. I didn't have the opportunity to to look at her chart before I left, but from that incredibly brief interaction with her, it was screamingly clear to me what was going on.

Today she was still on the unit, so I looked at her history. And surprise: The stepfather. The mother's boyfriend. The grandfather.

That's the sad part, yes, and here's the other sad part: She keeps getting away--one time literally jumping from a moving car--and she keeps getting returned. By the police. By the court system. By the psychiatrists. She runs away and she gets brought to the psych hospital and they crank up her meds until she figures out what to say to get released and then they send her back, right back into the viper's nest. This time will be no different. I'm not saying she's not also mentally ill and in need of treatment--she is--but her mental illness makes her a better target, a better victim, because she's considered to be an unreliable reporter of her own experiences. I can't help but see her as a modern-day human sacrifice (to what? to whom?) and I suspect that her fate is the fate of many such young women.

This is why I could never work in behavioral health.

On that sorry note, I said goodbye to the psych unit. Thank God.

We walked down to the hospital cafeteria and had lunch, and then went straight into a post-conference where we talked about a few things. We had to make a presentation about an educational plan that we had done. We had to present a patient observation. Then we got our final evaluations. Then we came home.

I was home a little after two p.m., two and a half hours early, so I changed from my scrubs into my pajamas and took a nap. There were 60 mile per hour winds today, which are always unsettling. They curdled my dreams.

When Dave came home, we went out for dinner, to the vegan thai place and ate noodles. Lots and lots of noodles. Spicy noodles. Laard na. And we brought home many, many leftovers.

On the way home, we stopped by Ulta. I was looking for a NARS lipstick, which they didn't have, so I picked up some plastic hair clips (the ones I have are metal and I wanted a plastic one to hold up my hair in the shower) and a primer from NYX that has a greenish tint to it, supposedly to cut out redness. (I'm curious to see how it plays with my rosacea.)

Then I came home and while Dave went to relax with the heating pad on his bad shoulder, I did some things I've been putting off. I paid my tuition bill for the term that finished today. I had my transcripts sent from the community college to the university. I got online and ordered the NARS lipstick and some new Clinique balm cleanser from Sephora. It was a high dollar day. Starting with Starbucks and continuing through my tuition payment, dinner, Ulta, and a Sephora splurge, I spent a few thousand dollars.

As I was wrapping up my spendthrift phase, Kelly called. This is incredible because on Tuesday, TWO DAYS ago, this happened to her (as described by Kevin, on their blog):

The surgeon replaced 10cm length of her ascending aorta with a 2cm length dacron graft by pulling down on the ascending aorta from the innominate artery, sewing to the graft and then sewing back to the heart.  ("We can't prove that this is better but we think it is.")  He was worried that we would see subsequent CTs and only see 2cm instead of the 10cm he cut off - as if we were paying by the cm.  He did some more stuff including cutting muscle away from her interventricular septum.  But what blew me away is that he repositioned the mitral valve by moving two papillary muscles, little muscles about the size of your little fingertip, that work the mitral valve, along with their attendant chordae tendineae, strings that go from the papillary muscles to the cusps of the valve leaflets.   "I moved this one from here to here and this other one from here to here."  He explained it very clearly almost like a carpenter explaining how he moved a door from this part of a wall to this other part.

 That's a thing that happened, open heart surgery.  I mean, she slept through it, but still. And two days later, she's up and walking and talking and using the phone in an efficient manner. (If it were me, I'd still be milking it, and having people bring me little things on silver trays when I rang a bell.)

So it was nice in an astounding way to hear Kelly being Kelly on the phone.

I forgot to tell Kelly about this cardiologist I got to watch work. This was last term and I followed a patient down to the cath lab and got there just as he was beginning to snake his way into the patient's heart to check things out. I sat in the tiny closet-sized viewing room with the nurse who was doing the documentation on the fly, and we watched the proceedings through the huge window and on the monitors. It was really interesting to see the procedure, but it was also really interesting because the cardiologist was enormous. Like, literally a giant sized person. The table the patient was strapped to was raised to accommodate the doctor, to be at a height a little above his waist, so it was about chest-height on the nurses. They had to adjust the monitor opposite him, on the other side of the table, and they were standing on their tippy toes and extending their reach using syringes and any sterile thing they could get their hand on to reach over the table, it was so high. I wasn't really paying attention though, since I had never seen the procedure before and under those circumstances, everything seems unusual.

BUT! But then he finished the procedure, took off his gown and proceeded to come into the tiny closet sized room with me and the nurse who had been documenting. And it was kind of terrifying, actually, in a claustrophobic nightmare kind of way. First of all, he filled the doorway, like, blocked out all light kind of filled the door way. And then he came into the room. I stood up to move out of his way and he was, like, no you're fine. And it's not like I'm a small person, either. So the two of us in that confined space, trying to get past each other? It kind of reminded me of those little tiny one lane roads, with two trucks heading toward each other. Somehow they have to pass and they do it, but it somehow defies some various laws of the universe. This was one of those situations.

Is it just me or is that a thing?