They say he's "on the edge", or "about to crack." Some are even nervous to go in his room, it just might be the moment that he attacks. You know.. claws out, fangs first.
Really?.... our imaginations can get rather wild sometimes. He won't attack, but that being said, nothing about his inpatient course is going to be pretty anyways. He came to us paranoid, suicidal and homicidal. He flat out refused anything and everything, from making eye contact to taking his medications. Finger to nose, we called Psych. And they recommended a pill.... (blank stare)... for someone refusing all medications... So, I explained it to the Attending. His pills, include his immunosuppression meds. If he refuses his pills. His body will reject his liver. And he will die. Him refusing his meds is essentially a suicide attempt. I got a light bulb finally, and they agreed to admit to inpatient psych. He started taking meds, and allowing labs to be drawn, which showed us that it was too little, too late. Liver was taking a swan dive from bad to dead. So he came right back to us for acute intervention and we subsequently slammed steroids and immunoglobulin into his veins as fast as we could.
We talk about psych residents, joke how they have "banker's hours." They're the last ones in the hospital and the first to leave. Over the years I've had friendly relationships with multiple of the psych residents. Interesting to learn that they all have their own therapist. I never did quite understand why someone who could get more than 6 hours of sleep a night needed a therapist. But I think I get it now... if one single patient can literally drain the life out of you. Best to learn quickly how to handle those patients and yet maintain the plug in the drain.
On a much less depressing side of things: I got my Letter of Nonrenewal. I signed it with a flourish and sent it on back to them. Much different place I am currently, than the last times I signed those letters as a prelim resident. My contract will not be renewed for the 2021-2022 year. I'm too tired right now to smile, but I feel a lightness inside, so I'll just say my heart is smiling as I say that.
Much love and prayers!
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