In which I try to make the judge read between the lines

Today, I had a probable cause hearing in which I had to testify in front of my extremely sweet, but extremely psychotic and paranoid sixteen-year-old patient. The thing is, I'd been doing therapy with him for two weeks, and even though he was absolutely convinced that everyone else was out to get him, he had started to trust me and tell me things...like how everyone else was out to get him. So now I had to give my testimony  and use the right words so as to not set off my patient and keep our therapeutic relationship intact.

Sounds easy enough, but I found myself trying to wink my way through it, hoping that the judge would understand the hidden meanings behind my words.

JUDGE

All right Dr. Wu. So can you tell me why this child should stay in the hospital?

ME

Um, yes sir. Our patient has had a very troubled past and had terrible things happen to him, including things that no child should go through...[and here I fought the urge to actually physically wink at the judge]. He has very firm beliefs that others are conspiring against him and the other patients and feels it is necessary to protect them at all costs. 

JUDGE

Hm. I see. Well Sam, would you like to say anything?

SAM

Yes sir. I need to get out of here, because they're trying to kill me. I'm not the one who needs to be here sir. There's a man in the walls who's a shape-shifter and he's going to kill us all unless I get out of here. I'm begging you, Your Honor, you gotta let me go so that I can avenge all of our deaths!!!

So much for trying to side step around the issue.

Please don't let me be the only doctor on this plane

The most stressful two minutes in my life aren't the two minutes I have to wait for the nurses to draw up an emergency intramuscular injection for my psychotic patient who is raging high on drugs and willing to take out the nearest person standing between him and his chosen manifest destiny. No, in those two minutes, I'm surrounded by trained nurses and sheriffs with tasers and hard restraints.

So those minutes are bliss compared to this.

I think every psychiatrist dreads it. And yet, it seems to happen to me more than any other physician I know. On my most recent plane trip home from Europe, I was in the midst of breathing deeply to avoid thinking about turbulence and birds flying into engines and having to land emergently on the Hudson River, when  a girl started frantically screaming that her mother had stopped breathing. Oh crap. Flight attendants rushed down the aisle, and then inevitably, the flight attendant leader's voice came on overhead to calmly ask, "If there are any medical personal aboard, please make yourself known to our crew by pressing your call light."

I didn't press my call light. Instead, I held my bated breath for someone else to press their call light. Surely, there was an emergency medicine doctor or an internist or a trauma surgeon on board. Surely, there was someone with more CPR experience than me.

Instead, all I got was silence.

Shit.

And then, a woman stood up and made her way towards the commotion. "I'm a retired nurse," she told the crew.

I exhaled.

But I kept one ear open, because I was fully aware that I was shirking my physician duties, and oh man, was this going against every oath that I had taken upon graduating from medical school?

What I heard was not pleasant:

NURSE

Oh shoot.

FLIGHT ATTENDANT

What?

NURSE

I can't feel her pulse.

HYSTERICAL DAUGHTER

MY MOM HAS NO PULSE???!?!?!?

NURSE

No...well...I just can't feel it. Maybe?

HYSTERICAL DAUGHTER

IS MY MOM DEAD?!?!?!!?!?

FLIGHT ATTENDANT

No, she's fine. Miss, you need to stop yelling. You're being hysterical. And that's not going to bring your mom back.

HYSTERICAL DAUGHTER

[bursts into further wailing]

Fabulous. I craned my head to look at the mom five rows back. I could see her chest rise and fall, so clearly she was breathing; she was pink, and she most definitely wasn't dead. A flight attendant was walking by me, so I tugged on his arm. "Hey, I'm a psychiatrist, do you need my help?" He brushed me off, "No, we have a retired nurse."

I had just been absolved of any duties.

And then I realized that the flight attendant probably didn't realize that I was a doctor. Didn't realize that a psychiatrist is a real full-fledged MD. And the nurse was making the daughter even more freaked out. So I unbuckled myself, despite the seat belt warning sign, and made my way towards the patient. Everything was in chaos. The patient had a mask on her face, but the oxygen wasn't connected. The nurse had her hand pressed up against the patient's carotid, pressed so tightly that her own fingers had lost blood flow. And the daughter kept shaking her mother, loudly instructing her to "wake up!"

