This is funny because I do actually have a strong background in psychiatry which has a fair amount in common with both neurology and psychology and Phineas Gage’s case is actually a pretty famous one in regards to the historical evolution of all three of those fields.

yeah it read plainly as a reference to me but people also tell me other people don’t know the kinds of things I do a lot of the time.

Honestly I’ve found the effects are more personal. I like interacting with the sh mods more; they’re a good combo of decent morals but also playful irreverence. They don’t get on me for honest jokes, but they’re also very willing to be like nah buddy it’s time to log off for a few days when they need to. (Hubs prefers the Twitter format if anybody knows a masto instance with similar vibes)

Oh hi I’m a psychiatric nurse!

Most important: Pick the three people you trust most in the world, put them in order of who you want making decisions for you the most (you also need to consider who will be the most level-headed & put your needs before their own emotions), then talk to your doctor about what paperwork you need to sign for that. Then talk to those people at length about how you want to die and what would make you feel the safest and happiest day-to-day until it happens. Think about what routines have brought you peace in your life, what things you do for fun / relaxation, what kind of music you like to listen to, etc.

If you’re up to it, I also highly recommend Wellness Recovery Action Planning. It’s more designed for people who are more likely to recover, but it’ll give you a template to go off to communicate your day to day needs in a written format for your legal decision makers and healthcare professionals to make you feel safe and comfortable as you progress through these next few stages. It’ll also have some spaces for you to mention any specific triggers (a lot of the time we find out someone has PTSD from sexual assault after a trip to the bathroom unexpectedly turns into a cage match and it would be nice to get a heads up instead). And if you do this have a special section just for music; it’s the part of your brain that’s likely to keep working the longest. Make two playlists, one to dance / have fun to, and one to relax / sleep to.

I wouldn’t fuss too much on the gun thing unless you already have one / have been used to having one for most of your life. If you were never a gun person before you’re unlikely to randomly just go out and buy one.

Good luck and I really hope you’re able to find trustworthy people to make decisions for you because without them to actually carry out your wishes, literally anything else you decide on now is completely moot.

it was wild when my mother who hated everything else about Obama was like “I do have to admit that he seems to be a good and faithful husband.”

Honestly it’s not even the CPR that particularly bothers me, it’s the intubation and the stuff after. I’ve worked with so many patients who don’t have a lot of working neural tissue left and their family just has them medically tortured for years because they want to see them blink occasionally. Next time I update my documents I think I’m going to add that if my family wants something to happen to me that I have to be held down for, they have to be in the room. If they can’t stand to watch / listen to me while it happens, they’ve no right signing off on it.

I feel the same way reading the Bible. Even as early as Genesis I was like damn Abraham I already don’t understand why you tried to pimp out your sister-wife ONCE so why did you KEEP DOING IT? Somebody recently commented that they find the Bible boring and I was like you need to find a modern translation because if you can even vaguely understand what’s actually going on that shit is WILD. Turns out humans have always been crazy AF and personally I actually find that kinda comforting. Makes a lot of modern shit seem less unmanageable. Another great example is the whole Onan thing. It’s wild that somebody decided to make it about masturbation when if you really get down to it it’s a story about a dude who thinks he’s being slick by obeying the letter of the current law to (literally) screw his widowed sister in law out of her rightful property and THAT story is TIMELESS.

um. yeah. they do that after regular surgery too. a shitton of sedatives will do that. ect is also associated with temporary memory loss but it wears off just as quick as with a regular seizure, a little faster even. Also every time I’ve been in the procedure room for it the most that happens is the person’s feet wiggle a little for a few seconds?

idk maybe it’s just that I’ve seen way more terrifying medical shit done when I was sitting suicide watch in the ICU (I’m a DNR after seeing what it takes to keep someone alive at the brink of death) but it was like the least unsettling thing I’ve seen in a procedure room. In my OR clinical rotation the surgeon was literally HAMMERING that Lady’s titanium hip into place for 6 hours.

Shit sounded like a dwarven mine in a fantasy movie just DING DING DING with a fucking hammer in a sliced open little old lady for 6 hours straight. THAT was disturbing. Feet wiggling for a few seconds is nothing. especially not when you see it bring someone back from catatonia so deep they can’t eat.

there is actually a huuuge overlap between anticonvulsants / antiseizure medications and anti-manic agents (mania being the opposite of depression).

