PSYCHIATRIC HISTORY

This is a case of KMT, 24/F, from ******* ** *** ****.

CHIEF COMPLAINT: (according to patient) "I'm depressed..."
Patient had no reliable companion at the moment of interview.

HISTORY OF PRESENT ILLNESS:
The patient was apparently well until around 9 days prior to consultion (PTC), when she had to shift out from one department to another. She took a post-rotation test and fared poorly, after which she was noted to be more quiet and appeared to be more deep in thought. The next few days, since she was tasked to be the liason officer of their group for the next two weeks, she seemed to be very busy the whole day, and when she went "home", she would just sit quitely on her chair, and immediately fall asleep. Sometimes she would perk up and talk excitedly about a certain Ortho resident, but then she would fall quiet again when she realizes that she was just being ridiculous. She has a general loss of interest in doing anything, was noted to be sleeping early but was up and about doing nothing at wee hours in the morning. She also fails to do her typical chores (i.e. wash clothes, arrange stuffs, etc), and could not answer her mentors' questions. She was noted to have an increase in appetite, and on one occasion cooked three packs of noodles at midnight, only to realize she couldn't finish it. She would sometimes be talking or singing to herself, and was often staring blankly into space. She has increased hours of sleep, but she would be sleeping on the chair (and haven't slept in the bed for days), yet she still feels tired and sleepy during the day. No auditory/visual hallucinations or delusions, however, she has ideas of references. She said she has a feeling that her room mates are talking about her and her negative characteristics. She often attempts to study, saying she is so frightened of her next rotation, but she could hardly finish reading a page. She was also noted to be frequently calculating some numbers, only to be frustrated that they don't add up. She would sometimes cry silently, her back turned to the whole world. She claims to have feelings of fear, doubt, anger, disappointment, anxiety, and self-worthlessness. Persistence of condition prompted this consultation.

Past Medical History: unremarkable

Family History: (+) hypertension, diabetes mellitus - paternal side

Personal/Social History: Patient finished a four-year post graduate course and is currently undergoing some sort of stressful training with no payment. She is a non-smoker, non-alcoholic beverage drinker, and denies illicit drug use.

Anamnesis: The patient is the eldest of two children, allegedly a wanted pregnancy, born via Cesarian Section in a private hospital to a then 26 years old G1P0 mother, with no feto-maternal complications. Her development was at par with her age. She was shy and quiet as a child, but was noted to be a quick learner. She could recite the alphabet and count in at least two languages at age three, and by age four was already reading out loud from the newspaper. She started schooling at age 5, with above average school performance, and was allowed to skip a year. She was sometimes friendly and sociable, but was generally shy to her peers. However, at third grade, she was noted to have several "enemies", mostly males, whom she would sometimes kick when they were praying in class. Because of this, she decided she wanted to transfer to another school. In her new school, she was noted to love to perform and take the front stage roles. She was also an achiever. However, her family suffered a financial tragedy, and at her young age she also thought her best friend has betrayed her. During that time of despair, she has learned to cope with her stressors by praying and giving herself to Jesus Christ. She became a devout Christian at age 12.

In high school, she continued to do well in class, but now preferred to do backstage roles. She loved writing stories and poems, drawing, and enjoyed watching movies. She had a close knit of friends. She also had one main crush, but thought other boys in her school were cute too. She grew up however without her father by her side, because he had to work somewhere far. Because of this, she has learned to be more responsible towards her family, and was emotionally close to her mother and sister. She finished high school with honors, but claims she was not totally happy with it, because she was constantly under the pressure of some of her realtives. She also claims that she felt jealous of some of her friends, but was quick to accept their differences because she believes in a God who is fair and loving.

Before entering college, she was emotionally traumatized(?). She refused to elaborate on this. She was a scholar and took up a course in BS Biology, but she really wanted to be an accountant. In college, she was more aloof, and often went shopping or watched movies on her own. Although she has a warm group of friends, she was noted to be quite peculiar, and had a sudden interest in Japanese animation, which eventually became an obsession to anything Japanese. She also stayed at home almost all the time, and was often encouraged by her mother to go out with friends, but she would decline. She was helpful at home and was a diligent student. She also finished with above average standing, but said she still wasn't satisfied with herself. She said there was something empty. Again, her father wasn't able to make it for her graduation because of work. Their family had financial difficulties, but they were somehow able to overcome their daily problems.

