Too Many Pushups

Written by Tad. Posted in Kooks

A 15-year-old boy got in trouble at football practice. As punishment, his coach sentenced him to do 150 pushups over the weekend. His mother was assigned to monitor him and make sure he was compliant.

On Monday, he was unable to move his arms, which were in severe pain, and he noted that his urine was darker than normal. All of this concerned his mother, who brought him to the emergency department. This story of over-exercising, followed by excessive muscle pain and dark urine was worrisome to me. Quick blood and urine tests confirmed my suspicion. He had rhabdomyolysis.*

The excessive use of the muscles of his arms and shoulders caused enough muscle damage that a protein, myoglobin, was released from the muscles in such large amounts that it turned his urine dark. If not treated, that same protein could be toxic to the kidneys. This patient had to be admitted to the hospital to get pain medicine and IV fluids until his muscles healed and the myoglobin was cleared from his blood and urine.

Over-exercising is one of the more common causes of this condition. As far as I know, I have never seen it just from over-use of the upper extremities. Since your legs have so much more muscle mass than your arms, it is a lot more likely for this to develop after over-use of the legs. For example, we often see prisoners who do squats over and over until they develop rhabdomyolysis. They come in from jail with leg pain and dark urine and have to get admitted to the hospital.

I wonder if my patient’s coach will assign 150 pushups as behavior modification again.

 

*I posted a case previously about rhabdomyolysis. Please see Dancing with the Stars in a previous post.

Also, for more information, check out this Wikipedia article: https://en.wikipedia.org/wiki/Rhabdomyolysis

 

Mr P., Again, Again

Written by Tad. Posted in Kooks

I am so sorry. Looks like this was still not working for some people. Here it is again. I am confident it will work this time. Thanks for your patience.

One the doctors I work with forwarded this article to me. It was written by Otis Warren, an emergency physician. It paints a great picture of a specific patient but also of the bigger social problems associated with public alcoholism.

Enjoy!

http://content.healthaffairs.org/content/35/11/2138.full

 

Eye Poke Defense

Written by Tad. Posted in Kooks

I was working in the Accident Room of Charity Hospital in New Orleans. A young man came in complaining of pain in both of his eyes. He said he had been in an argument with another man in a bar. The other guy had stuck out two fingers and poked my patient in the eyes. The pain caused my patient to bend over. When he straightened back up and opened his eyes, the other guy poked him again, the same way.

He was in so much pain that his friends brought him to the emergency department. A quick evaluation showed that his only injury was corneal abrasions or scratches on the front, clear parts of his eyes. Though this is a very painful condition, it rarely results in a complication and usually heals within a day or two. As per the custom then, we medicated and patched both of his eyes and sent him out with a prescription for pain medicine. His concerned friends helped him out of the emergency department and into their car.

Though we didn’t want to laugh at the patient, we did have a good laugh when I reminded everyone that, in The Three Stooges, Mo would poke Curly in the eyes in the same manner. When Mo tried to poke him again, Curly would use the Eye Poke Defense. He would hold his flat hand up, with the fingers extended, in front of his nose so that Mo’s finger tips could not reach Curly’s eyes.* I joked that our patient should have remembered that trick and it would have helped protect his eyes.

A few hours later, I was surprised to see this same patient come back in, patches still on his eyes, complaining of abdominal pain. He was in a lot of distress and clearly had something serious the matter with him. Only then did we get the rest of the story of what had happened at the bar.

When the eyeball-scratching altercation took place, the bouncer jumped right on the situation and, literally, threw both young men out of the bar. My patient was having trouble with his vision because of his eye injury and his balance because of all the booze he had consumed. When he was thrown out of the bar, he fell, striking his lower abdomen on the top of a fire hydrant.

A guy who has been drinking in a bar usually has a full bladder and a blow to the lower abdomen in this situation can lead to a rupture of the bladder and that is just what happened to our guy. Though he was just kind of sore there during his first visit, it wasn’t until he lost some blood and the blood and urine had some time to irritate his abdominal cavity that he started to get sick. He had to go to the operating room to have his bladder repaired.

Though holding his hand up, like Curly, may have prevented some injury to his eyes, I don’t think it would have done anything to protect his bladder.

 

*Here is a picture of Mo trying to poke Curly, who is very effectively using the Eye Poke Defense.

eye poke defense

Delusional Parasitosis

Written by Tad. Posted in Kooks

Two people came in an ambulance together. He was twenty-eight, she was twenty-six. They were put in the same room and had been instructed to undress and put on gowns. They both told the intake nurse they had things crawling out of their bodies. He focused mostly on his skin but she also had “things” coming out of her eyes, ears, nose, mouth and vagina.

 

When I entered the room, he was sitting quietly on the gurney while she was agitated and walking around the room. Usually, I start by talking to patients to find out what their symptoms and history are. Then I do an examination. It was not possible to do that in this situation because, as soon as I walked in the door, the young woman started to talk and, boy, did I get an earful! She came to me and started showing “them” to me. She had an LED flashlight and a magnifying mirror. She held the mirror up to her face, shined the flashlight onto her eyelid and said something like, “See that!”

 

When I asked her what I was supposed to be seeing, she gave me an exasperated look, turned the light and mirror to her lip and asked me, again, to look with her at what was crawling out. When I told her I didn’t see anything, she loudly voiced her indignation, pointed to her skin and said, “See! There it is right there! Are you telling me you don’t see anything?”

