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#1
02-27-2025, 11:48 PM
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Oh the other odd thing was the wife would occasionally stagger her way into a side room and come out with various crafts she had made to show me (lotta clients love to show off their stuff)
There were placemats for a dinner table she had knitted. They involved a crude drawing of stick figure people that looked like it was made by an 8yr old. Normally I would have to feign interest into looking at something so crudely made but then when I started looking… ….I realized all the stick figure people were laying down dead. And there was one standing on a stage. And this one had sunglasses, black hair, and sideburns. And behind that lone stick figure was a giant barrel that said “Kool-Aid” And she slurred “d-doooo you know what that is?” And being someone that is into dark morbid stuff I was like “ummm Jonestown?” And the husband was like “oh wow most people can’t get it” And I was like “you drew this and knitted it into a placemat?” And was like “yup”. And I was like “oh ok. Interesting to have such a dark subject interjected with such bright colors”. No point into delving into that kinda shit when I’m only seeing them today and she’s barely conscious But that was weird… | ||
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#3
02-28-2025, 02:26 AM
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Quote:
__________________
Ceterum autem censeo Denver esse delendam.
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#4
03-03-2025, 11:22 PM
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Another semi-interesting S/A request today, although this person had a psychotic disorder diagnosis independent of their drug use and was on court ordered treatment for it
Group home staff reporting that over the weekend this person went AWOL to do meth and have sex with homeless people, and that she (identifies as trans m->f) came back psychotic. I asked the staff are your residents allowed to come and go as they please and they were like “uh, no” So the client who was wearing long hair and a skirt asks to talk outside on cramped patio. She positions herself directly facing me when I normally try to be slightly sideways because it’s less confrontational, but it was a cramped location. All I was thinking is please act like a proper lady and keep those legs together, I don’t need to see what’s up your skirt. Normally if a client is nude hanging dong or has their ass out I say “hey let’s get some clothes on or a blanket to cover up with, I’ll wait”. But with someone being just unaware they are flashing up their skirt I’ll won’t say anything and instead just keep eyes up for their modesty. But luckily, even in a psychotic state, she kept knees together like a proper lady /salute But I wasn’t getting far in the assessment because she was pretty symptomatic, disorganized and often nonsensical communication. She did mention that she’s “from the streets” and that last weekend she left to do drugs with “friends”. And I’m thinking to myself “by friend you mean the homeless stranger that walks around outside naked sometimes? Yea the staff already filled me in on that”. But I didn’t say any of that But I’d start a sentence and she’d frequently interrupt like “oh sorry for how I’m looking, Paul from the CIA is using my eyes right now and if I start snapping they are casting spells”. And I’m like “oh ok” and trying to keep my train of thought through all the random erratic interruptions I am not getting far with the assessment because she’s too delusional but she did want to stay there so I ask what she plans to do the rest of the day then. And she says “well my court ordered treatment expires tomorrow so I’m thinking of going back to the streets then to see my friends again” and I’m thinking I can’t write that your plan is to go AWOL to do drugs and have sex with homeless men…. So was in a bit of a spot not wanting to leave her here in a psychotic state but she didn’t want to go anywhere but then police showed up. I had forgotten the GH staff had called them because the client was following them around in their personal space speaking nonsense loudly And then the police put the client in handcuffs and said she had felony warrants in [x] county. I told them she’s not oriented to self, date or situation more as just a heads up (but they could already tell) and to ensure they have her re-assessed in jail That was the end of that. There is a summary billing code I can use for client was arrested mid session | ||
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#5
03-03-2025, 11:47 PM
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Quote:
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Ceterum autem censeo Denver esse delendam.
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#6
03-03-2025, 11:47 PM
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Yep. Definitely glad you do that work so the rest of us don't have to.
