Tuesday, December 07, 2004

Grand Rounds 11- Psychiatric Delirium

(Fiction- Part 3)- Here for part 1 and 2.

We were unable to find Codeblue. That guy is never where he should be. We think he has a drinking problem but nobody wants to tell him. At least his Rosacea makes us suspicious. Regardless, it looks like we were on our own with this mystery. Psychiatry was our only lead.

If we’d be able to somehow persuade the shrinks to spill the beans all this would be over. What happened in that room? What happened in Risk Management? The cloud of mystery had to be lifted so that life in the Mad House could return to normal. During another meeting we engineered a plan.

The plan was simple, yet powerfully persuasive. Every resident in the house was told what to do. The instructions were crystal clear and even simple enough so that the Surgery residents couldn’t screw it up. For good measure, we questioned them thoroughly to make sure they had it straight. Things got ugly when the Surgeons accused the Medicine residents of being lazy and we had to whip out an EKG and watch them run for cover.

I headed back to the clinic to work on the fine details. On my way there I ran across DB who requested that I review some of my observations. DB is one of the Attendings I normally trust, however, he was recently indicted by the DEA for some “missing” pain medication and since then he’s never been the same. After he was seen at the Emergency Department last month with questionable painful “muscle spasms” I began to have my reservations about how much he could be trusted. The plan occupied my mind and so I cut our meeting short.

Here was our plan: All Residents would call a consult for a “change of mental status” in patients clearly suffering from delirium (change in mental status due to organic cause). The consult was ridiculous and we knew it. It was wasted paper and wasted hours of writing. But if Psych was to learn their lesson it had to be done. They would soon learn that everyone, even Psych Attendings, are at the mercy of the House Staff.

One by one all our old ladies with UTI’s were evaluated for their “change”. Shrinkette must have seen twenty consults that day only to consistently write “Rule out delirium”.
We would refuse to rule out delirium (since we knew it was) and we would call the same consult the following day. Once again, we refused to rule out delirium!

It was only a matter of time until Psychiatry would break.

Our luck struck on the fifty second hour. Intueri, the other psych consult, was the first to break. On day three, after seeing her 14th “Rule out delirium” of the day, and her 67th in the last three, she collapsed on the floor. All that could be heard from the wreckage was the whisper: “January 11th, January 11th, January 11th”.

It makes sense now. 1.1.1. is a date (January 11th). Well at least we only have to figure out what does “Big Circle” mean?

In the meantime, check out this week’s Grand Rounds at The Exam Room of Dr. Charles. Charles does everything well, I doubt this will be an exception.

P.S. Dear Readers, I apoliogize for these horrific fictional posts. OK, here's where I throw in the towel. I was trying to promote the upcoming grand rounds coming to the Mad House on January 11th..get it "Big Circle". Oh well, upon further consideration and much ?????? from fellow visitors who crought me back to my senses. I will cease now. no more fictional posts. Who likes fiction anyways