As Promised

So I promised to talk about psychiatry today.

Sometimes, I really envy those physicians who write about their patients on blogs. I am often worried that if I wrote about a patient, that patient would stumble onto this blog, read about it, figure out that s/he is the person I am writing about it, and it would end badly. I don't know how one gets around the privacy issue, even if their names are changed.

Maybe it is because most of what I treat is so sensitive, unlike pilonidal cysts, erectile dysfunction, severe constipation.

Maybe it is because most of what I say about a patient isn't all that favorable, and hardly anyone gets 'cured.' Unlike constipation.

The other day, I got a phone call from a mediator who works in the family court system. A patient of mine and his/her former partner are in a custody disagreement. Both parties are asking for sole custody, of course. It really pains me, after discussing the case with this mediator for nearly 1/2 an hour, that my ultimate recommendation to the Judge, is that my patient should not be granted sole custody. Not that because s/he is mentally ill (there are plenty of mentally ill parents out there) but because s/he simply isn't able to provide a secure, stable environment for the child. Not that the other parent would be a totally awesome option either (granted I have never met him/her,) but s/he has seemed very controlling, according to my patient. So here it goes, he says, she says, blah, blah, blah.

I take comfort in the fact that this Judge has a formal way of thinking about all these custody cases, and that what I say is only a small part of the final decision.

Really depressing, actually.

Meanwhile, late this afternoon I get a visit from our nurse, who is fielding phone calls. "There is this patient who is getting 'lines' on her face."

"Lines?"

"Yes, her PCP thinks it might be due to her psychiatric medications."

"Lines?"

"Yup, lines."

"You mean, wrinkles?!"

"I have no idea. She wants to stop by to have you look at it."

(I am about 99% certain that the meds she is on do not cause dermatologic changes. Her age, however, is appropriate for such formation of 'lines.')

I ended up calling the patient, explaining to her that as much as I can sense her distress, I am not a dermatologist, and I am of no help to her in the discussion/evaluation of these 'lines' that don't itch, or hurt, and that those 'lines' had been there for quite a while.

To think about the physiologic cause of the formation of lines was totally unfruitful. However, to think about the fact that this person's psychiatrist is on an extended vacation, that she recently terminated with a long term therapist, then it would totally make sense: Who is going to take care of me?

Meanwhile, Aidan is totally in the oedipal phase of his life. At bed time, while I was tucking him in.

"Mommy, you should always stay with me, forever."

"Really, even when you are married and I will still stay in your bed to tuck you in?"

"Yup. Stay with me forever."

"How about when you go to college?"

"Yeah, you stay with me. Daddy can sleep alone!" (Giggles...)

"Hey Aidan, what are you going to do in college?"

"Eat cereal with my friends, live in the same house with them. I will be in college for a day. You come stay with me though, ok?"

Zoe is obsessively re-reading the same books- books without actual sentences. I drone on like this, "Purple, Octapus, Stingray, Seashell. Orange, coral, sea star, crab. Turquoise, fish, whale, ocean." Again, and again, and again...