Not long now...

'til psychiatry is done.

• Saw an interesting man this week in geriatric psychiatry. He's just in his 50's but has a very unusual presentation of Alzheimer's disease in which he's losing his visual-spatial skills first. He's unable to read anymore, while he can see the letters/numbers he can't interpret what they mean. So he was telling us his frustration with trying to navigate the bus system and asking for tips on a European trip he's planning with his wife (i.e. what to do in the event that he gets lost & how to plan for that). At the end of the meeting, he accidentally picked his coat up upside-down. It was fascinating to watch him try to figure out what was wrong & subsequently how to fix it. After he left, I discussed it with his physician and he said that if he were to put on his jacket backwards, he'd know something was wrong but not know what nor how to fix it. A fascinating case (reminded me of Oliver Sack's book "The Man who mistook his wife for a hat") but a sad one too. He seems physically healthy and yet the typical prognosis of someone with Alzheimer's disease is on average 8 years after diagnosis. Yikes.
• Also spent a couple of days in child psychiatry this week. I saw one case of extreme anxiety which has prevented a child from going to school because of a fear of fainting (in fact, she's barely left her room except to go to the bathroom for 3 weeks). It's disturbing to see such dysfunctional environments some children grow up in and how it affects them. In that case, the mother & father both also have anxiety conditions - the mother spent the entire interview wearing "worry" all over her face, while the dad wrung his hands in the corner. The other households I got exposed to (and heard about through kids) were some foster homes in which the kids are minimally paid attention to (one child couldn't tell us any more about his foster father besides his first name after 3 weeks of living with him, and didn't know the name of the other foster child living in the house) or, in one extreme case, sent off to live with a hired hand while the foster mom collected the cheques from the ministry for care. Very very sad.
• Anyway, only 1 1/2 weeks left in psych and then I'll be moving onto Obs/Gyne. That might not be my favorite but it will be nice to be in a field that has lots of happy moments, I hope.