Wednesday, November 14, 2012

i shouldn't laugh, but . . .


Recently we had a patient who self-medicated in a weird way (I guess it wasn't that recent because I can't remember), and discussing him in Nursing Rounds brought up talk of a patient from several years back who also self-medicated in a weird way, for a gastrointestinal ailment. By drinking liquidized silver.* Apparently this is A Thing, and the result is called argyria. Argyria is when your skin turns irreversibly bluish-silver from consuming too much silver. It looks something like this:

Not our patient, but rather some guy from Oregon/Northern California (naturally) who has been ingesting liquidized silver for about a decade to help with a skin condition (??)

To these folks' credit, silver is widely used in the medical field for its antibacterial properties, though its use is generally limited to creams and extraordinarily expensive wound dressings.

*Technically it is colloidal silver that intrepid people are drinking, which for those of you who did not take any hard science classes after high school like I didn't is when two substances mix together to a microscopic degree but are not chemically bonded, as in a true liquid. I think.


From a personality-disordered patient whose husband had recently died and who was living in an unstable environment:
"I just want to go get his ashes and my flat screen and get out of there."
Everyone's gotta have priorities.


From a patient's History and Physical document:
"Pt presents a risk to herself and others due to command auditory hallucinations telling her to eat people, and also pt has not eaten in several days."

And speaking of eating, sometimes I have this surreal experience when I watch people eat that is akin to when you look at or think of a totally normal word for too long and then the word starts seeming profoundly weird. Sometimes I'll be watching someone eat, not on purpose--usually my gaze just landed on them and got stuck--and then I'll become overwhelmed by their humanity, in a kind of sad "we are all just a very elaborate collection of cells" kind of way. It is especially overwhelming on the psych unit, when I'll look out at my patient during mealtime, my patient who believes he or she is a prophet of God or Obama's campaign manager or Patti LaBelle's niece (I am making up none of these), but really it's just another unfortunate soul sitting at a plastic table eating overcooked hospital pasta, in a cotton gown worn by countless others before them and laundered with god-knows-what-chemicals, and wearing those little footie socks with the anti-slip grips. It breaks my heart.


A lot of my patients experience hallucinations--usually auditory, but occasionally visual or even olfactory (once a patient asked me if I, too, smelled the barbeque in her room--sadly, I did not). Unlike a lot of other psychiatric symptoms that I can relate to at least on some level, e.g., depression, anxiety, addiction, mania, paranoia, delusions of grandeur hello ages 13-17, I have no idea what it feels like to hallucinate and I kind of wish I did. Take it away, NPR and neuroscientist/prolific writer Oliver Sacks.

Here is Oliver Sacks chillin' at home in his favorite t-shirt like a boss. 


There's this shy, sweet, quiet patient I've helped take care of for almost three months. Being on the shy, quiet end of the spectrum myself (I'd say I'm more on the sour side though, selectively sweet if we're being generous), I've often had a frustratingly difficult time engaging with her. When I've been her nurse, our typical, uncomfortable conversation would go something like this:

Me: "Hey [shy sweet quiet patient], how are you doing?"
SSQP: "Good."
Me: "Any thoughts of hurting yourself or others?"
SSQP: "No."
Me: "Hearing any voices?"
SSQP: "No."
Me: "Are you particularly worried about anything?"
SSQP: "No."
Me: "Okay then, lemme know if you need anything!"

Then the other day I was sitting at a table in the Day Area with another patient, and she was sitting nearby. When the other patient left, we started chatting, just a normal, not necessarily nurse-patient conversation. And then I suddenly felt comfortable and asked her how she was doing with her psych symptoms, which I knew she'd had all along but had been too uncomfortable to ask about directly, or in a way that she would feel comfortable to answer honestly. And she told me about the voices and the paranoia and the delusions, and how they were getting better, and how she felt about being a shy, sweet, quiet girl in her early 20's and newly diagnosed with a major mental illness. "You never think it's gonna happen to you," she said.

I discharged her last night, and she was, finally, smiling and healthy and optimistic. It is nice and refreshing, and way too rare, to watch a patient leave and feel optimistic myself.


Here is this:

I wonder if they ever had an article about a Silver Man...


Anonymous said...

I'd say ... sounds like Eli Wallach.

When all is said and done, it makes good toast.

Anonymous said...

Also, this is a good article if you can find it: