Difficult psych patients

A friend of mine completed her psychiatry rotation here not too long ago. We were talking about it the other night, and she told me of an incident which showed her ability to handle a difficult situation. The public psych hospital here is a ward, and patient interviews, etc. aren’t conducted in the enclosed space of their private room, since it doesn’t exist. Think One Flew Over the Cookoo’s Nest, Bellevue, what have you.

In dealing with one patient, another kept bothering her. It was getting annoying. Finally, after having enough, she turned and said these words of serious kung-fu skill:

If you don’t leave me alone, I’m going to steal your thoughts.

The patient promptly left, and she went on about her business. Impressive. Hilarious.

Eye Pathology: Guess the Dx

Eyesore

A male in his mid-30s presents to an ophthalmologist complaining of left lower eyelid pain that began 2.5 days ago. The patient denies any history of similar symptoms. He also denies any discharge from the eye or exposure to any foreign substances, particulate or chemical. The patient reports that around the same time of the beginning of symptoms, his toddler daughter hit him inadvertently while playing, causing his glasses to hit the bridge of his nose on the left side, but denies direct trauma to his eyeball or eyelid. The patient also reports chronic use of loratadine (10mg qd) and occasional use of pseudoephedrine HCl (60-120mg/day in divided doses) for nasal congestion due to atopic seasonal allergies.

On physical examination, the patient is noted to have normal and stable vital signs. The examination of the eye reveals mild conjunctival hyperemia of the left eye without discharge. The medial aspect of the lower lid reveals non-fluctuant, slightly indurated swelling that is painful to palpation. Eye motion is grossly intact without pain.

What is the diagnosis?
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Belated update: No longer a med student

A thousand-mile journey begins with that first step, and so too does a long-overdue blog post also begin with the first words. You just have to start or it’ll never happen. That first step of a journey is pretty much the only one guaranteed to be 100% directly towards one’s goal. I mean, you don’t take the first step of a trip to the North Pole going south. You try for all the other steps on your journey to be equally directionally efficient, but detours happen, large and small.

I am on one such detour right now. The title is true, but I admit it is a bit “sensational” to get you to read further. ;) The unvarnished truth is that I am not in school this semester by choice. I completed my 2nd year. Done. No doubt about it, grades official. Instead of plowing ahead and making the academic, clinical, and physical leap to the hospital setting, I decided instead to take a breath after having the wind knocked out of me so many times recently. What more natural academic break would med school give than the traditional space between 2nd and 3rd year? So to put the title in perspective, no, I’m not currently a med student, but I am not quitting. I will be resuming exactly where I left off in January, thanks to my school having rolling semesters. So in essence, I am giving myself a 5-6 month break.

Why am I doing this? Simple: “Physician, heal thyself.” My life was no longer in control, at least not to a standard needed to excel in school nor to be happy with life. Several pending health issues, a marriage going through some serious valleys, numerous separations from daughter, being shafted by my school regarding my USMLE timing for petty bullshit reasons, and certainly not least, crippling financial hardship (my loan year was months away from cycling yet I was approaching zero in the bank with a wife and child to consider) were the main factors pushing this decision. I could have been stubborn and said, “Fuck it–I’m no quitter; I’m going ahead anyway,” and people could have even applauded my determination. But I’d be a ticking time bomb, literally ready to psychologically detonate at any moment with the increasing pressure. Practically speaking, it seemed wiser to handle this on my terms in a “controlled” fashion than push ahead and wait for said meltdown in the middle of a semester where it would have academic impact as well. Speaking from the heart, though, there are certain decisions just feel right independently of all the mental masturbation of pros and cons, to-do lists, spreadsheet forecasts of finances, etc. One can’t ignore such realities completely, but some decisions in life live “in the gut”–in this case, borne out of some archetypal survival instinct–and I had to concede the silently obvious. The final thing I needed to do to seal the deal was work it out with my job to ensure I had the funding to work these months since not going to school meant no student loan money. Once that was settled–literally days before classes resumed–it was like a huge weight was lifted from my shoulders. I was sad that first Monday and Tuesday when I knew all my classmates were starting without me, seeing the emails fly back and forth about all the scuttle I was not there to experience, but in my heart I knew it was not yet my time–there were more pressing matters at hand.

In spite of my waxing philosophical above, don’t think this is all touchy-feely goodness. I still have the issue of what the hell to do with my USMLE Step 1, for example. There are no good solutions, but the “proper” decision, not taking any risks with the ECFMG, is to take it upon returning to school. That’s 6 months away and feels like board suicide for someone who had geared up prep to take it yesterday. I am constantly reminded that details of various fungi, adrenal gland enzyme deficiencies, and properties of Class Ia anti-arrythmics are certainly draining out of my recall at a nice flow rate every time I even attempt to pick up a study book. However, I have to trust myself–I am certainly no dummy–and that I can figure out a plan to minimize the leakage in the interim and re-prep (which for a 2nd go-round should be faster/easier) over the holidays and still have the confidence I’ll get the score I’m capable of. It’s hard, though, to have that self-discipline for something so specific when your life is not currently revolving around it.

In the end, this, like all the other things on my plate, are challenges I have to rise to meet. I’m not handling everything as neatly as the words on this post, I promise you, but I hope to get there. Claudia is on board with me, my daughter’s back, and we can finally be a family again, settled in here in Mexico for good. 3 months of Claudia living out of suitcases and various family members’ houses as she did her surgery, therapy, and other things back home reminded her that home is, as we say in Texas, “where you hang your hat.” Our home, the place we as a family call our own as long as I continue my studies, is here in Guadalajara.

Hopefully, my temporary status as med-student-in-limbo doesn’t affect whatever readership I have. I know I’ll always have my true blog friends, but I promise that in spite of not having personal medschool stories to share for a while, I still have lots to say. My stories of the next few months may not be sexy material for Grand Rounds, but they will as always be honest, unique, and hopefully interesting, too. I hope you are here to read them.

Run! Run!

Trying to pack car….fast as possible…avoiding category 15 hurricane…aiieeeeee!!!!

This is actually deja-vu all over again, since when we first left for Mexico in the big house move in 2005, we were then outrunning (and eventually being overtaken by, as our movers were little girly men who didn’t want to get wet) what became non-newsworthy TS Emily.

No movers this time, just 4 months of wife’s and baby’s things (and perhaps something or two of me to wear if I am allowed) into a Ford Focus. Yeah. Fun times. Not.

Will be back online soon from the comparative paradise of Guadalajara weather, having recovered from chronic heatstroke, familial craziness, and a 14h drive with a 15-month-old in a roller skate that will probably leave me scarred. But to have family together again, all in our own home on our terms…priceless.

First things first, though, and we must outrun the perfect storm *snicker*, so the laptop lid closes for the last time as I pack, pack, pack and load, load load. Wish us well! Lots to write about when I get back…looking forward to it.

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