She proceeded to take on a post-graduate course, also with a scholarship, expecting she would also fare well. However, she was already tired of studying and hardly read her books. She would sometimes fail, and sometimes would get just barely passing grades. She lived a happy-go-lucky life and didn't take her studying seriously. Her obsession for anything Japanese also turned into an obsession for anything Asian, and she would splurge all her money on a lot of pirated CDs and on internet fees. In her fourth year, she got a cut off her scholarship and felt ashamed about it, but didn't show any signs of her pain. She underwent one year of harsh training in the hospital, but said she feels she did not learn anything and was often not confident in whatever she's doing. She graduated at age 24, this time with both her parents on her side. She applied for another year of training in a far away place, and was accepted, and is now living alone in an old building with poor water supply. She claims to have problems with money and time management.

PHYSICAL EXAMINATION
Seen and examined conscious, coherent, ambulatory, not in cardiorespiratory illness with stable vital signs, essentially normal systemic findings, and essentailly normal neurological exam.

MENTAL STATUS EXAM
Seen and examined a cute and adorable an adult female, calm and disheveled fairly kempt, wearing an all-white uniform (however the pants are a slightly yellowish off-white color compared to her top), appropriately dressed for age and sex. She is seen sitting pensively in front of a really nice flat screen 17" monitor. She is cooperative to examiner, but has fair eye contact. Her mood was depressed with a hint of slight anxiety, with an appropriate affect. Her speech was spontaneous, but she has a weird accent. She has goal-oriented thinking with no tangentiality, circumstantiality or looseness of association. She does claim that she has ideas of references. She is preoccupied with thoughts of her family, her CDs, the board exams next year, a certain Ortho resident, and her financial problems. She has poor impulse control and admits that she wants to tear off a page from the attendance logbook (she already tore off 1/3 of the page) for reasons she is too embarrassed to reveal, and she has fair insight to her illness. She scored 30/30 in the MMSE.

ASSESSMENT
Axis I - Adjustment Disorder with Depressed Mood
Axis II - None
Axis III - None
Axis IV - Financial Constraints, Preoccupations with various thoughts, Exposure to a ward of psychiatric patients
Axis V - GAF 81-90

PLAN
Initial supportive psychotherapy.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Addendum (but this is unconventional, and not medical, therapy):
> To secure funds - LOTS of funds.
> To secure 1 unit laptop, with DVD-Writer, after which...
> May load patient with one dose of her favorite anime, then continuous anime infusion every day.
> May also start patient on terebi doramas or scanlations, whatever is available.
> May hook patient to a DSL connection.
> May restrain patient to a certain good looking Ortho resident, if he is willing. XD
> Refer accordingly.

I HAVE GONE BONKERS OVER FRESHNESS PERSONIFIED

*** WARNING! SOME OF THE LANGUAGE, SCENES AND CONTENTS MAY NOT BE SUITABLE FOR THOSE WHO DETESTS MUSH! YOU HAVE BEEN WARNED! XD ***

I met him during my first Ortho-ER duty. That was almost 2 weeks ago. It was my first time inside the ER, and I remember feeling so lost and confused. I was about to take my lunch when he arrived. Tall, fair and soooo good looking, he introduced himself as the ER cover for my resident, who was doing an operation upstairs. I just had to put down my food and hurriedly started endorsing our patients in the ER. There were 19 of them, backlogs from the previous three duties. We checked all of them, and when he gently examined this one little boy whom I referred through text early that morning, I realized who he was. Or at least I now know his name. It felt so nice standing beside his well-built physique. I couldn’t help but smile and feel lucky.

