Bummer!

Quote from a new patient:
"I have dissociative identity disorder, and my main alternate personality keeps trying to help me kill myself. She ususally gets me to overdose. That's why I only pick up my meds a week at a time."

Quick announcement

Just a quick reminder to my fellow staff members:

If someone is having a medical emergency, CALL 911!
Feel free to call the nurse after that. That's what I'm here for. But please don't call me first, demand that I come to your building two blocks away, and when I ask why you haven't called EMS on that lady having a seizure in the lobby, respond with "she said no when I asked her if we should call them!" (If you can talk during a seizure, you're probably faking it. At the very least, it's not a typical thrashing grand mal seizure where there's concern about managing your airway.)
I'll let you in on a little secret. In addition to having nice muscles, the paramedics have much cooler gadgets than I do. I have a stethescope. They have IV fluids. I can check someone's blood pressure--they can intubate someone and force them to breathe until they get to the hospital. Call 911!

Chart check quote of the week

I found this typo while doing chart checks yesterday:
"Abused by history"

WTF?

I like my job. (Unlike my previous jobs in hospital med-surg nursing, 95% of my patients can walk under their own power. ) But sometimes life with my co-workers can get a little weird. Not "doing yoga at lunchtime" weird. More "out of touch with reality" weird.

Mass e-mail from the head of risk management: "Please register for mandatory training on the 15th. If you don't know what it's about, it may not apply to you. Please ask your supervisor for more details."

"I'm trying to make mandatory meetings a little more fun. So next month, dress up as your favorite super hero for the unit meeting," the big boss said. (This was immediately after he mentioned famine and mental health in Soviet Russia and how "suffering is good for the Russian soul.")

Anyone know what Nurse K looks like?

Thanks anyways

Honesty may not always be the best policy. For instance, look at this quote I found in a patient's assessment:

"Military: He has never served. He says he applied in high school, but they turned him down for psychological reasons. When they asked why he wanted to join the army, he said it was so he could kill people."

Overheard at work

One of the things I love about my job is the way we're very open when discussing our own mental health. After spending so much time trying to decrease the stigma associated with mental illness and help our clients overcome it, we're pretty fearless when it comes to talking about our own issues. But sometimes it makes for some odd conversations in the breakroom.

Social worker: "I guess it's just part of my illness talking. I worry too much about making sure my job gets done right."
Secretary: "You're great at your job! I think the problem is you worry about the wrong things."
"What do you mean?"
"Have you seen the yahoos who want to be President this year? Now that's something to worry about!"

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!"

Fashion tips from Child Protective Services workers

Overheard at work:

"I don't wear much makeup. Usually just foundation. Unless I have to go to court or something and then I put on eyeliner."

E-mail amuses me

Dr. Analytic has decided to change his e-mail signature. After months of having it read
"Dr. Overly Analytic, MD, PhD
Medical Director, Random County Mental Health
Putting the 'fun' in 'dysfunctional' "

he has changed the last line to be a revolving selection of lyrics from 80s rock songs.

"Dr. Overly Analytic, MD, PhD

Medical Director, Random County Mental Health

Here we are, we're the princes of the universe!"

"Dr. Overly Analytic, MD, PhD

Medical Director, Random County Mental Health

It must have been cold there in my shadow"

Police report of the week

"He says his cat told him he needs to drive into the vortex to save Shania Twain from the aliens who are holding her hostage."

Office space

The nursing office at RCHM is white. The only decoration on the walls is a large poster (thoughtfully provided by a drug company) illustrating locations for intramuscular injections. The over all effect is less reminiscent of interior decorating magazines circa 1995 and instead screams "we're too lazy to decorate."

So I brought a small picture of my family and put it up on top of the bookshelf.
"Do you have to do that?" GoodbyeNurse asked. "I hate looking at pictures of people I don't know."
Guess I shouldn't have given him that pep talk about being more assertive and sticking up for himself!

Drug reps confuse me

Drug reps visit our office often. They tell us all kinds of things about their product in the hope that the doctors will prescribe it. Some of it may even be true.

