Hands on/hands off

"Hallucinations" have been running rampant at VTCC. Attention-getting strategies among the adolescent girls reached an all time peak last week when one person's "flashback" (which constituted blinking one's eyes quickly and standing still") managed to domino effect a whole series of similar blinking/standing still and a whole lotta complaining. It's clear no one was going to get anywhere with the chicas by telling them 1) they're faking and 2) the version of the flashback that's going around isn't even close. So instead, we have taught each other and nursing staff to merely accept and usher them on to the next activity without a lot of fawning. We are in the business of moving forward. Slowly, I think, the staff are getting used to the fact that therapists don't need to be paged every time a "hallucination" rears its melodramatic head, and I instead coached a nurse via phone today on how to deal. One of my patients is in the habit of saying flippantly, "page my therapist," like I'm a maitre'd or something :)

This is week 3 of my adolescent girls' process group that I lead with one of the new staff psychologists. She has a high tolerance for bickering/other shenanigans and generally lets the girls go for a while before intervening or helping the communication process along. The girls have all latched on to the idea that they have a venue to confront each other about interpersonal drama, which needless to say, is rampant just like any other group of adolescent girls. Last week we had screaming and storming out. This week, all was well for a while...the ever annoying "I-statements" were being made, no one yelled, and everyone made a concerted effort to remind each other not to yell, or leave, because nothing got resolved that way. And then a switch was flipped. Patients A & B were confronting one another when C piped up that the group should not gang up on B. A round of "oh we're not" was murmured, and C, who has a legitimate degenerative cognitive disorder, fired back with an disproportionately defensive tirade that was very much in the instinctual and not at all related to the girls in the room. In about 0.5 seconds, C leapt across the room and began attacking patient D, whose voice had been among the murmurings. I had been sitting next to C, and leapt up, pulled C off of D, turned C and pushed her out of the room. C and I sort of stood around for a minute kind of dumbly looking at each other.

I considered myself lucky...firstly, being in the room with the leftover girls and the crying did not look like it was a good time, and secondly because Patient C didn't turn her beating toward me. I probably would have been capital T toast because my lord she is strong. The real bummer was all the fall-out that came afterwards. After C left the unit to go into the hall, D came out and sat on the couch before me crying. Stab me in the heart- in a tear-choked voice she cried at me, "why didn't you stop her!?" It wasn't the time to mention that in fact I did, but what I didn't do was prevent her from getting hit in the first place.

To add a bit of insult to injury, everyone has an opinion about the validity of our group now, which is a shame because no one got to see the good in-vivo teaching of communication skills and the steady teenage girl voices that proceeded the attack. Once I did my paperwork, I stopped by my colleague's office so we could apply ourselves heartily to the self inflating whoopee cushion. Then I peaced out and went home, unwilling to listen to staff's concerns anymore. I have got to get outta my couch potato habit, although my new, inexplicable obsession with the Bravo show "Million Dollar Listing" has been a hard one to break!

Today I started a new assessment... a 13 year old girl was admitted to the acute unit for 30 days conceivably for diagnosis clarification. What I learned today was: my hunch that family secrets were the root turned out to be true. Damn, I love it when I'm right. I'd like to present Exhibit A, the margins of my legal pad from yesterday's admission interview with family and patient, which contained my hypothesis from yesterday:
Stepfather--> overcontrolling ---> anger problems? ---> trust/lies----> SECRETS.

I paged the girl's therapist: You would not believe the crap that was left out of the admission interview yesterday. Diana. 83131 (my office number). The therapist called me back from the MD work room and put me on speaker phone so the attending psychiatrists could hear too. The details aren't important, but what I now have before me seems to be a classic case of the identified patient. This poor girl has carried the brunt of all the stress and has been made to look like a delinquent, a hateful daughter, and a whore. There isn't a pill in the whole cabinet that can address severe family dysfunction/denial and straight up lying, and believe me we've got some good ones!

I'm actually presenting a family therapy session on DVD in our family clinic today at 3:30...its a DVD of my Spanish speaking family, the interpreter, and me, basically trying to keep up. Now every Wednesday at 3:30 we have Family Clinic, which is supposed to involve us bringing in live families to have therapy while all the other trainees and 2 supervisors sit on the other side of the glass. They're supposed to discuss and critique, periodically phoning in to make suggestions and give directives to the therapist in the session. Fun, huh? Shawn and I signed up to present DVDs this first week, since no one had a real family to bring, and we did a little "Hospital Track" dance of unity this morning. We are, of course, better than others because of this, and will be steadily adding to our choreography :)