What is an S/A in that context, in slang it means something ALOT different and google was not helpful. Quote:
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#7
03-04-2025, 12:20 AM
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Quote:
I don’t only get these types but they do happen to be one of my fav types (while most other clinicians dislike to really dislike them), and also usually more interesting than the typical depression, anxiety, or suicidality stuff And yea arrests during sessions are more common than you’d think. I was making casual convo with a co-worker and I’m like “I overheard you doing your virtual teams mental health court hearing [she was sitting at her desk which is in an area with lots of other co-workers around]. I always do those virtual court testimonies in the training room so that other people won’t overhead client’s PHI but that’s fine you do you” smiling. She’s a sassy girl, one of the sassiest in the office which = really sassy for mental health, and so I break her balls sometimes. Before she could do a sarcastic retort I asked “how it go, they get COT?” [court ordered treatment] And she was like “of course. She was the one who grabbed my throat and held a knife to my neck. Her mother saved my life” and I was like “oh my God, that’s crazy!” or something [immediately distracted thinking was she sassy around a client? You never know what they are capable of, not smart] And then she said sarcastically “BUT DID YOU DIE?!” And I was like “heh, good point I guess” | |||
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#8
03-05-2025, 11:17 PM
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Today’s request at work wasn’t S/A so doesn’t fit the theme of this thread but it was kinda weird so I’ll mention it
PCP office requests me for their 61yr old patient. Said he was being evicted and was asking for “end of life” papers from them (whatever that is, even they didn’t know), and almost as an afterthought the RN was like “oh and he’s pretty delusional” I go in and introduce myself and he’s cooperative but manic. Man, manic people can be a handful. He’s high energy and won’t sit down. In the back of my head I’m joking to myself thinking “is me sitting and you standing here like a power move or something? Haunch it” But he wasn’t going to be able to sit. Nor to stop rapidly talking, not even….for…..one….second With manic people they will tangent into a tangent so many goddamn times you will never get to the end of that rabbit hole, they will literally talk non-stop for hours straight. So if I’m going to get any of this assessment done I’m going to have to interrupt with every single question I ask. He’d be like “I met the queen of England and I have royal blood and that’s why they keep kidnapping me because they want my blood and-” and I’d have to be like “I heard you are being evicted?” Anyway, the delusions were pretty wild for this guy. He mentioned he had been kidnapped and raped over 100 times (I’m thinking that’s a lotta raping, enough to make any room stink). They also raped his dog and his dad in front of him. He fairly early on mentioned that one of the people who raped him was Robert Benjamin as if I’d know this person. He then clarified it’s the person in the P. diddy song all about the Benjamin’s or something P Diddy was actually a fairly big part of his sexual assaults. Apparently he had been kidnapped and taken to P diddy parties where he was gang raped. Apparently there was (and I believe this is real) some gal with a C name like Cassie? Who was beaten at one of these parties. Well my client was also beaten with her, and they took both of their blood My client was visibly distraught as he related how an unknown man earlier this year burst into his RV, strapped head to toe with guns and ammo and said he’s going to assassinate him. He mentioned that the man had multiple guns and also a showerhead on his vest. I was thinking, if that were me, the terror I felt would dissipate for a few seconds as I asked “is that a fucking showerhead on your vest?” Lol, it would be like if he said the guy was strapped with weapons but also had a toilet seat cover. It just kills the terror for me Other stuff the client mentioned was: - He had been visited by angels many times and they let him know that they were protecting him. He said he had the archangel Michael visit him and that he was a member of the Legion of Light AND the Galactic Federation (and I’m thinking isn’t that second one like Star Trek or something?) - He was the one who exposed pizzagate - His blood that they take when they kidnap him sells for $20,000 because it is royal blood What’s tough for him is that hallucinations can actually cause PTSD if they are vivid and disturbing enough. So to be hallucinating being raped over and over must be pretty psychologically damaging, to him all those experiences were very real He was cagey about safety stuff, but the PCP office would be furious if I didn’t get him treatment and he was too delusional to be able to understand and accept voluntary. So he did confirm that he asked for “end of life” papers, that he was being evicted, and that “they” were going to murder him, which is enough along with the delusions for a psychiatrist to infer he might harm himself with him putting the onus on the imaginary people ruining his life. And yea my request for involuntary treatment was accepted. I had gotten his address from him for the police pick up order by offering to send a police welfare check (since he felt like the police weren’t helping him I said I can send them to check on you). I could have gotten it from the Dr Office staff anyway because he had already met criteria for being a danger to himself and that allows a break of PHI confidentiality. But I’m sneaky and can usually get addresses on my own But yea that was def a weird one today | ||
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#10
03-05-2025, 11:46 PM
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I had one more request today that I could mention but it’s not as interesting, more of an ethical dilemma. But going on a jog atm will have to post it (prolly will here) in a bit | |||
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Hybrid Mode
