Gansta's paradise

It's a Harry Potter/Dangerous Minds mashup!! Hermione Granger teaching a bunch of inner-city kids? Genius.



Seriously, I haven't seen a parody this good since SNL's early days.

Is it bad that I wish they would make this movie purely so that I could watch it? This is box-office GOLD.

It's like you're a drug

ME
Ugh, I had McDonalds for dinner. Fries and a fudge sundae. And now I feel gross and disgusted with myself.

MIKE
Sounds like someone needs to go to some MA meetings (McDonald's Anonymous)...wah wah.

ME
Hahaha, I totally do!! I'm addicted to their fries and I think about them ALL the time. It's starting to disrupt my life. Hahaha, I'm laughing, but I'm serious.

MIKE
There you go. But you should determine whether it's abuse or dependence

ME
Oh it's dependence. I will do illegal things to obtain it. For instance, I will leave work early because I need to get some fries. Truancy! If that's not dependence, I don't know what is.

MIKE
Did you use to order a small fry, but now you have to order a large to feel just as happy?

ME
Yes! Now I have to order TWO larges. One to have later, because I worry about not having it when I really need it!! Like at 2 in the morning! McDonald's isn't open then!

MIKE
I think you hit at least 3 criteria within 12 months....Michelle, I'm afraid you've met DSM IV criteria for McDonald's Dependence

ME
Sigh. I've denied it for so long, but you're right. I need help.

MIKE
Diagnosis 304.90 - don't panic, you're not alone. Millions of Americans just like yourself suffer from this very same disease. But you can be cured. MA can help.

ME
Hahahah, this is such sad nerd humor.

MIKE
Michelle, McDD is no laughing matter.

Cute is what we aim for

This is the cutest thing I've ever seen. Seriously, if you don't smile upon seeing this video, you might be dead inside. Just saying.

There must be more

I was raised in a Presbyterian household. My grandfather was a prominent pastor in Taiwan and my family was always very involved in church and church-related activities when I was growing up. However, once I left for college, without my family around, I stopped attending sermons religiously. I still went every now and then, but it seemed like schoolwork and studying for exams started to take more and more precedence to the point where I was only going for Easter and Christmas. And as shocking as it might be to my father, I sometimes ate without saying grace. I had unfortunately become what the evangelicals would call a wayward Christian.

But I never lost faith. And I never forgot what I was taught – the doctrines, the stories, the miracles.

So once I started third year on the internal medicine floors, I figured I would be able to talk with patients about faith if they needed it. I figured I could say prayers and I knew most of the words to the hymns and songs. Bring it on.

Yet I was never asked to be part of my patients' faith-based healing. When I walked in the door, all my patients wanted were the concrete details. What were the LFTs like today? Were they low enough that the patient could leave? Did the cultures come back yet? Had someone determined the cause of the fevers?

I figured it was because I was lucky. None of my patients were terribly sick. All of them were going to walk out of the hospital. There was no need for prayers from me, really. They weren’t about to go off to that kingdom in the sky. All they needed from me was to know when they could go home. In fact, I think if I were to suddenly ask about faith or spirituality, I would probably scare my patients into thinking that they were about to meet their maker.

Then last week when I was on psych consults, it seemed like we were talking about religion and spirituality with everyone. We had one patient who wanted to leave AMA even though he had osteomyelitis of his sternum. He had refused blood draws and IV antibiotics, convinced that God - who had brought him back from a coma after a terrible car accident - would save him yet again, without our intervention. He wouldn’t cooperate with us, muttering prayers under his breath and tuning us out. We had been consulted to see if he would be eligible for involuntary hospitalization. He was a religious fanatic, to be sure, but perhaps he was delusional as well?

We were also consulted for another patient who was truly on his deathbed, when he told his nurse that he wanted to withdraw care. He was tired of living in the ICU, living on machines, unable to speak to his wife, unable to see his kids. The surgeons had called in the chaplains, and at a family meeting, I was struck by how the trauma surgeon kept referring to how it wasn’t time yet for the patient. That he had to have faith that he would get better. That there was a reason that all this was happening to him. There was a light at the end of the tunnel, and that light had nothing to do with taking him up to heaven.

It seemed like the doctors were using or disregarding spirituality and religion as they saw fit. The patient with osteomyelitis was diagnosed as a delusional schizophrenic. Sure, he was claiming to be a religious man, but my attending believed it was more a delusion than anything. And so we used that to involuntarily hospitalize him. He was a danger to himself and he needed to be kept in the hospital where we could monitor his infection, even if he wouldn’t let us give him meds. On the other hand, the ICU patient was someone who had lost his faith. And so we used that to say that he didn’t have capacity. He was too depressed to be thinking clearly. They had both wanted to withdraw care, but for completely different religious reasons.

One patient had too much religion and so we deemed him to have no capacity. Another patient had none, yet we also deemed him to have no capacity.

We deal with religion but not in the way I thought we would. So, I’m still trying to figure out how spirituality fits into modern medicine. How does hoping for miracles fit into something based on the scientific method? Where does the abstract fit in with something so definite?

