Awkward!

A lot of what I do is contacting patients about their medication issues. But when a new problem popped up ten minutes before my lunch break, I decided to see if someone else could handle it.

"Carlene," I asked the secretary closest to me, "Can you call Mr. Felonious and tell him we faxed his prescription to Local Pharmacy?"

"Sure thing." Carlene turned to the other secretary. "Judy, can you do that for HelloNurse?"

Judy looked nonplussed. "I guess so, but why can't you call Mr. Felonious yourself?"

"He robbed my parents' house for drug money about four years ago, so I try to avoid him."

"That has to be weird--he has appointments here every week," I said.

Carlene chuckled ruefully. "Especially since his family still lives across the street!"

Pass the Febreeze!

Co-worker quote of the week:

"Mr. Smelly lives by himself and he's kind of malodorous. The best thing that could happen for us all is to have that guy go for a walk in a rainstorm. A heavy rainstorm."

An important distinction

Officer Perky called my office to tell me about a client who was having multiple contacts with the police on account of his psychosis.

"We've been getting a lot of calls from the neigbors on account of his behavior. He's really making them nervous. The report from last week says he broke into Local Church Campground and announced to everyone that he's the Second Coming of Christ.

"However, Mr. Religious wants to correct his records and he says we were wrong when we did the initial report and he's Jesus' older brother, not Jesus' second coming. Just thought you should know."

Hope my boss isn't taping my calls

A large part of my job is answering phone calls from patients. Sometimes I find myself giving advice that isn't directly related to their current problem, but also needs to be said. My nursing instructors would call this "health teaching," but they probably wouldn't have found themselves fielding calls from inebriated patients seeking more benzodiazepines.

Like on Friday:
Ms. Issues: "When is Mr. Casemanager coming by to bring me my medications? I'm having a bad mental health and anxiety day and really need my Xanax."
I could tell from the way she was slurring her words that she had been drinking. "Ms. Issues, can you tell me what you've had to drink today?"
MI: "Two beers--I know I need to quit, but--"
Me: "Actually, I'm way more concerned that it's four in the afternoon and that's all you've had to drink for fluids. Can you tell me anything that you've had to drink today that didn't have alcohol in it?"
MI: "Uh.... No, can't think of anything."
Me: "Have you had anything to eat today?"
MI: "Nope. So is Mr. Casemanager coming by today or not? I'm really having a bad mental health day and need my Xanax."
Me: "He'll be by at his usual time, but drinking on an empty stomach usually leads to puking, and then you'll really be having a bad mental health day. Can you fix yourself some toast and drink some water after you hang up with me?"
"Yeah, I can do that. Tell Mr. Casemanager I said hi!"

Overheard at work

Female crisis worker, talking about a recent patient assessment: "So I said to him, 'Joe, are you seeing anything or hearing anything that you're not quite sure if it's there or not?' And he said 'well, you look really good today.' "

Drug of choice?!

As I was doing routine chart checks last month, I came across this notation in the initial assessment of a new client:

"Substance abuse: Client says he smokes marijuana and snorts Smarties."

I wasn't sure if this was a new name for a street drug, so I asked the therapist who'd done the assessment to clarify.

"No, he snorts crushed Smarties candy. He even did a line in my office."

Good point

Patient quote of the week:

"My family tells me 'tobacco is an antipsychotic that will kill you, but keeps everyone else from killing you in the meantime.'"

Brains are squishy

Helmets are good. Not only does wearing one (gasp!) protect your head from severe injury, but it can even protect other people's heads from severe injury. (By modeling good behavior and convincing them to wear helmets...)

I was recently trying to explain this to Mr. Skateboard. Between multiple traumatic brain injuries and organic brain damage from before he got sober, Mr. Skateboard's memory is somewhat impaired. (He didn't come see us for three months because he forgot where our office was.)

"Are you wearing a helmet when you're out skateboarding with the kids? Because a bonk on the head can really scramble your brains," I said.
"Nah, I been bonked on the head a lot and I'm fine!"

On being part of a community

One of my middle-aged patients has suddenly taken up skateboarding. Not many people suddenly decide to do that at age 45, so I asked him why he'd decided on that hobby.

"I wanted to do more stuff with the neighbor kids. I mean, I known 'em since they were babies and I was runnin' the meth house, but I'm sober now and I thought it could be fun. They always looked up to me and I thought it'd be nice to be be a good influence for once."

Patient quote of the week

"I've got PTSD, but I was in the Army and served in Desert Storm, Bosnia, Kosovo, and Afghanistan, so I come by it honestly."

That was a pleasant surprise

Mrs. Worried is one of my favorite patients. She's intelligent, polite, and very involved in her care. She's been on the same medications for years, and we don't mess with them. She's also very forthright with us when she has concerns about the medications.
She called last week about her Xanax prescription. "I know you guys had to reschedule my appointment with Dr. Warmnfuzzy for about three months out because you're so busy. And that's fine, but I've only got three or four days left on my Xanax, and I don't have any refills and I wanted to make sure Dr. Warmnfuzzy did something about that before I see her, because I don't think I can be off it for three months!"
I reassured her that I'd talk to Dr. Warmnfuzzy and get her the necessary prescription. "But she's pretty busy and it will probably be at least three or four hours before I can get this done," I warned her.
She laughed. "Honey, I've got fifteen pills left. If I go through all of them before this afternoon, I don't deserve to be on Xanax!"

Time to chart veeery carefully...

Because it's not like I wasn't paranoid about my personal safety before I started this job....