Oh yeah electroshock therapy is actually something we still do. I’ve worked at two places actually who do it. They put the patient under full medical sedation like they would for surgery (they even have a little mini recovery and PACU in the ECT suite). In fact the only main difference between an ECT suite and an OR suite is that the actual procedure room is just clean, not fully sterile since they’re not actually opening the person.

On the floor we have to observe all the same pre-op and post-op precautions, like NPO (nothing to eat or drink) after midnight, and changing them into clean clothes in the morning. We don’t have to do a chlorhexidine scrub (again not sterile) but showers are encouraged (sometimes the patient is too sick / overestimulated to tolerate even a bed bath though). Our only special precaution is that we have to stop all anti seizure meds the night before because the whole point is to induce a seizure.

They just put electrodes on kinda like they would with an external defibrillator to stop an abnormal heart rhythm (except obvs they put them on the head, not the chest). Then induce a controlled seizure that lasts like 60 seconds or so, then use medications to stop the seizure if necessary. In fact it’s almost exactly like a heart defibrillator in that we’re turning their brain off and on again to get it to work! Funny that that works with organs like it does with computers! 😅

edit: and since someone asked (and someone did correctly answer a few comments down but-), it’s for catatonia and treatment resistant depression mostly. I’ve had patients so deep in catatonia they can’t eat and need IV fluids to stay hydrated and need to be turned and cleaned to prevent bedsores and other skin breakdown because they literally can’t move. and ECT brings them back somehow. 🤷‍♀️

The people it works for will keep coming back outpatient usually too. We’ve even had people show up in the ER downstairs saying they can feel the depression / catatonia coming back and wanting to be readmitted for another course (but if they didn’t have complications the first time around they usually just take them back on outpatient). It’s literally life-saving.

Yeah. It rubs me the wrong way to hear jokes about being attacked at night being a good thing, and I’m trying to find a reason people would keep making it to me even after I ask them to stop that’s maybe trauma based in the setting of how they’re perceived by the wider society instead of them just being assholes. This is also exactly why even if I do turn out to be a trans dude I’ll still probably never interact with “the trans community.” I’ve never encountered a group of people less willing to discuss how gender dynamics actually play out for me in the world I’m living in. I’ve had MAGA coworkers who are significantly more accepting and validating of my evolving gender expression and how it’s affected me than other trans people. People also don’t like hearing that as a trans dude I’d still be unable to empathize with a lot of my patient’s lived childhood trauma of being raised as a cis male to the extent that my cis male coworkers can. Part of that is people just not believing that trauma exists (which is it’s own issue) but a lot of it is just people so deep in their own specific traumas around invalidation that they’re just completely unable to have a constructive discussion about how their actions affect other people even within their own community.

Hole.io

It’s completely ad-laden garbage but I looove the art style for some reason and the actual gameplay outside of the weird resource management shit they added to sell in-game currency is soooo satisfying.

I shudder to think where Epic EMR is in all this. It’s got to be a disturbingly large part of the market share at this point but it’s by far the single easiest to use EMR I’ve ever touched. Like at least omni is drafting behind pyxis. Cerner is waaay behind epic and we don’t even talk about meditech. Epic is just so easy to use. The flowsheets literally link to an outline of a person where you can literally mark the person’s lines, drains, and wounds and just click them to see the flowsheet for each one, add a new entry, etc.

But I worry sometimes that it’s such a big part of the market now that if some fundamental flaw brings a large portion of it down it’s gonna hugely impact the health system. There are baby ICU nurses exiting their new grad years barely knowing how to titrate a weight-based drip because they’re so used to epic linking to the pump to calculate and titrate the drip automatically. I hate to give one to the ED nurses but at least they’re used to just eyeballing their coworker’s bag running on gravity out of the corner of their eye from the room around the corner.

I’ve had several trans women tell me it’s gender affirming to be harassed / belittled by men and I can’t decide if that’s a fetish or just a really fucked up toxic coping mechanism (or toxically coping by developing a fetish?).

Having been born female a lot of the things my trans girl friends report as being gender affirming actually have very little to do with the lived experience of being female that I’ve shared with my non trans female fiends. Like one friend told me it’s not gender affirming even just to shave, she MUST be lasered hairless at all times and like. It’s wild to me that feminism came so far just to have transgirls get stuck back in the 50s somehow. I guess maybe they have to start over from the beginning idk. Or maybe it’s gotten so tied up in fetishism due to wider societal stigmas that even they themselves struggle to separate the two.

