On this date in 1994, Jeffrey Dahmer was clubbed to death in prison by another inmate

Psychiatric disease fascinates me...that is NOT to say it doesn't frustrate the hell out of me...

I have a patient that I cannot discharge from the hospital. She is a middle aged woman, formerly employed as a registered nurse, who underwent a knee replacement a few years ago. Sounds normal right? Her psych diagnoses include borderline personality disorder and obsessive compulsive disorder. To elaborate on what that means, her compulsion is "picking" - meaning when she gets nervous/depressed/agitated/whatever, she PICKS at her old knee incision...about a year ago, she picked so extensively, she got down to bone and metal (the knee replacement) - requiring extensive reconstructive plastic surgery and a revision of her knee because it obviously got infected with no skin/muscle/fat protecting it from the outside world. She recovered (from the surgeries, not the mental illness) but recently after some family drama, she started picking again (only got halfway down to metal before we admitted her for psychiatric workup and prophylactic casting) Essentially we put a giant fiberglass cast over her whole leg so she physically can't get at the incision to pick at it) So, like I said, we can't discharge her until she's mentally ready to handle it.

Meanwhile, across the hall from her is the guy I've admitted at least 4 separate times in the last month and a half. Quick synopsis: hip replacement, infection, successful revision surgery, dislocation, dislocation, dislocation, revision surgery, infection, multiple surgeries including plastic surgery flaps for covering his giant infected wound - most recently admitted for continued drainage (aka - infection). Sounds like bad luck right? NOPE, only in part - guy's bipolar and got all manic (one of the characteristic feelings during a manic phase is INVINCIBILITY) so he forgot all common sense and dislocation precautions and did stupid stuff to dislocate his hip, thus necessitating the cascade of revision surgeries. Today I was helping the plastic surgery resident (one of my friends) take a bunch of sutures out of his belly (from one of the plastic surgery flaps) - now another hallmark of a manic phase is HYPERSEXUALITY, so I (and the blond southern belle plastics resident) endured a few comments not fit to be recounted here...in the presence of the guy's wife!

After taking out what seemed like yards of suture material, the guy was left with some well-scabbed incisions on his belly, and he calls out "what do I do about all this scabby crap?" In my best professional doctor voice, I explained that with some gentle washing the scabs would fall off in a couple days...but MAN did I ever have a COMPULSION to look him in the eye and retort "Well, the lady across the hall could take care of picking those scabs off for you!"

When in Rome...