I went into doctor mode and tried to not think about my own insecurities and turbulence anxieties as the plane dropped and weaved in the air. "Hello ma'am, I'm Dr. Wu, and I'm going to take care of you okay?" She nodded at me and squeezed my hand as I held hers and checked for her pulse. "Do you take any meds?" Her daughter hysterically started crying again, loudly saying, "No, my mom is completely healthy! She doesn't take anything!!" But the mom squeezed my hand again and looked at me. I pulled her mask away so that she could answer me. "Cymbalta and Wellbutrin," she whispered faintly to me.

Slam dunk. This was one of mine.

Feeling slightly more reassured that I could handle her emergency, which was seeming more and more like a panic attack, I smiled at her. "Is that for depression or anxiety?"

"Anxiety."

Yes. Definitely one of mine.

I sent a flight attendant to get me some ginger ale, and sat down on the aisle and worked through some breathing exercises and guided imagery. When the flight attendant returned, I prayed to the placebo gods, and gave it to the mom, telling her "Ginger ale is perfect for nausea, and you know what? You're probably a little dehydrated, so this will help with that too." The placebo effect worked, as she took a sip and immediately smiled, saying, "Oh I do feel much better now."

She took off her oxygen mask and I made my way back to my seat.

Just as I was starting to drift back off into my jet-lagged sleep, the flight attendant came by with paperwork for me to fill out. So, instead of resting, I filled out all the random documents that needed to be signed. And realizing that my name was now connected to this patient, I felt compelled to turn around to look at her every fifteen minutes, to make sure that she was still alive and breathing.

So much for the Good Samaritan rule.

The icing on the cake? My seat neighbor, upon seeing that I wasn't going to sleep anymore, immediately launched into all of her own sleep and bowel movement problems, and didn't stop talking for the remaining five hours of our flight.

Dr. Meanie Bikini knows.

Just watched the pilot episode of the CW's "Emily Owens, MD" and dude..the mean attending on that show might be Dr. Meanie Bikini's doppelganger.

....and the character's name is awfully close to Dr. Meanie Bikini's real name.

Holy crap!

I've been compromised!! My cover is blown!

Shut everything down! Initiate evacuation plan #4!! Save yourself!!

Pew pew pew!

What a trick or treat consult

ME

This is Michelle from psychiatry! 

INTERN

Oh, hi, thanks for calling back. I wanted to place a psych consult?

ME

Sure, what's going on?

INTERN

We want you to come evaluate our patient to see if she needs to be put on a hold for grave disability.

ME

Okay...why do you think she's gravely disabled?

INTERN

She stopped eating yesterday.

ME

Did she say why?

INTERN

No, but she looks sad.

ME

Hm, was she eating before?

INTERN

Yeah, it's really weird. She's pretty cooperative with everyone, but she just stopped eating yesterday. There's been 0% intake since yesterday at lunch time.

ME

Huh. That is pretty weird. Let me do a quick chart review to see if she's ever seen psych before. I'll call you back.

---

On chart review, I found out that the patient had a small bowel obstruction, and was scheduled for surgery today. And when you're going for surgery, you don't get to eat the night before. 

The patient was just following the surgeon's instructions.

Yes.

This was a real consult.

Halloween humor

Seriously.

Well, if all Asians look the same

This morning, I walked into the hospital like I always do, but instead of going to get my usual morning cup of coffee, my jaw dropped.

My patient was meandering around the lobby, loudly trying to get a security guard to help him.

And me? I was freaking out.

Because my patient was on a psychiatric hold. And unless my attending had decided to pull rank and come into the hospital early to discontinue the hold, my patient should have been in the locked unit, and not on the verge of eloping, just mere feet away from the entrance/exit and out of my psychiatric jurisdiction.