Idk but in the end it’s super uncomfortable to be told that a negative thing that has pervaded my life, threatened my physical safety, and limited my opportunities for social and professional advancement since birth is “gender affirming.” Like one friend literally told me word-for-word “I want to be afraid to go out alone at night.” It’s pretty disrespectful / insulting actually, and I could not get her to understand that.

I love this in theory. Just needs a big user base.

I’ve been working inpatient psychiatry for almost a decade now and here’s how we talk people out of delusions…

…you don’t. Confronting the delusion directly helps their brain practice protecting the false belief system and strengthens the neural links / pathways. It’s like the ruts made by a wagon wheel, the more the wagon travels the path the deeper they get. You can try and haul the wagon up out of the ruts onto a different part of the road using brute strength but 10 seconds later it’s gonna fall back in and you’ll exhaust yourself trying to wear a new track so close to the old one. You’re much better served just sending the wagon somewhere else entirely and waiting for the ruts to erode on their own (this metaphor also maps well to addictive / difficult to discontinue behaviors; it’s often easier to disengage from the entire constellation of behaviors and stimuli around the habit, including things like people and places, than it is to just stop the habit itself).

So if you really do love this person and want to bring them out of it, do your best to send the wagon somewhere else. Just glaze over for a second while they rant, then change the subject and engage fully with something reality based you can create a connection with. Try to connect over knitting or gardening or woodworking or music or old movies or sports or whatever other hobby or social activity / discussion you can use to connect with them over that’s reality based.

That’s how COVID sucked them into all this. It broke up the knitting groups and gardening clubs and cooking classes and all anybody had left to socialize with was Facebook conspiracies. If we want out, we need to focus on rebuilding those communities.

I mean. There was also 0025, 0125, 0225… It’s actually fallen on 25/25/25 20 times now…

The university cops are great where I am but the city cops are very hit and miss. The university cops were my backup for violent patients when I worked the medical center and they actually had pretty decent deescalation skills. At the very least they would just defer to me and standby assist unless I specifically told them to initiate a hold. And when they were doing standbys they wouldn’t verbally threaten or physically impose they’d just stand loosely at my shoulders and be like “hey buddy we’re just here to keep everybody safe.” Vs the city cops are only allowed on the unit long enough to serve involuntary admission paperwork like “hey here’s your copy of the form signed by the magistrate that says these nurses can’t let you off the unit.” Which is good because they’re like 25% decent, 25% matter-of-fact (acceptable), but like 50% are assholes.

Like some patients are super entitled, yelling racial slurs, spitting, etc and I understand it’s difficult to keep your composure if you’re not specifically trained to (although they really should be) but a lot of patients are clearly just not with it. Like either wildly delirious and rambling about alien conspiracies or just straight up visibly developmentally delayed. And I’ve seen officers talking shit to people with like obvious high needs autism, downs, etc and the best I can do is just tell the cops to give them the paperwork in the mousetrap and hurry the patient inside but like. What the fuck.

It’s kind of cute though when you get a new one who just recently got the job to Help People™ so they’re not a bastard yet and this is one of their first experiences with a psych hold and they’re standing there with their body cam on having just unlocked the cuffs and the patient just immediately yanks their pants down and starts screaming about the invisible snakes and spiders on their genitals and the baby cop just 😦

Oh, hon. Everywhere has rednecks. Mexicans have rednecks. Indians have rednecks. If we ever meet aliens they’ll probably have rednecks too. We’re universal. We’re inevitable.

As a psych nurse I’ve only met two people who actually unsettled me, both turned out to be serial murderers. I used to work forensics specifically (the “criminally insane”), so I’ve met lots of rapists, murderers, and a ton of pedophiles. Most of them are just either pathetic and trying to not go to prison where they’ll get their shit kicked in, or did something real stupid while not knowing their ass from a hole in the ground. As long as you follow some basic rules you’ll be fine (don’t be alone with them or within arms reach if you can help it, bring a buddy if you do, and never let them between you and the door, etc.) and honestly half of that is more for their safety than yours (you’d win the fight, but you’d be in a lot of trouble).

But both of these dudes just gave me an instant back of the neck prickle. All you can do is interact as little as possible, exit every situation as soon and as smoothly as you can, protect your newer workers who don’t know better, and hope the doctor discharges them ASAP. There’s no fixing that and all you can do is escape and hope they quickly go somewhere they can be contained properly (ideally a max security prison).