I’ve always thought that it was a way of coping. Sometimes for the patient, sometimes for the family. And now I’ve come to realize that sometimes it’s just for me. In a field that is so concrete, I need to be able to hope that things can work out, even when all the numbers and all the images - everything - tells me that it can’t. I need to believe that miracles can happen so that I can get up every morning and keep going.

Taking chances

Life is calling. How far will you go?

I'll go to the edge and back. And I hope it's with you.

Let it snow

ME
When are you getting back in?

LISA
Late Sunday sometime.

ME
Btw, it's snowing in Chicago right now!

LISA
Oh crap! Seriously? A lot? I have to drive!

ME
Erm. To be honest, I closed my blinds because it was making my room too cold...but according to my gmail theme, it's snowing, cause there's snow on my inbox and chat boxes.

LISA
HAHAAH, I thought you had a weather app or something, but no, you're relying on your google theme?

ME
[embarassed]
It's actually kinda sorta pretty accurate.

LISA
HAHAHA

Back against the wall

He was a well-dressed man in his fifties. He had a history of bipolar disorder, avoidant personality disorder, and childhood seizures. He had been hospitalized 25 years ago for having suicidal thoughts and depression. When he was discharged, he was assigned a psychiatrist who would see him on a regular basis. He was doing well. But, when that psychiatrist moved away eight years ago, she tried to set him up with someone else in the practice. Yet given his avoidant personality, he just kinda got lost to follow-up.

So it had been eight years since he'd seen anyone for his mental health issues. And then today, he decided to call up the clinic and ask for an appointment.

Oh sorry sir, but the next available appointment isn't for 2 weeks. Will that be okay?

He paused, counting the number of days til he could be seen in his head. Sure, he replied hesitantly. Go ahead and schedule me.

And what shall I say this is for? asked the receptionist.

Oh, well, I made a pretty major mistake at work a couple of weeks ago, and I've been feeling really kinda anxious and guilty about it. And I think maybe my depression is getting a little out of hand again. He was being forthcoming and honest about his feelings. So the receptionist wished him a good day and hung up.

He walked into the ER three hours later. Why was he here? He couldn't really say why. So the ER triage nurses flagged him as a psych patient, and the psych team went to go see him. Was he depressed? No, not really, he said. He had made a mistake at work a couple of weeks ago, and his boss yelled at him, but no one was hurt and everything turned out okay. Since then he had had some suicidal thoughts. But they were fleeting - nothing serious, he claimed. He had thought about jumping out his window, but he couldn't do it. He knew it was wrong, he said.

And now sir? Do you have any thoughts of hurting yourself now?

No, he replied. Not at all.

The patient had called up his sister and brother (who lived just a couple of towns over), and they were waiting for him in the waiting room currently. His dad was awfully sick, so he felt depressed about his dad's worsening health. But that was it.

Any firearms in the house?

No, sir.

The psych resident on call wasn't sure what to do.

He felt uneasy just letting the patient go, but the patient wasn't having any suicidal thoughts now. And his family was here and supportive. And the holiday weekend was coming up. Did he really want to hospitalize this patient, when it seemed like all he really needed was an outpatient psychiatrist? Really, there were far more patients he'd seen who needed to be hospitalized and weren't, so maybe this wasn't the best use of resources.

Sir, I think I'm going to let you go with your family on the condition that you see someone in clinic soon --

Oh, I have an appointment for next Wednesday! the patient interjected.

-- oh that's great! Okay, and I want you to realize that there are a lot of people out there who care about you, so if you ever feel like you might be thinking of hurting yourself, I want you to call 911 right away. Or come into the ER again, okay?

The patient promised.

Thanksgiving came and went.

And then Wednesday came and went.

The patient didn't show up to his appointment. The attending's secretary left a message on his landline - Hi sir! You were scheduled to be seen today in the Mental Health Clinic - please call back so that you can reschedule!

The attending got a call back later that afternoon. It was the patient's sister.

Tearfully, she informed the psychiatrist that her brother had killed himself two days ago - jumped out his window to his death 57 floors below. No one had seen it coming or thought he would do it. Her other brother had had lunch with him the day before he jumped, and he had seemed okay. Fine, even. And before he had jumped, he had called 911. But by the time help had come - no more than 4 minutes later - he had deadbolted the door, refusing to let anyone in to help him. They set about trying to tear down the door, trying to find someone with a master set of keys. But thirty seconds before they were in, he had jumped.

---

Our lecturer finished her story. And we, the students, sat there in shock, realizing that many of us would have done what the resident did. He didn't fill any criteria for major depressive disorder, he wasn't endorsing any suicidal ideation, and he had a great supportive family. We would have sent him home, too. Yes, there was that vague I don't know why I came into the ER bit and the whole prior psych history, but he seemed stable. He had seemed like he knew that he needed some help and had set the ball rolling with the psych appointments and calls to his family. True, we weren't there, so we couldn't pick up on minor body cues and such, but it seemed like the resident had made the right call. After all, who wants to be stuck in the hospital during the holidays?

Our lecturer was telling us the key clinical pearls from the story - that safety trumps any DSM-IV diagnostic criteria. That if you have a weird nagging feeling about something, you're probably right.

In every field, there's a fatal end point. Heart attacks for cardio, strokes for neuro. In psych, it's suicide. We might not have lipid panels or MRIs to go on, but we have our gut and our intuition. And that's what we have to trust.