I never saw him again till 2 days after when I assisted in the operating room. Actually, at that time I was “eyeing” //rotfl// another good looking resident whom I assisted, but I saw him in the next operating room. He looked great in a scrub suit. Actually, men in scrub suits (unless if they are wardmen XD) do have their own charms. Sadly, I never got the chance to assist him in an operation. Even until now, I regret the fact that I was never given that opportunity. But maybe it’s all for the best. Who knows what crazy things I am actually capable of? //silence// Go figure. XD

The next time I saw him, I think, was three days after, during my ward duty. I was so looking forward to that duty, because he was going to be my resident for that day. Unfortunately, I hardly saw him, since they don’t really stay at the ward. I spent most of the time doing intermittent catheterizations on 5 Spine Unit patients who have unfortunately lost their ability to void. I was also tasked to extract quite a number of blood samples and line several patients, which I am proud to say, that I all did very satisfactorily (all credit for my skills goes to my one year clerkship in NMMC, YEAH! ^o^). Luckily, there was a point that night when he actually did drop by the Nurse’s Station to use the phone. He was sort of leaning on the counter, showing off his glorious butt //ahem// BACK. ^o^ As I looked at his broad back, I just had to resist the urge to hug him from behind. I am not that crazy. Not yet anyway. //rotfl//

The next morning, after I finally finished all those gadzillions of blood extractions, he was there again at the Nurse’s Station, using the phone again. Actually, I didn’t really take the time to notice him, since I was frantically searching for the ward report logbook, but apparently, he did notice me (probably got distracted watching me walk back and forth XD). And when our eyes met //rotfl//, he smiled as if amused, and mouthed, “What are you looking for?” (he really couldn’t talk so loud because he was still holding on to the telephone XD). With an embarrassed look, and suddenly conscious of my post-duty status, with all the glory of a disheveled uniform and uncombed hair, I smiled weakly and replied, “Ward Report”. He then pointed to a nurse and mouthed, “Ask for help.” I smiled pathetically and tapped one of the nurses on duty. The nurse tried to look for the logbook too, but he couldn’t find it as well. I probably must’ve looked dismayed, because when I caught his eyes again, he asked again if I already found it, and I shook my head. He then pointed to another nurse and, I don’t really remember anymore, but did he personally ask the nurse to find the logbook for me? Anyway, tonikaku, I eventually found the logbook, and somehow credit it to his unanticipated assistance. I don’t know. Maybe he’s just naturally uber-nice and helpful, or maybe he did it because got annoyed at me walking back and forth in front of him. //LOL// I don’t really know. I didn’t really think too much about it. I was only aware of a dreamy feeling which enfolded me which I could only associate from the mere sight of him. XD

Three days later, I was in the OR again. And the heavens must be on my side, because as I was walking from RCB to LCB, I was just right in time to see him enter through the door. He was wearing a blue polo shirt, and for some reason, he always looks like he had just taken a bath, and so that’s why the very first thing I thought was, “My goodness, he IS freshness personified...” XD And when he saw me, he immediately had a look of recognition, and smiled warmly at me. I also smiled back casually, but deep down I felt like I was plastic melting under the warmth of a cozy fire. He walked towards the LCB, but since he wasn’t in proper OR attire and hence considered “unsterile”, he could only stay behind the green line. But I was wearing scrub suit. So I just pretended to just walk past him, and as if I just noticed him again, I turned back and asked, “Sir, do you need me to call anyone for you?” //with a friendly smile//. He smiled, as if relieved, and asked me politely if I could to give the Xray plates to Dr Yson. I smiled obligingly and said, “Sure!” I was glad to do anything for him. I was willing to do almost anything just as long as I could see him smile at me with that sweet look of appreciation. XD

