I wasn’t so lucky as to get one of my first picks for an internship site prior to completing my doctorate. Instead, I “cleverly” worked with a hospital administrator who, despite never having done so before, agreed to allow me to work with the psychiatric component of the hospital which consisted of in and outpatient services.
Since they had never had a psychology intern before, the powers that be pulled out someone’s old residency schedule from med school and allowed as how that should work. Thank goodness they did pare it down some, or I might still be there. Nevertheless, they ensured that I rotated through outpatient mental health, neurology, inpatient psychiatry, and emergency room training.
My very first outpatient mental health case was a lady of about 60 who entered the room very timidly, shook my hand, and sat where I directed her. I briefly glanced at her intake information then asked her to put into her own words why she had come for the visit. Several moments went by, then she almost whispered ” I’m afraid I have a lot of trouble with silent gas.” Incredulous, I said “Are you aware that this is the mental health wing?” She said yes, but that her primary care physician had referred her. She then confided, “This silent gas problem is embarrassing and I can’t seem to control it. It makes me very anxious when I have visitors. In fact, I’ve done it three times since I’ve been in this office.” Red faced, I turned away from her to write a consult to ENT, as it was clear she could not hear.
My stint in the ER was the worst. You know the deal, full moon, out come all varieties of people to visit the ER. Some with truly life-threatening injuries, while others had sniffles or heat rash. One of the principles drummed into me throughout my tenure was “once you render a diagnosis, do not change it, as that will cause the patient to lose confidence in your ability.” I heard it so often, I was almost afraid to make a diagnosis….but no guts, no glory. So I ventured forth from time to time and was lucky enough to be right; however, on this night, it was not to be. The ER suddenly became overwhelmed with crisis cases, so all the physicians were fully engaged in one life/death situation after another. The chief of the ER sent a nurse to get me. I’m thinking they want my opinion about someone needing psychiatric hospitalization. Off I go, meet with Dr. Incharge, and he says, we are swamped and won’t get to everyone without help. “What can I do,” I asked. He said first you and Ms. Headnurse triage the patients, so we have a better handle on what we’re up against. About 30 minutes later, I and Ms. Headnurse report. Dr. Incharge promptly told me to immediately take an 80 year old gentleman to an exam room and perform a cursory review of his systems and report back. I did as told, found an empty exam room, and Ms. Headnurse took his vitals. I then went through the motions of listening to the man’s breathing, heartbeat, watched his pupils shrink when light struck them, and listened to his gut (which was an experience in itself).
The elderly man complained of stomach pains and a chronic state of diarrhea for four consecutive days. I listened to his belly gurgle and moan and felt him tense in pain from cramping. Meanwhile, he keeps asking over and over, “what is it doc? I can’t live this way”……and so on. I felt compelled to offer the poor man some hope, so I blurted out, “Sir, what you have is commonly known as ‘locked bowels.’ He was immediately outraged and said, “what the hell are you talking about? I haven’t kept anything inside me for days. Locked bowels. That’s the stupidest thing I’ve ever heard.” Somewhat embarrassed by my slip of the tongue, I quickly recovered by saying “Yes sir, you do have locked bowels. They’re locked in the open position.”
I’m sure others among you have had odd/funny experiences in your training and practices. I’d love to hear them. Until next time…..
Mental Health Professionals 