How did this happen? While my mind thought a million dark thoughts at the county nurses and their inability to pay attention to anything other than their cell phone texts, I tried to smile serenely at my Spanish-speaking-only patient.

"Hola senor! Soy su doctora! Por que...outside....aqui?" I asked him as I tried to figure out which of the few Spanish words I knew could apply to this situation.

He looked at me, confused, but thankfully, not attempting to escape.

"Vien con moi..." I motioned to him to follow me, as I started conjugating French verbs, hoping that the languages were similar enough that he would understand me.

He followed me passively back to the unit. Didn't raise a fuss when I swiped my badge to unlock the doors, wasn't perturbed when I hissed at the security guard for allowing this to happen, and followed me all the way to his room.

"Here you go sir. I'll come talk to you in about thirty minutes okay?" He had no idea what I was saying, but nodded pleasantly at me. I led him into his room, and then led him straight back out of it.

Because my patient was sleeping soundly in bed. And this man who had been following me around, was apparently not my patient after all.

I awkwardly grabbed his arm to look at his patient ID wristband, realized he was supposed to be on the sixth floor, and took him back to his proper room. And then I went and got a big plate of tater tots for the security guard to apologize for my earlier death glares.

J's wedding

"Why are you visiting Atlanta?"
"Oh, my best friend is getting married."
"How nice! Are you the maid of honor?"
"Hahaha, no, this is my best guy friend."
"Ah. [awkward pause] So is this a Julia Roberts' My Best Friend's Wedding kinda situation?"
"Oh GOD no."
---
J got married yesterday.

Ten years ago, if you had told me that J would be the first of us to get married, I would have snorted Coke out my nose in disbelief. But here he is. Married, with an adorable kid and a slightly manic dog, making mortgage payments on a cute little apartment in Seattle.

I don't really know what I expected from the wedding weekend. J and I barely have time to talk these days, instead relying on figuring out snatches of our lives from quick texts and one-liner emails. But he still has an uncanny ability of knowing exactly when I need to hear from him. True story: he texted me exactly eight hours after my disastrous car crash, before any mention of it went up on the blog or on facebook. I guess that's why he just might be a fantastic psychiatrist.

The thing is, J and Lisa made me believe in true love. Because that's what we've got for each other. True, unadulterated - completely platonic, yes - but absolute, total, and undying love. It's okay that we don't have those long JLM homemade dinners, where we depended a little too much on our guaranteed acceptances into medical school to completely slack off and watch Bravo reality TV marathons for hours on end. We don't have time for that anymore, what with our actual jobs and the whole being states apart instead of mere blocks away.

But I will always remember that J always knew my idiosyncrasies. That he would bring me two halves to a bagel, that he'd throw snowballs in my face, that he'd go grocery shopping with me and tell me to start my day off with a big bowl of pink cereal, that he'd give me his honest truth, no matter how hurtful it might be at times. J knows me. Just like how I know that he dances like an absolute dork, that he watched every episode of Smallville religiously because of his unwavering love for Kristin Kreuk, that when he falls in love he loses sight of everything else (including organic chemistry unit tests), that it doesn't matter how much he's eaten, if you put another plate of food in front of him, he will eat it and yet, it will never show up on his nonexistent gut. Yes, I know J, too.

And so, even though he denied it, I knew he got misty-eyed when his bride started her walk down the aisle. I knew he got a bit choked up on his vows but instead just gruffed them out as quickly as he could. I knew he was nervous when he first walked out to take his spot, forgetting to smile until me and Lisa beamed slightly-crazed grins at him. And that's when I knew that this was far from the end of our friendship. No, I won't deny it -- when Jeff smiled back at our over-the-top grins, I got a bit misty-eyed too, so happy that my best friend has found someone who can take care of him the way he took care of us, someone who doesn't deny him his friendships, someone who loves him and his somewhat annoying quirks.

We're expanding our JLM trio into an AJLM quartet. We're still separated by state lines and time differences, but it doesn't matter. None of it matters. What matters is that, as corny as it sounds, we're friends forever.