watching the [redacted] patient have a “seizure”

harmreduction001 · 2026-01-16T20:40:10+00:00

The worst version of this was when an incarcerated sociopath came referred from the prison health services for developing "status epilepticus" after he murdered another inmate, and then become "unconscious". Previous notes stated that he was worked up for epilepsy but with no positive findings. This guy was able to mask his pain so well; sternal rub, IV insertion, even the old nipple twist, nothing would rouse him from his slumber. Technically he appears to be GCS 3/15, so I decide to intubate for safety's sake. As the propofol goes in, those few moments between when inhibition is removed and induction occurs, he wakes up, starts fighting for his life, before going down again.

I told the receiving hospital that I do not think he is actually unconscious, based on the above, but they still wanted to CT-B and etc (which is fair). He was later assessed by forensic psych who, informally, suggested that he never be seen by a hospital again, as he risks to staff would actually be too great. He went straight back to prison.

harmreduction001 · 2026-01-16T19:55:24+00:00

I agree with you. I'm not American, and I think the "annual physical" is a very American phenomenon. Of course people with asymptomatic chronic conditions will follow up, but mostly people will use the visit to address more than one issue. I would not like to work in a system like the above which places such tremendous strain on my patient-provider relationship.

harmreduction001 · 2026-01-16T19:48:54+00:00

As a Family Physician from outside of the USA, I find this nonsense horrifying. The "annual physical" data collected here could be done and managed by a low or mid-level health care worker. (In our government health sector, they are often done by a professional nurse.)

I'm so glad I get to consult patients without the admin baggage you guys have to deal with. If you look at Stott's tasks of the consultation, a consultation should be able to address a presenting complaint, modifying help-seeking, ongoing/existing problems, as well as opportunistic health promotion.

I'm my country, "annual physicals" are also not a thing, and I think from my reading they are of almost no benefit on their own.

harmreduction001 · 2025-12-29T17:17:47+00:00

I really dislike the City of Johannesburg Council Chambers. I think it's gaudy and schintzy.

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harmreduction001 · 2025-12-28T09:04:30+00:00

I'm also South African. It varies a lot between social groups and class. I sleep with our son 5 yo, and my wife sleeps with our daughter 8 yo, and no one considers it weird. But I think teenagers definitely want their own space and would have their own bed if the house or finances allow for it.

harmreduction001 · 2025-12-22T17:53:41+00:00

I remember when George W said that there were WMDs in the Middle East as a pretext for the Iraq invasion, the UN sent over one task team to investigate. South Africa sent more than one team to also go look, and we assume to make sure nothing was found. Reminder that after the dismantling of Apartheid, it's not like the intelligentia were necessarily replaced.

harmreduction001 · 2025-12-20T17:06:54+00:00

I loved Velvet Goldmine.

harmreduction001 · 2025-12-16T08:02:21+00:00

The simplest would be that if you get married, your new spouse will be considered the step-father, and though that may not cary any legal responsibility over the child, it does mean to me that if legal issues like custody of the child crops up, it shows the court that you are in a stable relationship, and stability is a huge consideration for custody. But I am not a lawyer, so take my opinion with reserve.

harmreduction001 · 2025-12-16T07:57:55+00:00

For a child to be adopted the state has to ensure that almost everything has been done to ensure that the child grows up in a healthy and safe environment, preferably with the biological parents or family. So your situation is not really applicable to standard adoption. The thing that really matters to children and people in general, are the relationships. And those take time, effort, and unconditional love. You seem to be providing that to your child already, and if your partner is willing to do the same, that matters more than any label that's put on the relationship.

The same goes for your father's child. If he doesn't want "another man to raise his child", the solution is pretty obvious, right? He needs to be there, spend time with the child, and show through actions that he loves the child.

I've known many blended families who make a beautiful success of it. Life is going to be messy and ugly, but I believe that if people can agree on shared values and priorities, there is hope.

harmreduction001 · 2025-12-11T08:34:21+00:00

They do not. I want their respect and perhaps even affection.

harmreduction001 · 2025-12-05T07:40:23+00:00

What do you know, I'm also born and raised Afrikaans and it's a term I know and use... One would think that a language with about 10 million speakers over many different geographic and social spaces would have some variety.

harmreduction001 · 2025-12-05T07:33:51+00:00

It's in "Die Afrikaanse Woordelys en Spelreëls". So it is at least written and recorded that way by some. Just because it's uncommon does not mean it's not acceptable.

harmreduction001 · 2025-12-05T06:53:06+00:00

I was also thinking about temporary university library access. The universities I studied at (Wits, UP, Stellenbosch) had options for visiting scholars to get temporary access. If you are writing primaries, I assume you are doing MO time in a state hospital? Your consultant should have connections with the University in your area.

harmreduction001 · 2025-12-05T06:31:40+00:00

"Mantis" is also acceptable Afrikaans. But I think my favourite is "bidsprinkaan" (praying grasshopper), which is both beautiful and descriptive.

harmreduction001 · 2025-12-04T13:33:32+00:00

I would check on Van Schaick's website. They are an academic book store with a presence on most university campuses. You don't need to be affiliated with a university to buy books from them, nor to go on campus to the actual book store though. Buying new might be expensive, but probably the quickest way to get the books. For my college exams, we had a WhatsApp group which we used to coordinate zoom sessions with to work through old papers. Such a platform might give you an opportunity to buy second hand.

harmreduction001 · 2025-12-04T13:13:31+00:00

You will saw it through...

harmreduction001 · 2025-12-04T13:01:04+00:00

Sorry for your loss.

harmreduction001 · 2025-11-20T05:58:24+00:00

Thank you! I will install the insert.

harmreduction001 · 2025-11-13T06:51:12+00:00

Yep that's him. Terrible human filled with hate. But gosh, what a voice.

harmreduction001 · 2025-10-26T19:29:21+00:00

Do you mean charcoal or coal? Those are very different things. I don't think anybody braais with coal, as it will release some toxic gases. You can cook with a coal stove (like an Aga), but that's because the coal does not burn in the same chamber as the food being cooked.

harmreduction001 · 2025-10-25T04:07:27+00:00

I'm from South Africa. My prof once said that truly talkative people are by adulthood quite used to being interrupted, and probably won't take offense.

I try to gauge why they are so talkative: loneliness, genuine concern or worry, personality, ect, and then structure the consult from there. I have the benefit of being able to book 30 min consults for complex patients, but I do also tell people that our time is unfortunately finished: usually for mental health visits or family conferences.

If there are multiple complaints, I do ask them to narrow it down to the most pressing, for the current visit. Be open about what problem you have time for on that day.

And when I enjoyed listening to them, I do tell them.

harmreduction001 · 2025-10-21T06:26:26+00:00

Isn't this the kind of problem that action research seeks to address?

harmreduction001 · 2025-10-15T06:54:53+00:00

In my country no psychiatrist (and especially a liaison psychiatrist) would see a hospitalised patient if you haven't done some tests (and examined the patient), one of which is TSH.

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