The next day, Thursday, was another ER duty for me. And count my lucky stars, we’re on the same team again. He was my ER resident, and I was looking forward to us treating our patients together. ^o^ However, unfortunately, I didn’t see him at all the whole day, because he was stuck in the OR. He did call me twice just to check on the situation in the ER, and the sound of his soothing voice was simply enough to make me say, “Yes Sir! Yes Sir!” to all of his instructions. I told him I didn’t have his trodat (it’s like a name stamper(?) we use in the hospital which contains the doctor’s license number) so I couldn’t request for Xrays, and when he realized this, he told me to just sign with his name and just write his license number - 10***3. ^o^ 10***3! Teehee! It gave me great joy to sign and use his license number! ^o^ And he also gave me his password to the computer so that when I log in the doctor’s orders, I would be ordering under his name. ^o^ //laughs sheepishly// Actually, we do that with our other residents, but somehow, writing doctor’s orders under his name made me feel closer to him... //gags// XD. Actually, he never showed up in the ER that day, and it made me sad, because I was really busy and had a lot of patients for him. It was a good thing other residents covered for him, and I had to apologize to almost all of the patients because I had to make them wait for a very very very very long time, since he was still at the OR, assisting a consultant for a very long procedure. At around 1130pm, I left my post at the ACU-Extension to my clerk, Tonton, because I still had to serve my three hours at the triage area.

I also saw quite a number of patients at the triage, and perhaps they were all around me, that was why at around 130am, when he finally arrived at the ER, he didn’t see me at all. //sad// But yes, I saw him. He was wearing a white shirt, and even though he was at the OR the whole day, he still looks so fresh. Yep! He is indeed, freshness personified! ^o^ He went in the ACU-Extension, probably to check on the remaining patients who were still there, and I was itching to go in and tell him about my “accomplishments” for the day, but I couldn’t leave the triage. After around 30minutes, I saw him leave the ER, but he never saw me. //sad//

I felt sad when I went back to ACU-Extension at around 230am. I waited the whole day for him, but we never saw each other. The thought alone frustrated me. But I believed deep in my heart that he was coming back, and yes, he did! YEY! //LOLz// ^o^ When he arrived at around 3am, he looked like he was so tired and a bit confused (I guess since he didn’t know any of the patients, which are supposed to be HIS patients, LOL), so I gladly gave him a rundown of what happened during the day. I think I was relatively efficient in manning the Ortho-ER (at least that’s what I would like to believe, anyway XD). So he decided to first take care of the young guy with shoulder dislocation, and he and Tonton (my clerk) tried to do traction-countertraction on the patient. But since the shoulder was so stiff, so we decided to take a break and let the patient drink some muscle relaxant first. While waiting for the medicine to take effect, he sat on a chair, and within minutes fell asleep. I looked at him and was amused. He looked so tired and he even had his mouth slightly open, and he even snored once or twice! //giggles// But somehow I found him all the more adorable! ^o^ Eventually we had to wake him up because one pay patient needed to be admitted already, and he had to make the admitting orders. And when the pay patient was about to be transported out, he handed me HIS SWIPE CARD (because the ER back door won’t open unless you have a swipe card) and when I held it, I felt really proud and happy, as if I was entrusted with something important (Gosh, it’s just a swipe card, misakichan! XD) //LOLz//

Then we went back to fix the dislocated shoulder again. Since he was hot was feeling hot, I got an electric fan for him. And then when he told me to plug in the... (oh no! what do you call that thing with lights for the Xrays?!)... well, to plug in that thingamajig the negatoscope, I was up and about trying to plug it into the outlet. But for some reason I couldn’t plug it in, and when he saw me, he laughed and said, “Hindi dyan! Inaantok ka na ata...” (Not there! I guess you must be sleepy already!) XD I sheepishly smiled and realized that the negatoscope had a separate outlet for its plug. LOLz Baka de-su! Anyway, so he applied constant traction again to the arm, and as I looked at him, I prayed silently to God to give me someone just like him. Strong yet gentle. Tired yet persistent. Handsome like a prince yet seemingly just like a nice-guy-next-door. //sigh// I must have really gone bonkers. XD

