Doing Hard Time

Last week I finished up my rotation on the psych consult service at UCDMC and started working the in-patient psych service at the Sacramento County Jail.

Wow.

The rotation started with one of the officers taking us over to the "Weapons Room." On display in this room are dozens of shanks, saps, clubs and ropes that had been collected during various shakedowns over the past 20 years (if you haven't noticed already, I also picked up on some of the prison slang, it makes me feel kinda cool). I mean some of these weapons were pretty intricate! Shanks made out of everything from ping-pong paddles to mattress springs and toothbrushes. One guy wove a sap out of black plastic bag (it was very impressive). Coaxial cables turned into nooses, newspapers into clubs (if you soak them and roll them tight enough, it's just like wood). Honestly, if those prisoners devoted half the time they spent on those weapons on doing something productive, the world would be a better place.

After scaring us all, the officer handed us a piece of paper and told us to sign it. The paper essentially said that if I was ever taken hostage by a prisoner, neither the jail nor the state of California would bargain for my release. Cami was not very happy about this. However, they did provide me with a 10 page document entitled: "What if you were taken hostage?" The packet includes real survival gems such as "Don't threaten the person," and "Don't become annoying to the person." Things I might have otherwise been tempted to do. The real kicker was this little pearl:

Remember: Many hostages who end up getting killed bring their deaths upon themselves.

See, I thought it was the bad guy who ended up killing the hostages. I guess I have a lot to learn about being taken hostage.

Working at the jail is pretty intense. We do our morning rounds with a deputy sheriff. He opens the doors to the cells and we talk to the inmates at the door, but we aren't allowed to go in. If the deputy can't make it, then we talk to the prisoners through the food hatch. This makes for difficult conversation, as sound doesn't carry well through the hatch and you end up sticking half your face through the little window. You have to be careful doing that though because you can get gassed pretty easy (Fernie claims he was nearly gassed last summer). You are not allowed to be alone in a room/elevator with an inmate. You should never turn your back to an inmate. You can't open any of the main doors, you just stand in front of them looking dumb until one of the officers watching on the camera buzzes you in. Like I said, it's pretty intense.

The best part? Lunch is provided by the "trustees," prisoners who have earned the right to prepare food for the staff and officers. Scary? Slightly. But it's actually pretty good food and the rolls they make are just drenched in buttery goodness. However, I word on the street is that the punch is not well supervised and it is probably best just to stick with water. I think I will do that.

You Can't Make This Stuff Up

After finishing up my surgery rotation, I have started my 8 weeks in psychiatry. I've been working with the hospital's consult service, which essentially means I hang around in the student lounge all day waiting for my pager to go off. When it does and go and analyze the people who are acting a little crazy. From the lady who thought she was the conjoined twin of Canadian ice-skater Kurt Browning, to the guy who was being treated for stabbing himself in the belly (the third time in the last month). However, it hasn't only been dealing with crazies. In fact, the majority of time is spent with people who are depressed, manic, delirious, demented, or taking a lot of other psychiatric meds which might interfere with the medication their primary teams are giving them. It has been incredibly interesting and educational.

In yet another example of med student stupidity, I was assigned to examine a burn patient for delirium and paranoid delusions. I went up to the burn unit, read the guys chart and prepared to interview the guy. The chart had mentioned that the patient had been making statements about some of the nursing staff being involved in some anti-government group called "The Tribe" which was seeking to "take out" certain patient's who might be a risk to their overall cause. The patient was concerned that he had been singled out by this group and any minute was going to be packed into some crate and picked up by a helicopter, flown to some remote location and dropped to his demise (seriously, you can't make this kind of stuff up).

After brushing up a bit on his meds, I asked the nurse where he was and went in to talk with him. I explained who I was, that I was with the psychiatry team and that I wanted to talk to him about some of the things he'd been experiencing over the weekend. He was very cooperative. I told him that I understood that he'd expressing some concerns about a group called the Tribe over the weekend and asked if he was still thinking about that group. He informed me that he was, in fact, still very concerned about the Tribe. He confided to me that the Tribe had done something to him and showed me the stapled-shut incision on his abdomen as proof (if he had known who I was, I sincerely doubt he would have let me anywhere near his staples). He was clearly still delusional and also fairly delirious, so I let him be and wrote up my progress note on him.

Two hours later, while rounding with my attending and team, I reported that my patient was still delusional. I also mentioned, off hand, that I was impressed that he was able to provide such a detailed history about the Tribe to other physicians, given that he had a stoma and it was very difficult for him to talk. My attending quickly interrupted, "He has a stoma? I didn't notice that." Just as I was about to say, "Well, it was pretty hard to miss," it dawned on me that I must have spent 30 minutes talking to the wrong patient. I felt like a real bonehead. Everyone had a pretty good laugh at my expense.

Sure enough, there were two patients on the unit with the same first name. The nurse I consulted pointed me to the wrong room. Amazingly, the patient did not need much prodding to buy into the whole Tribe conspiracy theory, which leads me to only one of two conclusions: 1) The patient I interviewed was delusional, delirious and very impressionable, or 2) There really is some crazy society infiltrating the Nurses station up on Tower 5. I had to go back and interview the real guy, who was every bit as nuts as the other one, only sans stoma. [Ed Note: Turns out the other guy actually thought he was a leprechaun too, fitting given the fact that it was St. Patty's day]