Tales from the Bedside

Some cases are just hard

Not everything in the emergency room is what it’s like on TV. There are real people here with real aliments and complaints of new or chronic pain. Not everything is always visible to the physician either. Sometimes a patient has a pain that is felt deep within in the skin and no amount of imaging is able to detect what it is. Sometimes the complaint is psych related. A patient may be hearing voices or seeing hallucinations, but to them the voices and visions are just as real as you and me.

I had a case where a very young girl (late teens early twenties) presented with what looked like acute psychosis. (Per the Cleveland Clinic: “The presence of psychotic symptoms usually indicates an underlying organic or psychiatric condition. Disruption of thought processes, hallucinations, delusions, agitation, and rapid deterioration in behavior are some of the common manifestations of acute psychosis.”)

She looked like a really nice person, was even attending university, however she was dealing with a lot of stress in her day-to-day life. Unfortunately, she did not know how to deal with it. When asked a direct question, she would not give a direct answer. She would talk in circles and multiple times, my physician had to redirect the conversation to keep the patient on tract. Sometimes, she would laugh abruptly at inappropriate times or when she felt the question being asked of her is laughable. The question could be something like “How much sleep do you get?” To me, this is a simple question however, to her, not so much. She just kept laughing and laughing, but stop when the physician would touch her arm or hold her hand.

With cases like this, the physician always has to ask if the patient would like to harm themselves or others. This question males me really uncomfortable, because I have seen individuals answer yes. I have never been a suicidal or homicidal person, so I never understand why someone would want to harm themselves or others. Fortunately, she answered no but she did express she wanted to get help because she knows those harmful thoughts are there. Like I said, some cases are just hard.

I’m not really sure why this case continues to stick with me. Every time I think about this patient, I’m reminded of someone I know who is facing similar situations. I begin to wonder do they handle their stressors in a healthy manner. Mental health is just as important as physical health.

Everyone should take 30 minutes out of their day and just find a quiet spot and relax. Be still. Pray if you like. Calm your mind. After a few days, you will see that your overall stress has decreased. If you’re not an individual who likes to be still, then find a creative outlet. Join a gym or sports club. Just remember to take time to care for your mental health.

Like always, leave a comment, ask a question or email me with any concerns. I pray everyone has a blessed day.



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