Tee shirts with bizarre slogans are very popular among our clients. I've seen people wearing shirts that said everything from "Can't sleep... clowns will eat me!" to "If sex is a pain in the @$$, you're doing it wrong." The thoughts expressed may not be "appropriate," but they're usually good for a few laughs and conversation starters.

But tell me what I'm supposed to say to a wild-eyed, disheveled gentleman who reeks of stale sweat, vomit and booze wearing a shirt that says "I like you--I'll kill you last!"

We have standards?

Our electronic charting system annoys me regularly, but it has one very useful feature: the "pop-up reminder." There's a lot of stuff that we need to keep track of that doesn't need to be part of the "permanent medical record:" what pharmacy patients are currently using, who their primary care practitioner is, when does their probation supervision expire, etc. The pop-up function is very handy for noting these things.
I was checking charts last week and found the following pop-up in a patient's chart: "Not allowed to contact LuAnn for any reason. Do not put through to her voice mail either!" LuAnn is one of our social workers, so this was odd. When I had time, I asked her about it.
"Yeah, he was wildly inappropriate the last time I saw him. I mean, even by my admittedly low standards, he was really inappropriate."

Patient Tee-Shirt of the Day

I saw a patient wearing a shirt that said "I don't listen to the voices all the time, but they have some pretty good ideas."

Do I look like I give out drugs for fun?

Mr. Methhead is one of our "regulars." People tell me that when he's sober and stable on his medications, he's a pretty cool guy. Since I've never had the pleasure of encountering him in either of those states, I'll take their word for it.
Monday, I got to field the following telephone call from him, several hours after I'd given him his regularly scheduled antispychotic injection:
Mr. Methhead: "Hey, I've got the worst headache today! Do you think it could be from that shot you gave me this morning?"
Me: "Maybe, but I wouldn't bet on it. Skipping caffeine can cause bad headaches, though. Did you have your coffee this morning?"
MM: "No, but I had some black tar heroin over the weekend. Would that do it?"
Me: "Yes it would. Heroin withdrawl will really make you feel like crap. How's the diarrhea and vomiting today?"
MM: "I'm not puking, but the @%#s are bad. Do you have any heroin?"
Me, very thankful it's a phone conversation so I don't have to try so hard to keep a professional facial expression: "No, sir, I do not have any heroin."
MM: "Oh, then do you think the doc would prescribe me some OxyContin?"
After the usual reminders to him that we're a mental health office and DON'T prescribe pain medication (We don't do this under any circumstances. Your arm could fall off in our waiting room, and we still wouldn't. We firmly believe in "not feeding the bears.") , drink lots of clear fluids, call 911 if you can't breathe, etc, I managed to somehow gracefully disengage from the phone conversation only to look over and see the interns gathered at my door with their best nonchalant expressions plastered on their faces. You know, the ones that say "No, I haven't been eavesdropping even though my eyes are the size of saucers."
"What's up?" I asked, trying to keep a straight face.
One of the braver ones spoke up. "Our supervisor told us you'd give us tetanus shots as part of the new hire process..."

Staff quote of the week

“I don’t know if it is an ethical conflict to go to a patient’s funeral. To be honest, all I really remember from the ethics manual is “don’t have sex with patients”—not like you’d want to with our patient population!”

Vacation woes

Dr. Warmnfuzzy went on vacation recently. As is our policy when a doc is on vacation, all requests for medication refills on her patients were referred to Dr. Analytic. And as is his policy, he filled the prescriptions with only enough pills to get the person through until their next visit with Dr. Warmnfuzzy.

Which meant that I got to field the following phone call:

Mrs. Worried: "Hi, I'm a patient of Dr. Warmnfuzzy and I picked up my prescription of Xanax and realized that it was only filled for ten days and I wondered what's going on. I mean, I've never had my medications get eaten by the dog or blown away in a hurricane or something weird happen to them for early refills--does this mean Dr. Warmnfuzzy doesn't trust me anymore?!"

After the myriad daily phone calls from assorted drug seekers, it was very nice to have a call from someone who was less concerned about the quantity of Xanax they'd been prescribed than why they'd been prescribed that amount of Xanax.

A drug is a drug is a drug?

Mr. Methhead is one of our long-term patients. He's been with RCMH for ages. While our chart numbering system is currently at six digits and growing, his medical ID number only has four! Due to his bad decisions on how to finance his drug habit, he takes a break from us regularly to spend quality time with the nice folks at the Random County jail, but he always comes back.

He's out again, and that means he's on my list of clients who come in for regularly scheduled injections of long-acting antipsychotic medication. As I gave him his injection last week, he said "Wow, I got such a rush from that!"
At a loss for words, I just stared at him before finally stammering out "You know, Mr. Methhead, that may be the nicest thing anyone's ever had to say about Prolixin!"

Probably not in my job description

Even though I work as a psychiatric nurse, I do a lot of other things in the course of the average day at work.
Like passing out condoms.
I'm a firm believer in preventative medicine. It's a lot easier to prevent contagious diseases than it is to deal with the consequences once they've taken root in a population. Since most of my patients aren't in the most stable of circumstances to begin with, the last thing they need is a serious infection or an unexpected family member.
As part of this philosophy, I pass out lots of condoms to the therapists, crisis team, caseworkers, etc. I'm much more tactful about this now than I was when I first embarked on this project.
"Sheryl, would you like some condoms to give your patients who may not be making the best lifestyle choices?" is a much better way to initiate the safer sex conversation with a co-worker than:
"Hey Sheryl, want some condoms?"

Overheard at staff meeting

Therapist: "I think Patient Steve is getting a lot better: He was telling me about his kids' mother 'and she told me, 'Steve, which do you love more--the booze or me?' and I told her it was her, but it seems I was wrong.' "