IRFD's (see title) ya know, the things that are involuntarily implanted somewhere inside you, usually via tick ingestion and placed without consent - well I guess some people want these removed, but I (me, Jenni) don't really know much about that because I'm not educated in artificial intelligence and chip-like devices I am told by my patient. WHAT?!?! I hope the reader is as confused as I was when my patient was telling me this.
The MA's in the clinic are great where I am, they give a heads up when a pt seems odd or perhaps a drug seeker risk. We don't keep drug seekers in our clinic. In fact we don't even prescribe narcotics on the first visit, and sometimes not the second, but anyways, the point is the MAs are usually right on about patients. So when the MA told me today that she thought the patient seemed a little odd - I should have given her a little more credit. I went in the room with a completely wrong attitude - or rather, with my guard down. Anytime a new patient comes in with Migraines and joint pain, the level of suspicion is up and so keeping that in the back of my mind I did my H&P, which suddenly went places I couldn't imagine. Stories of holes in stomach, surgeries against a pt's will in which a foreign object was placed such as IRFD, and desiring to have an abdominal US and MRI of the head to find other implanted devices all with an element of disconnect. There was some other interesting history too including a prison stay, asking for pain meds and having burning and numbness in non related areas and occasional rectal bleeding. I was totally lost as a student. I did a complete exam, really trying to find something to report back that made sense. I thought the pt was just a tweeker - kinda seemed nervous, and a myriad of symptoms that didn't make sense. I even tried asking some of the most direct questions I have ever asked to no avail. So dumbfounded I reported to my preceptor with my tail between my legs. My preceptors questioning was even more to the point than mine and the disconnect even further and soon the questions weren't even being answered but merely an intro for the patient to diatribe into IFRDs and having holes in the stomach and people holding him down and waking up with foreign bodies in his head. Then came out the big dog questions - the psych questions. (I'm an idiot I thought!) Although I had dabbled there, I was so focused on beating out a narc seeker I kind of missed the obvious. My patient was delusional! To shorten a very long story, the pt was referred rather immediately to psychiatric care - whether the pt actually goes who knows, but needed medication and observation - badly. Turns out this kid (younger than me) is an ex-meth user who lost his brain to drug-induced schizophrenia. WOW. Can we say blind-sided? Craziness. So, moral of the story - don't do meth. Oh and P.S. to this story, if a patient needs to suddenly use the restroom, and you ask them to go in a cup, just in case we need it later, you may want to remind them that if they aren't going to actually give urine in the cup, at least use hot water and mind the cuff of their shirt when filling the cup.
In other clinic news, my days have been far from dull. I did my first full exam in SPANISH (I can't imagine however painful that was for the patient - I imagined a 4yr old giving a lecture on brain surgery to neurosurgeon fellows) - unfortunately I just don't know how to discuss exposure to infectious diseases in Spanish, but did manage to come to the conclusion that it was possible TB - and I'm not sure what the cavitary lesions on the CXR are from, I can't wait to get those results back. I reported my first patient to public health - sadly that patient has yet to fill her prescription yet or make a follow up appointment (I guess some people don't mind the foul discharge). I may have seen my first skin cancer which (if it is truly cancer) has already occupied nearly half the face along with a 5cm mass on the back of the neck that has been growing for 6mo - but wasn't a concern for the patient since he can't see it in the mirror. Finally, a pt with cerebral palsy and severe mental delay offered me her baseball helmet that she wears for safety only to retract her offer with a "I don't like your pink socks" quip. Interesting considering she was wearing pink pants, a pink helmet, pink shirt and white shoes and socks all with pink. Oh, and did I mention that the hypernatremic patient in the ICU didn't make it to Monday? She barely made it to Sat morning. I was a little bummed.
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