Today was the first time we really got pimped. One of the guys was presenting his patient, and mentioned that he was taking Abilify; he was unfortunate enough to state the wrong dosage, which got the attending’s attention. So after he got the dosage straightened out, he demanded what was the generic name of abilify, what kind of drug was it, and what were its side effects. Everyone else froze, because the drug is so new we didn’t study it last year. I sat up on the edge of my chair, because I had randomly absorbed that fact. It’s proper name is aripiprazole, and it’s an antipsychotic. So I said that, and the attending was pleased that one of us knew, and didn’t get upset that I didn’t know the side effect.
Five minutes later, the same guy mispronounced Lamictal (dare you to say it right!), and of course got asked the generic name, class, and side effect. And he didn’t know. And I sat up again. It’s lamotrigine, an anticonvulsant, also used as a mood stabilizer, ie to prevent mood swings in bipolar disorder. Again I didn’t know the side effect, but he let me off, and explained Stevens-Johnson syndrome, which is an extremely severe bullous rash that can happen with any medicine, but is specifically associated with a handful; it blisters the skin completely off, so the patient can end up looking like they’ve got second-degree burns all over their body. Very dangerous. Thus you always jump when you hear a patient on lamotrigine has a rash of any kind.
This is the kind of thing I determined not to do, look like a know-it-all and a show-off. But so far the other students are just glad somebody knew. Of course, tomorrow the attending is going to expect me to know all the answers, and I won’t. . .
After rounds we had to leave to go to didactic, but first I had ten minutes to spend with a new patient. He coolly informed me that he had gotten angry with three people, and planned to kill them, to the point of stalking one of them with a knife, but that guy had his sister along. So my patient had decided not to go ahead with the murder – instead, to overdose on drugs and kill himself! But he couldn’t get the drugs right away, so he came to the hospital instead. Sure. He agreed that he gets angry easily, and has thought of this solution before. Remind me to stand right next to the door when I wake him up early in the morning?
I forgot to write down this story from my Saturday on call. On rounds I was supposed to be presenting a woman who had told me she was suicidal because she had just been betrayed by her boyfriend of three and a half years; later on she told me she had been married a second time in 1980, and that marriage had lasted 23 years. So I related both of these statements to the team, and said I wasn’t sure quite how that chronology worked. And they just cracked up. I intended to go into OB? Had I ever heard of extra-marital affairs? Was I aware that such things occurred? They were extremely amused. Yesss.
I guess that tells you how naive I am, that my first assumption was that the patient had her chronology mixed up, rather than that she had a boyfriend and a husband at the same time.