Interesting things are always happening at work. When I take report from the night nurses in the morning, we usually have a few things to chuckle about, but Tuesday absolutely took the cake on this. I had three patients with different delusions that were, shall we say, unusual. The first had the delusion that a Doritos truck is following her. Yes, it was that specific. I can see why that would upset someone, especially if you are interested in keeping your slim figure. The second patient believed that a vibrator was stuck in her vagina, in spite of the fact that she was thoroughly examined in the ER by a doctor and there was no contraband in there. This delusion was part of a complicated set of beliefs she had about an ex-boyfriend; he was stalking her, he had put the vibrator in her, and he was living in her attic. The last patient thought that there was a little (very little) two-year-old child in his pocket. Isn't psych interesting? Really, it truly is. Most delusions involve some degree of paranoia (you can see that in the first two), and the most common focuses are religiosity, sex, and persecution (often by the government).
Most people think delusions only occur with schizophrenia, but nothing in psych is that clear-cut. The brain is so stunningly complex, most disorders are actually pretty unique to that single person. Disorders often overlap in symptoms. The field of psychiatry is fairly new so it's evolving (there was an article in Newsweek this week about the explosion of bipolar diagnosis in children -- the author thinks it's being overused). And since you can't diagnose with a blood test, communication with the patient is key. If that's limited, your diagostic task is going to be pretty tough.
At the end of my shift Tuesday, one of the techs told me that a family member wants to talk to me about one of my PICU patients (incidentally, she was one of the three patients I mentioned above). Now, it's 15 minutes before I go into report and I could have handed off this task to the next shift. But I know that I would not want that done to me, so I talk to the family member when we finish report. I have seen the patient all day, so I am in a better spot to respond to questions with knowledge. Unfortunately, I can tell right off the bat that this family member is very pissed off. She states that she thinks the patient hasn't made enough progress -- which is amusing, since she was admitted less than 24 hours ago. Does she think we give them one pill and they're cured? She asks numerous questions about things outside my scope of practice -- things that only the psychiatrist can answer. But I know that if I curtly refuse to answer, it won't go well so I shift the focus to what I can talk about -- how the patient coped that day, what activities she did, what medications she is on, how she responded to staff. That goes pretty well.
But her last question is when it falls apart -- she wants to know what's the diagnosis. (By the way, all of this is discussed with the patient standing there, listening. Which is actually better, as being open and direct is my preferred way to do this.) I tell her that the diagnosis is bipolar with psychotic features. Her nostrils flare. "Oh, that can't be right," she exclaims. "She has delusions! She is imaging things! That's not bipolar. That's schizophrenia." So I have someone who read an article once about mental illness and is now an expert, I think to myself. Oh boy. How to encapsulate a complete course in mental health in five minutes to educate her? I try, but I can tell that I've failed when she says "Well, that's all interesting, but I want to talk to the doctor." Unspoken, of course, is that I'm just a stupid pill-pushing nurse. Oh well, I tried. And all that effort just made me 30 minutes late getting home.
Dani is loving New Jersey, and I can see why from the pictures she's posted on Facebook. It's so green and lush there now, compared to Austin. Jersey has beautiful summers, I miss that. She also got good news on her SAT -- can I brag? She got a 2010. Exactly what she predicted, by the way. The airlines have found a way to extract more cash from parents of spoiled little princesses, by the way. When we put her on the plane to Newark, the bag was 8 lbs overweight and we had to pay $100 for that. And guess what....she'll have to pay another $100 on the way home. I'm sure it will be much more than 8 lbs overweight then.
One last thought. Dani and I went to Victoria's Secret right before she left, and they had a specially-trained bra-fitter there. So we both got fitted and boy....we were wearing the totally wrong size (especially her). We bought new ones in the correct size and WOW, huge difference in both comfort and appearance. Every woman should do this! And VS must be really happy, because I have five new bras now. Ha.
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