Well, he ultimately fixed the arm (YEY! ^o^) and just when you thought everything’s over, the surgery people came in and referred a vehicular crash patient who just came in with a terrible open fracture. We went to ACU to check on the patient, and he told me to get gloves and lots of OS. I was so hyped up by that time I would’ve gotten him anything he wanted...
>>> He: “Gloves...”
>>> misakichan: *hands gloves to him*
>>> He: “OS...”
>>> misakichan: *opens up a lot of OS for him*
>>> He: “Do we have wadding sheet?”
>>> misakichan: “I’ll find one for you!” *runs to find wadding sheet and really brings one back*
>>> He: “Micropore?”
>>> misakichan: *opens her bag and takes out a 2” micropore*
>>> He: “OK... let’s remove all of these...” *points to the messy leg*
>>> misakichan: *confused* “REMOVE THE ENTIRE LEG!?!”
>>> He: *dumbfounded at misakichan’s stupid answer* “Er, no... what I mean is remove all these blood-stained OS and clean up this mess...” 0___o
Kyaaaaaaahhhhh!! How embarrassing to blurt out something like that!! XD I don’t know where that came from... Maybe it was because I lacked sleep, but I just had to make that silly remark! XD

Anyway, after the hustle and bustle of that open fracture patient, we went to see our other not-so-toxic patients and he gently cleaned and packed their wounds. Even though he was a tall, strong guy yet he really has gentle hands. I’m a girl yet I appear more brash and seemingly callous when dressing wounds. XD Then since it was around 6am already, he said he had to go up to refer to his senior. It was sad to see him go, but I also needed to finish my job, update doctor’s orders and prepare my endorsement papers. I was groggily typing and I swear I didn’t understand what I was typing anymore, when he came back again, maybe after around 20-30minutes, to finally clear the patients. I immediately was up and about, but maybe the exhaustion was finally showing on my face. He told me which patients to discharge, what to do with this patient, what to prescribe to that patient and so on and so forth. He had quite a number of instructions, and maybe he wasn’t sure if I was getting it all in, because he kept repeating it over and over for me. //LOLz// It is indeed hard to communicate with someone who has been up all day and all night in the busy ER and yet hasn’t even slept a wink. ^o^ Finally when he was finished, he also gave a sigh of relief and looking at me, with that heavenly face and what appeared to be a mix of a boyish + amused + sheepish smile, he said softly, “Benign naman yung duty natin diba?” (Our duty was relatively benign, right?) and I swear, at that point I knew I lost it. I lost my heart to this absolutely sweet and gentle and wonderful and amazing and good looking and [insert gadzillions of positive adjectives here] person! My heart aches for the fact that that was probably the first and last - the only - time we can work together. I probably won’t see him again. Or maybe I will, but he would no longer be my resident. It is such a sad thought. u___u But yes, maybe that is for the best. Because we must not long for something which will never be ours (but I actually never wanted to make him mine or whatever, just as I never really wanted to make my sempai mine even though I have liked him for all those years and even told him about it XD). Apparently I failed to mention, after this extra long pointless story of fanatically deranged infatuation whom I doubt anyone would have the patience to actually read, that this guy already has a fiancee. Of course that is to be expected. Guys with these kinds of ideal features are already leashed to women who most likely also possess the same ideal assets. It’s just like watching the prince you adore end up together with the princess in a stage play, while all that time, you are just standing alone in the dark corner, silently longing and hoping and praying hopelessly behind the stage. u__u

//deep long sigh//

Enough dorama already! //LOLz// I haven’t blogged for quite a while, so maybe this is why I’m all melodramatic! Teeheehee ^o^ Well, we’re finally finished with our Ortho rotation which is a sad thing because I’ll be leaving the den of bishounens for a ward of mentally challenged patients. I mean, heller!? Who would actually want to do that!? XD But then life must go on. But hontou ne, many of the Ortho residents are really charming, and they are so so so uber nice. It’s really sad to go... u__u

Well, here’s a consolation for me...


