Running late for the morning research seminar, I have twenty minutes to see the new patient on the floor. Time enough, I think, as I walk in the door.
'Hi, I'm Dr. P, I'll be taking care of you while you're here on our unit.'
She asks for my credentials. I hand her my ID card.
'So, you're a resident.' She might have said vermin.
Uh oh. 'You'll be meeting a senior attending physician later. May I ask you a few questions?'
'Let me tell you something first. You are supposed to be a professional, but your behavior is not. You need to make better eye contact like I am making with you. You also need to stop jerking your head.'
So much for 'empathic' nodding. She goes on for the next five minutes, hard to interrupt.
I already have a diagnosis. Which is good, because she'd rather see a more professional doctor. Later, she tries to incite other patients to a non-compliance strike. Fortunately, her abrasive manner pushes them away. She plays the piano all day long and sings in the hallways. We spend a lot of time calming down other patients.
My attending offers to transfer her to another resident's care, but I can't let this one go. I go back the next day.
'You can be my doctor. I come from a good family. I can see that you are a genius, too. Amen.'
We bargain over medicines. She refuses the sedative she takes at home but agrees to take the mood stabilizer. I couldn't care less about the sedative; the battle is won.
Three days later, she's still grandiose and demanding. But its getting better.
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