Friday, November 19, 2004


Is there a dark cloud over my head? I'm working on the psych unit today, covering for a colleague who's on vacation. I've met only two patients so far, and they are both having medication side effects. The side effects range from "moderate" to "yikes..."

The patients were severely ill when they were first admitted. My colleague has been working very hard with them. The patients' symptoms have obviously improved. But today's labs suggest that some organ systems--the sort that you really can't do without--are being affected. Repeat better. If it's the meds, it's probably reversible, but I need to do something soon. This is what any branch of medicine can be like. This is what we're reading about every day in the news...monitoring meds, detecting and dealing with side effects.

We have no residents or interns here, so I'm on my own. Call the lab, call the pharmacy, call the internists, call the outpatient psychiatrists who know these patients. Quick calls to the on-call specialists--would they mind looking over these labs, please? (Are they cringing - "Damn, a psychiatrist and her meds...") But they are very nice to me. They all promise to see the patients ASAP. They give instructions for repeat labs, more tests. We debate: What should we do next? Everyone has a different opinion. We go back and forth. My documentation lengthens. I write everything down.

And I talk to the patients. Yes, you have improved, but we're concerned...the labs are telling us that you're having trouble with at least one of these meds, and possibly more than one. We're working on it now. You've just met me today, but I'm working with these other doctors too. We're all working on this...and we need to talk to your families, too. (That's one thing we insist on here...full disclosure.)
But what to do if the patients relapse when their meds are changed? Now I'm not just "filling in" for another doc. I have to roll up my sleeves and dig in. Find old charts, review more history. And write everything down.

And I still have to finish my rounds. What will I run into next? Time for a staff meeting. Got to run...

update: my specialists tell me that one patient's symptoms are unrelated to the psych meds. It's a newly diagnosed, unrelated (and unexpected) medical problem. They've swooped in to manage it, and here I am on the sidelines...I will have quite a report for my colleague when I'm done.
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