You ask what’s this?! Well, this just happens to be THE DR P----- LOVE BREAKFAST de-su!! ^o^ He went on duty again the other day with Rona. And yesterday morning, he bought breakfast for Rona and her clerk Peter! (UWAW!!! So lucky! I’m so so so so so so envious!!! u___u) But Peter was already tired and wanted to go home immediately, so he left his share. And Rona, my dear good friend Rona, immediately texted me at 7am (good thing I was already up) asking me if I want breakfast from Dr P-----. I was like, “KYAAAAAHHHHH!!! DO YOU HAVE TO ASK!?” and I was immediately at the ER, giddy with joy. ^o^ Pia, the receiving intern and our block’s Ortho LO (Liaison Officer), upon knowing that it was breakfast from Dr P-----, wanted it too, BUT NO!!! IT IS MINE DE-SU!!! ^_______^


DR R----- P----- LOVE BREAKFAST de-su!!! Itadakimasuuuuuuuuuuu!!!! ^o^

PROPOSAL

Shaoran: Misakichan, anata wa totemo kawaii de-su!! Will you marry me?



Misakichan: Kyaaahhh, ShaoRan-kun! *blushes* We're still too young to get married... XD

***chuuuuuu***

AMBU

Last night, Shay2x had an asthma attack. She apparently ate something she was allergic to, and after 2 hours, she could no longer speak and had difficulty breathing. Hya and I took her to the PGH AMBU-ER for nebulization. Good thing we live INSIDE the hospital, oe else we wouldn't know what to do. After three doses of Salbutamol, Shay2x's condition improved significantly. We could no longer auscultate those awful wheezes in her lungs. *sigh of relief* I hope something like that doesn't happen again. XD

Anyway, I haven't updated for a while, gomen ne... XD Well, on to the boring details of my life...

First of all, I'm no longer an OB-GYN intern. I've already finished my 2 months in OB-GYN and we have shifted out to ORTHOPEDICS. It's a different system compared to OB-GYN. For one, we go on 24h duty EVERY 5 DAYS! YEY! I was ER duty last Tuesday, and I was relatively benign. I only had 6 consultations: 3 of which were OFWs who jumped off the buildings in Lebanon who were cleared and discharged, 2 were referrals from the Surgery-Trauma service, and 1 patient whom we sent home after putting his arm on a sling. In the OPD, we only see 4-8 new patients per day (unlike in OB where we see more than 100 patients in OPD!!). In the ward, I only have 4 patients, and three of them were discharged already. ^o^ I don't have any patients for daily clean/dress wounds. I love assisting in operations because we do very unusual procedures like hip arthroplasty and IM nailing, and we drill screws into bones and attach metallic thingamajigs to keep legs intact. I even had the chance to operate the C-arm (it's like a C-shaped X-ray machine). In NMMC, only selected and experienced RadTechs can man the C-arm, so I was totally surprised that the students here operate the C-arm. And we always have Teaching Rounds where we learn a lot of interesting stuffs. Anyway, what's best about this ortho rotation is... *blushes* there are a lot of CUTE male residents. Nyahahahahahaha And they are so uber-nice too! I like THREE of them! LOL But I guess if they look that good then they are probably married. XD Anyway, it's too bad the Ortho rotation is only 2 weeks. After next week, we'll be shifting out already to Psychia. We will have to adjust again, but it still won't be as toxic as OB.

I also finished watching GOONG. I love all the sweet Shin x Chaegyung scenes, especially the part where Shin proves to Chaegyung how much he loves her by removing their caps and kissing her in the midst of a crowded street. And I love the OST! I keep listening to it over and over again. Demo, to be honest, I didn't really like the story. I don't know about the manhwa, but the dorama version was a bit of a drag. I don't understand why two people who are obviously in love with each other and are actually married to each other are unwilling to express their true emotions. Chaegyung obviously loves Shin and even admits this to Yul, but when Shin started showing interest to her, she started acting like a baby. I don't get it since Chaegyung seemed so much like a fighter in the start. There is such an inconsistency in the flow of the story and the development of the characters. *sigh* But I love Shin. I love beautiful men. Although Shin is really not beautiful. And Trina said he wears pink. Although I think that's OK, since my sempai wears pink too. And even Himura Kenshin wears pink! I think men who look good in pink are attractive men.

Well, whatever! XD