Monday
In a previous issue, I wrote about a gentleman suffering from bipolar disease and comorbid alcoholism who had decided to set himself straight. Sadly, today I received word from a colleague that he was hospitalized over the weekend. Apparently, he developed abdominal pain and astronomical serum liver enzymes after drinking alcohol while taking valproate. To top it off, his wife was admitted to the OB service of the same hospital for preterm labor. What a rotten way to start the week.
Tuesday
RI, a 21-year-old man, arrived with his mother. RI is a junior at an Ivy League university who has withdrawn from school due to debilitating fatigue. He has been to numerous physicians and “holisticians” over the last few months, including an endocrinologist at a major northeastern academic medical center. As you can guess, the results of his workup for a medical cause have been inconclusive. Both he and his mother deny that depression has been suggested as a possible diagnosis, despite the fact that his symptoms have lasted over 6 months and include hypersom-nolence, anhedonia, and feelings of poor self-worth. Even more amazing, his mother has been taking medication for depression for many years. After having spent hundreds of dollars on “natural” remedies, they were both quite relieved at my suggestion to try generic fluoxetine. Gee, this is such a slow pitch that it ought to be a home run. I hope it doesn't turn out to be an embarrassing swing and a miss.
Wednesday
I often wonder if one needs to have some level of psychiatric abnormality to run for high-level public office. Now in the midst of another election season, I am even more convinced.
Thursday
Call weeks during the cold and flu season can be very draining. Currently, my practice counts 6 toddlers and infants hospitalized with bronchiolitis or pneumonia, including a pair of twins. What I'm thinking right now, at 2 a.m., is how I could get those twins' mother a hefty dose of alprazolam.
Friday
Because of frequent comorbidities, I like to send children for comprehensive testing before prescribing medication for attention-deficit/ hyperactivity disorder. PT, a delightful 8-year-old boy, returned today for follow-up after testing. PT, like many young men, likes to play “wild animal hunter,” but apparently spoke about guns enough to catch the attention of the psychologist. The psychologist evidently asked the boy if he would kill a deer if he came upon one in the woods. “It depends,” he cautiously replied as he looked at his mom and dad. He then turned to his inquisitor and asked, “Is it deer season?”
I've always liked that boy.
Footnotes
Editor's Note
Dr. Wolff is a board-certified family physician in private practice in Cornelius, North Carolina. He finished his family practice residency in 1997. He has graciously consented to share stories from the trenches of primary care. While his practice diary is taken from actual patient encounters, the reader should be aware that some medication references may represent off-label uses.
We at the Companion are certain that these vignettes will inform, entertain, challenge, and stimulate our readers in their effort to address behavioral issues in the everyday practice of medicine.