Who's Mad?

So I turned up at work feeling like a toilet roll. This is the continuation of a previous post that got sidetracked when I made it to the First Edition of the British Medical Blogs. Yey! I can not really provide an explanation why I’ve chosen to use these banal two words to describe my state of being but it was the one closest to feeling like crap that I can think of at the time. Seems like an appropriate metaphor for feeling really thin, featherbrained and can’t be bothered to do anything as challenging as a therapeutic transaction with patients who sometimes if not more often know more about their medical conditions than I do. I once looked after a patient who has Googled every ache and pains she ever had, every pills or tablets taken and every diagnoses accumulated as if it is some form of a “fascinating morbid collection”, literally and figuratively. Makes you wonder: What’s wrong with collecting stamps? Or stuffed dead animals? How could anyone obsessively collect an alphabetically arranged mental card index of a random number of pathologies or allergies that they could just pull out from the back of their heads each time they see a slight rash or a spot of discolouration on their skin? I remember having this kind of anxiety each time we had a trip to the hospital to see actual patients or diseases for our related learning experience as a student. This may sound like a fun outing or a field day, but more often than not you end up lying down on your stiff bed in the dormitory having cancer or tuberculosis. Imaginary ones at least. Thanks to the web for wider access to medical information, medical blogs like " this " and popular medical programs on TV, now this kind of phenomenon is not just unique to medical / nursing students.


Hypochondriasis is the new opium for the masses. So it’s quiet possible that anytime soon after you’ve extubated ( remove tube / artificial airway ) on an asthmatic patient who had a respiratory arrest ( ceased breathing ) you might find yourself unprepared to his / her witty sense of humour:

“Nah, TB’s my disease.” And wished you had equipped yourself with appropriate House MD’s unconventionally artsy verbal skill: “You own a disease? Well, I’m sorry I missed the IPO on dengue fever.”

It’s quite easy to get psyched about it, and on the other hand, quite hard to psyche yourself up about them especially now that more and more people are crazy about medicine or just plain crazy. Of course, verbal interactions in reality unfortunately deviate quite steeply from art. You can not look at a heavily bruised patient who jumped off a nearby bridge and say: “Oh, well that rules out the race thing, ‘cause you were just as black as last week.” May work hysterically on TV, but I doubt it if you can pull it off in reality without getting sacked for being un-pc ( politically incorrect ).

Although patient’s in ICU who are subjected to sensory overload, sleep deprivation, loss of control and lots of other various factors could be ( unable to find a pc word at this point ) just as mad: known as ICU psychosis. Most have grown dependent to their carers from prolonged helplessness that they reverse back to being a child:

Client: Can I go out please ?
Nurse 2: No I am afraid you can’t.
Client: Why ?
Nurse 2: Because you said this morning you were going to jump off a bridge.
Client: How do you know ?
Nurse 2: Because all nurses are psychic !

So unless you are like these witty, witty Mental Health Nurses that could read patient’s minds and could maintain a childish conversation to an adult with an otherwise child’s brain called reciprocal transaction in psychoanalytic theory - looking after a conscious, chatty and wardable ( should live in the ward if there is a bed there! ) patient can be really, really daunting indeed.