"I wanted to clean out my bowels, so I ate soap."

As part of the psychiatry rotation, you spend several weekend and weekday nights 'on call' with the resident until 11:00pm or so. You split your time between seeing patients in the psychiatric emergency room and answering questions about ward psychiatry patients from nurses. On one afternoon with the resident we got a question from a nurse about a patient on the wards who was complaining of "bowel distension" and some mild abdominal pain. I recognized the name of the patient as one of the patient's my team was following so I offered to go upstairs and talk to the patient first. The resident said he thought this was a great idea and said he would be arriving about 10 minutes after me. Here is a summary of our conversation (at least as good as I can remember):

Me: "Can you tell me about your abdominal issues?"
Patient: "Well, I know my abdomen is very distended, and I am really constipated."
Me: "Tell me more. When was your last bowel movement?"
Pt: "I have had two bowel movements today and they were both pretty loose and I had two bowel movements yesterday too, but I know I am constipated. Look how big my abdomen is."
Me: "Some people might think that if you have 4 loose bowel movements in the last 2 days, that you probably aren't constipated. Can you tell me if you have changed anything about your routine or what you have been eating recently?"
Pt: "Well, I really wanted to clean out my bowels, so I ate soap."
Me (confused, and trying to keep a straight face): "Uh, allow me to clarify. You ate soap?"
Pt: "Yeah, soap. You know, it comes in a bar."

Hmmm... I wonder what the source of her loose stools and abdominal distention/pain was?

When you think about on a very basic level, it sort-of makes sense. If you want to clean your hands, you use soap. If you want to clean your dishes, you use soap. If you want to clean out your bowels, wouldn't you also want to use soap?

Oh so good. Soap. Deliciousness in a bar. Maybe those food scented soap bars really have a market.

A couple people I have spoken to had their mouths washed out with soap when they were younger after saying some bad words. They say that it actually doesn't taste that bad. I wouldn't know.

Voices.

In psychiatry you learn that a surprising number of people hear voices. Many people can successfully go through day to day life hearing voices (aka auditory hallucinations) and frequently without other people finding out. When we talk to patients who have auditory hallucinations sometimes they like the voices. It may be the voice of their mother telling them comforting things. Sometimes it is their own voice which is telling them positive self talk saying things like, 'don't be sacred' or 'you can do it,' etc. However, perhaps even more frequently, the voices are degrading and cruel. They may say things to the patient over and over again such as, "You are worthless. You are worthless. You are ugly." One patient said the voices said to her, "Eat, eat, eat, and die." Others have voices that say, "Kill yourself." Over and over again. Perhaps the most horrific, are the voices are those that state that if the patient does not kill him or herself that something terrible will happen to the rest of the world (the world be destroyed, all the children in the world will die, etc). Usually the patient has some sort of understanding (however small) that voices do not indicate reality and that if the person does not kill him or herself that the world will not come to an end. However, this led me to the question: What if the patient actually believed that if he or she didn't kill him or herself that many other people will die?

In Biblical philosophy it is said that there is no greater love than to lay down one's life for one's friend. Likewise, it is also considered by many to sacrifice yourself in service to your country. In some religions it is considered a sin to commit suicide which may even result in the person committing suicide going to hell. But what if the patient truly believed that if they didn't kill him or herself then many other people would die? In that situation, although it is of course a terrible tragedy that the individual has tried to end his or her life, is it not also an incredibly selfless act? Although their reasoning is flawed as they have been given incorrect data, they are acting along one of the most noble of moral codes of our culture. Just food for thought.

Reading notes every morning - better than a best-selling mystery/adenture novel!

I am now in the depths of my psychiatry rotation in Seattle. It is a great and truly memorable experience! Medical students are divided into teams that round on patients in the hospital fr psychiatric reasons. For the most part, patients are being held against their will for their own safety (either for suicidal thoughts/plans or psychosis or something similar). The teams usually consist of an attending psychiatrist, either a psychiatry resident (psychiatrist in training) or a psychiatry physician's assistant, 1 or 2 medical students, a social worker, a pharmacist, and occasionally a pharmacy student. The teams are generally a lot of fun and are very dedicated to helping patients.

In the morning, the students get there a little before the other members of the team and look up labs, medications and read nursing and other notes from the team's patients from the team before. Then before rounding the medical students can update the team on what is going on with the patients before team interviews the patients each morning. This is a very similar pattern to what happens on other rotations in the third year of medical school. However, what is different about psych is WHAT is written in the notes. On other rotations, the notes usually have the patients blood pressure, heart rate, how much fluid they consumed and how much the urinated, how they slept, how much pain they are in, etc. In summary, overnight notes in other third year rotations are just a touch boring. Occasionally something exciting happens (your patient worsened and might have to be sent to the intensive care unit or something else sad or upsetting), but generally not the most exciting part of your day. Psych notes have a lot of this medical information too, but they also have descriptions of what the patient said or did the previous afternoon and night. By almost every definition, psych notes are almost never boring. In fact, opening up psych notes in the morning was one of the my favorite parts of the day. It was even better than opening up a best selling adventure or thriller book because you never knew what patient might have done over-night.


My pictorial version of psychiatry notes - they are better than an adventure/thriller book or movie. Even more exciting and unexpected.

I loved OB, now I am on my psych rotation!

I had a blast on my OB rotation in Anchorage. It was a lot of fun. I got to see lots of deliveries, numerous surgeries, and work with some very cool people. I had such a good time on ob, I actually started considering at a specialty choice. (We will see what the rest of third year has in store for me surrounding my life decision making plans). OB had some wonderful moments. Mom's and babies are lots of fun.

Despite our enjoyment of OB, at the end of our stay in Anchorage, the cold weather and the very short number of daylight hours made us pretty happy to get on the plane and come back to Washington State.



Here is a picture of the OB students I was with in Anchorage. From left to right they are Jonathan, Lindsey, Kristin, and me. This was taken after our final exam on the very few hours of day light. By the time we were about to leave a large portion of our conversations focused the fairly depressing topic of astounding lack of daylight hours. Here are just a few of our sample conversations:

Jonathan at 1:30pm, "Hey, guys look at the beautiful sunset outside." We looked outside, and indeed there was a brilliant red sunset behind the snow covered mountains. It was indeed beautiful, it perhaps would have been even more touching if it was occurring at 5 or 6pm instead of 1:30.

Lindsey, at around 11am a couple days later (just a couple days before the shortest day of the year), "Hey, guys, look! It is another beautiful sunset." Me, "That is beautiful, but it is before noon, so that would make it a sunrise." Lindsey, "Uh, that looks just like the sunset a couple days ago. Are you sure it is not a sunset?" Allow be to explain this conversation. Towards our last days in December, the days became so sort that the sun essentially rose as a sliver of light from behind the mountains in the south (around 10am), and set as sliver of light a few hours later as a sliver of light coming behind the mountains from the south. Thus, other than the time of day, the sunset would be difficult to differentiate from a sunrise.

After a brief, but well needed break for Christmas, I am now on my 6 week psychiatry rotation in Seattle. I am looking forward to some unique experiences and catching up with people in Washington.

Enough with spam comments on my blog!

I curse you internet junk-mail spammers!!!!!! (earthquakes, thunder and lightening sound). No more spam comments on my blog! No, I don't want comments trying to sell Viagra on my blog posts about learning Swahili in Tanzania. Anonymous comment posting has been eliminated due to abuse by spammers. You must now have a Google account to make a comment.