A Happier State of Mind

September 15, 2011, 7:13 pmDoctor Psychobabble28 comments

“To be interested in the changing seasons is a happier state of mind than to be hopelessly in love with spring.”

- George Santayana

Today was yet another great day.

Dog on a roll

I walked to the hospital in the morning, and was dripping with sweat by the time I arrived. I renewed orders and checked in with my patients. One of my patients was hyponatremic (low sodium). I instinctively thought that my patient may have psychogenic polydipsia (dilutional hyponatremia due to excessive water intake). I ended up being correct. I explained to the nurses what was going on and asked them to monitor and restrict his fluid intake. Looking back on this, I realize how awesome it is that it’s taken me years of education and experience to be able to develop what is now an obvious hypothesis. So cool.

I then spent the rest of the day in psychiatry lectures. First class: “Pathophysiology of Schizophrenia.” Our professor inspires me to think, read, and learn. He embodies awesomeness. Second class: “Human Development.” A class that inspires a lot of controversy and some really great jokes involving trolls and goats. Then a resident meeting and lunch. Third class: “Neuroscience.” Learned more about sleep than the vast majority of the population would understand. Fourth class: “Forensic Psychiatry.” Had a fun lesson in American History, Criminology, and how the Bill of Rights applies to psychiatric patients. Fifth class: “Motivational Interviewing.” We had a role play session, and I played a psychotic patient who didn’t want to take meds. Was a lot of fun being on the other side of the conversation.

I walked home in the rain with a fellow “psycho,” Audra. Minutes after we parted ways, a lady stopped me on the sidewalk and said, “Hey doc, you probably don’t remember me, but I was your patient a few months ago at the hospital. I never forget a face. And I’ll never forget your face. I want to thank you for your kindness towards me and my family. It meant so much.” I replied, “thank you for letting me know. Your words mean so much.” So. Very. Awesome.

I then arrived at home and decided to take the night off from running. My partner Micah came home from his trip and we’re about to enjoy dinner together.

It’s now about 20 degrees colder than it was this morning. The chilly breeze is blowing my curtains and I’m at peace with the coming of Fall!

Photo: My doggy Molly sneaking into and sleeping in my other doggy Scope’s dog bed.

Part of My “Doggy Doos” Photo Collection

  • Moontoad

    Your friend’s name, Audra, means storm in Lithuanian.

    • http://doctorpsychobabble.com Dr. Psychobabble

      that explains a lot. every time we walk home together, it rains!

      • Moontoad

        You can punch her in the arm then and say “ow-dra”, and roll the r.  Cuz’ that’s how it’s pronounced.  And should make her say ow.

        • Moontoad

          more of a cross between oh and ow, but ow is fine for your purposes.

          • http://doctorpsychobabble.com Dr. Psychobabble

            :)

  • Moontoad

    Your friend’s name, Audra, means storm in Lithuanian.

    • http://doctorpsychobabble.com Dr. Psychobabble

      that explains a lot. every time we walk home together, it rains!

      • Moontoad

        You can punch her in the arm then and say “ow-dra”, and roll the r.  Cuz’ that’s how it’s pronounced.  And should make her say ow.

        • Moontoad

          more of a cross between oh and ow, but ow is fine for your purposes.

          • http://doctorpsychobabble.com Dr. Psychobabble

            :)

  • Lindeman

    Is your patient taking Lithium? It’s a common cause of central hyponatremia.  I hope you considered this. 

    • Lindeman

      ERROR! I meant nephrogenic DI.  My bad

      • http://doctorpsychobabble.com Dr. Psychobabble

        i know what you meant. :)

    • http://doctorpsychobabble.com Dr. Psychobabble

      good question. no, he was not. in fact, he was not taking any medications and was an otherwise young, healthy kid (except for his psych issues). 

  • Lindeman

    Is your patient taking Lithium? It’s a common cause of central hyponatremia.  I hope you considered this. 

    • Lindeman

      ERROR! I meant nephrogenic DI.  My bad

      • http://doctorpsychobabble.com Dr. Psychobabble

        i know what you meant. :)

    • http://doctorpsychobabble.com Dr. Psychobabble

      good question. no, he was not. in fact, he was not taking any medications and was an otherwise young, healthy kid (except for his psych issues). 

  • Lindeman

    Oops. Forgot to ask: what IS the pathophysiology of schizophrenia and how come none of us ditch-diggers in primary care have ever heard of it?

    • http://doctorpsychobabble.com Dr. Psychobabble

      another good question!

      the funny thing about the class is that it’s actually not entirely about the pathophys of schizophrenia, but more about the history and philosophy behind it.

      the answer is we don’t really know the pathophys. like most things, it’s a combination of genetics and environment. but there is some really interesting research on how those 2 factors play out, including brain wave oscillations…..

      • http://www.facebook.com/rob.lindeman1 Rob Lindeman

        I appreciate why you use the expression “we don’t REALLY know the pathophys.” That’s a common locution when we mean to say “we don’t know the pathophys PERIOD.”  I will grant that there is some really interesting research on how genetics and environment produce schizophrenia, but how this adds up to pathophysiology is another thing entirely.  

        Since this professor is teaching you the history of schizophrenia, no doubt you have learned that to this day, investigations have turned up NO pathological correlates to the phenomenology of schizophrenia WHATSOEVER.  Countless hypotheses as to the nature of the putative pathology have come and gone and no doubt there will be more.  Until we actually nail this, however, schizophrenia is ONLY phenomenology.

        • http://doctorpsychobabble.com Dr. Psychobabble

          Agreed.

  • Lindeman

    Oops. Forgot to ask: what IS the pathophysiology of schizophrenia and how come none of us ditch-diggers in primary care have ever heard of it?

    • http://doctorpsychobabble.com Dr. Psychobabble

      another good question!

      the funny thing about the class is that it’s actually not entirely about the pathophys of schizophrenia, but more about the history and philosophy behind it.

      the answer is we don’t really know the pathophys. like most things, it’s a combination of genetics and environment. but there is some really interesting research on how those 2 factors play out, including brain wave oscillations…..

      • http://www.facebook.com/rob.lindeman1 Rob Lindeman

        I appreciate why you use the expression “we don’t REALLY know the pathophys.” That’s a common locution when we mean to say “we don’t know the pathophys PERIOD.”  I will grant that there is some really interesting research on how genetics and environment produce schizophrenia, but how this adds up to pathophysiology is another thing entirely.  

        Since this professor is teaching you the history of schizophrenia, no doubt you have learned that to this day, investigations have turned up NO pathological correlates to the phenomenology of schizophrenia WHATSOEVER.  Countless hypotheses as to the nature of the putative pathology have come and gone and no doubt there will be more.  Until we actually nail this, however, schizophrenia is ONLY phenomenology.

        • http://doctorpsychobabble.com Dr. Psychobabble

          Agreed.

  • Jon

    Counter quote, “You’ve got to change your evil ways, baby.”
    - Carlos Santana

  • Jon

    Counter quote, “You’ve got to change your evil ways, baby.”
    - Carlos Santana