Friday, April 11, 2008

Bi-Polar Bear

("This looks like a job for Bi-Polar Bear!!! But I just can't get out of bed this month..." For those of you who are not familiar with The Tick, I suggest you clickity click and find out what you are missing).

Anyway, friends and neighbors, I have come to realize that some of you are angels straight from heaven, and some of you hate me and wish I would just go ahead and knock myself off so you wouldn't have to deal with me anymore. Of course I haven't had thoughts of killing myself, but if someone doesn't stop this pain, what choice do I have? Would you want to live with pain like this? No, that would be it. You can't put me on the Crisis unit for saying that, can you? I'm not saying I am going to kill myself. It's just that if I wanted to, you couldn't stop me. Why should I stick around here? Even my father wouldn't care; he 's always said I'm a loser. Now how am I supposed to feel about that? You know, if I could just get a little something to take the edge off... no, not that, only lorazepam really works... no, 2mg isn't enough, I'll need more like 10 or 15mg to really help... seriously, they haven't been giving me my home medicines and now I haven't slept for four days! Just don't give up on me. You understand me. That other doc who was in here, I don't know what his problem was, but it was like he wouldn't listen. Or he thought I was crazy, or something--just made me feel terrible. But not you, I'm so blessed to have you, you are the one who is really going to be able to help me. You are so wonderful, God sent you, and... what? What do you mean you won't give me 15mg of lorazepam? You're just like all of those other doctors, aren't you? Where is that other doctor, the nice one, the one who actually listened? Send him back in here, and don't bother coming back, okay?

OK! Now, those of you who have not had psych or the delightful experience of interacting with numerous patients probably feel confused and blindsided. Everyone else got to the second or third line and a neon sign in their head lit up, and that sign flashed BORDERLINE! BORDERLINE! BORDERLINE!

Believe me, it is just as fun as it sounds to interact with Borderline patients. By which I mean, it is no fun at all. It is one of the most frustrating things that exists in medicine, although what makes it so hard sometimes varies from person to person. For me, it's hard because most of these patients have had lots of bad things happen to them--some just because, some self-inflicted in some respect--and they are in a lot of pain but have no idea how to get themselves out of it. Also, Borderline patients tend to be master manipulators, they push your buttons, good or bad, they make it REALLY hard to take care of them, either because they are not telling the truth, alienating the team, disobeying orders, etc etc.

Also, a tip for those of you just starting into the clinical world: At least half of the patients who tell you they are "bipolar" actually have Borderline Personality Disorder. Probably more like 80%. Unless you are on psych, and then you probably will be lucky enough to see truly bipolar patients in a manic phase ("No weapon forged will prevail against me!!"--not a Tick quote, an actual patient quote). You'll secretly wish you could feel like them for just a little while.

Quick side note: I've learned that just because someone thinks that a white van full of Navy SEALS is following them around and then jumping out of the van to chase them with bicycles doesn't mean they have paranoid schizophrenia. Apparently it can also mean that they have been taking 16-30 pills of dextromethorphan at a time for the past five years or so (along with several other street drugs, of course).

Anyway, I'm off to learn about more psych, so I can find a few more frightening diagnoses which almost apply to me. Also, I think I see a white van outside.

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