Last week, the rep for Meltthevoices came to visit. As far as antipsychotic drugs go, it's pretty effective, and comparatively cheap. (Only seven hundred dollars a month!) Unfortunately, the people at MegaDrugs who designed it didn't think the design process through completely. The concept that if you're going to have a medicine taken by dissolving under the tongue you may want to think about how it tastes apparently never crossed the creators' minds. Within six months of FDA approval, the company nearly stopped making it because the patient reaction to the taste was so negative.

So I asked the drug rep about this.

"I got so many complaints about the taste that I even tried a small sliver of a 5mg tablet to see what they were talking about--and it was really bad--"

"You actually took antipsychotic medication just to try it?!" GoodbyeNurse interrupted.

"Well, yes, but I took it at bedtime and didn't have anything planned for the next day in case it made me too sleepy to do anything." He abruptly remembered his spiel. "And that's why it now comes in MegaBerry flavor!"

GoodbyeNurse raised an eyebrow inquiringly.

The drug rep sighed. "Yes, I tried it too. It's definitely an overpowering fruity berry flavor, but it's way better than the original."

More things you don't want to hear during staff meetings

At the "Difficult Cases" staff meeting last month, we were discussing how best to re-engage Mr.Incredibly Unhappy with our services. He had stopped taking his medications some time before, and had decompensated to the point where he was having multiple weekly contacts with the RC Sheriff's office for being a public disturbance.
Barry had an idea. "LuAnn is his case manager. I'm sure she can take care of it!"
LuAnn had different plans. "I'm rubber, you're glue, everything you say bounces off me and sticks to you!

Time for a new dictation service

I found this in a patient's chart this week:

"I will call the client's PCP about her gigolo's vain dissension."

It's called JUGULAR VEIN DISTENTION!

The sad tale of Not Quite Bright

IntimidatingShrink has been a forensic psychologist for a long time. In addition to doing standard mental health assessments on inmates, he also gets to do competency and "how likely are you to re-offend" exams. He keeps us posted whenever "our people" wind up in the criminal justice system.

I got a call from him the other day.
"You have a Not Quite Bright on your caseload, right?"
"Yeah..." I've got about ninety people on my caseload. It takes a minute to remember who's who without accessing our computer records.
"You may want to put his case on hold for a few months. He's back in jail in meth possession charges."
This surprised me. "He just was in last month on meth charges. Did he jump bail?"
"Mr. Bright got arrested yesterday when he went to his court date for last month's meth charges. He actually had more meth in his pockets that he brought to court!"

You brought WHAT to the potluck?

One of the therapists retired last week. As we usually do, the department threw her a going-away party. People brought lots of cakes and pies and side dishes.

And two golden retriever puppies.

They were about eight weeks old; at that stage where they're all fluffy and big-eyed but still waddle and occasionally fall over their own feet when they walk. I'm still not sure why they were there (or even who brought them) but they sure were cute!

Can't make this stuff up

An excerpt from a police report I found in a patient's chart:

"Officer Perky visited the residence and saw that the door was ajar. To maintain community security, he went inside. He found a trail of broccoli throughout the house, leading to the bedroom. On top of the dresser in the bedroom was a banana peel, arranged to look like a small shrine..."

Please tell me I didn't hear that

Lunch time gets interesting around here.

Therapist from Child & Family department: "Man! I hate dropping stuff on the floor here, because I have to pick it up!"
"You don't have to pick it up at home?" I asked.
"I do, but I have three dogs, so it usually gets eaten first."

In mental health, it takes one to know one

The title of this blog comes from something my husband said to me as I was leaving for work one day: "Have fun working with crazy people! And be good to your patients too."

Or as SuperNP likes to put it: "We're all working here because we're not all there."

I love my co-workers?

During my break at work one stressful day, I called my husband. We had a nice chat, and I ended the call with my usual "I love you, bye."

I heard something behind me. Dr Warmnfuzzy was standing in the doorway to my office. "I love you too. Can you fax this prescription to OverpricedMeds?"