 

Patients with mental problems causing them to believe their skin is infested often have sores where they have been digging at themselves. They point to these sores as evidence of their disease. In this woman’s case, there was not a scratch or sore anywhere she pointed, just normal skin.

 

As soon as she detected that I didn’t believe she was infested, she got really upset. She started referring to others who had seen “them” and asked me what I thought the others had seen, if there was really nothing there. The most specific I could get her to be when referring to other witnesses was “the doctor at the shelter,” but she was too agitated to tell me if she had been previously seen by another doctor and what, if anything, had been done for her.

 

When I continued to be unconvinced she had something coming out of her various body parts, she suddenly turned her attention to her partner. She pointed to his skin, which was marked by multiple sores which looked like he had been picking at himself. He was not nearly as animated as she was but he sat there, patiently trying to help her identify things crawling out of him. He was no more successful in showing me what they were looking for than she was.

 

When I tried to get specifics about how long this had been going on, what these things looked like, how big they were, what color they were and where they went after they crawled out, it only made them more indignant, unhappy and agitated.

 

At this point, I turned to an approach I developed years ago to deal with patients who are convinced they have a problem when I am sure they don’t.

 

I told them I recognized that they knew they were infested with something and I acknowledged how upsetting this must be. I told them I also knew they were not infested. I told them they had a mental disorder and named it: delusional parasitosis. I said I understood that they didn’t believe me. I also told them I was firm in my opinion and they were not going to convince me otherwise. In concluding, I said something like, “So, it is time for you to leave. I will give you the telephone number for our Mental Health Urgent Care clinic as well as a number to get a Primary Care Physician in a clinic.”

 

I have found that this sort of firmness is necessary because truly delusional people can’t be convinced. The more you try to get them to see logic, the more they get upset that they are not convincing you. I just have to tell them I am sorry, recommend they get psychiatric follow up and send them out, almost always upset and unhappy with me.

 

In this case, things just went from bad to worse when I followed this time-tested approach. The woman got even more agitated. She paced around the room, hollering about the lack of care they were being provided. She demanded to see my boss and the head of the hospital so something could be done. She was so agitated that the nurses called security and soon there were three uniformed officers outside the room. It got so bad that a Sherriff’s officer, there with a prisoner from the county jail, came to the room to see what was going on.

 

My two patients refused to get dressed. Refused to leave. Refused to take their discharge papers. They said they were not going anywhere until something was done for them. Finally, after the Sherriff threatened to arrest them, they got dressed and stomped out, the woman hollering and cursing.

 

Over the years, I have seen many cases of delusional parasitosis and its companion condition called Morgellon’s Disease, where people think they have fibers coming out of their skin. Each case has been a little different. Some patients are calm and, in every other way, reasonable. They talk logically of their complaints. They are pleasant in taking recommendations to follow up with their doctor but they remain convinced they are infested. On the other end of the spectrum, some patients act truly crazy, as with the woman described above.

 

Sometimes people connect their infestation to their environment. I once saw a man who was certain something was crawling out of a mat he had to stand on at work. No matter how many times the mat was changed and the area cleaned, as soon as he went back to work, he got them again.

 

I had a patient who was sure she was infested with bedbugs. No matter how I tried to help her understand that bedbugs just crawl out of your bedding at night, suck your blood and then crawl back to the bedding to wait for another night, she was sure she had bedbugs under her skin. She could not be convinced otherwise.

 

Another time, I saw a twenty-five-year-old woman who was convinced she had lice in her hair. The fact that no lice or nits could be produced had no effect on her beliefs. She had been treated multiple times for lice and, yet, she was sure they persisted. She constantly dug at her hair with a pencil until she had a huge ball of tangled hair on the back of her head. Even as she talked with me, she dug and dug in her hair, trying to get a bug out to show me.

 

Once, I had a couple come in wanting papers they could use to force their landlord to do something about the bug infestations they had from their apartment. Their place had been fumigated multiple times and the landlord and pest people told them there were no bugs. My patients were unable to provide a bug as evidence. Yet, they wanted a doctor’s note saying they were, indeed, infested so they could force the landlord to do something about it. When two people are equally involved in a delusion, it is called folie a deux.

 

I have seen many patients with delusions over the years. This case was amazing for two reasons. It was a fascinating case of folie a deux. Also the woman had absolutely the worst case of delusional parasitosis I have ever seen. She had things coming out of every part of her body. She was agitated and aggressive. She was threatening and refused to put her clothes on and leave when she was dismissed. It is an amazing example of how your brain can play really nasty tricks on you.

 

If you are interested, read more at my favorite medical reference: https://en.wikipedia.org/wiki/Delusional_parasitosis

To Room 11, Stat!

Written by Tad. Posted in Kooks

The other night, an overhead announcement in the emergency department caught my attention: “Dr. Tad to Room 11, STAT! Dr. Tad to Room 11, STAT!” Since I know my staff would not call me like this unless there was a real reason, I dropped everything and hustled to Room 11.

I got there just as the patient was being moved from a wheelchair onto the bed. I made my way through the crowd of staff filling the room, everyone hurrying to take her clothes off, get vital signs, put her on a heart monitor and start an IV.

When I got to the bedside, I saw a young woman who looked dead. She was pale as a sheet. She was unconscious and not breathing or moving. I could not feel a pulse.

I barked orders to make sure someone was doing each of the many things that needed to be done at once. In situations like this, we use the pneumonic “ABC” to prioritize our actions. “A” is for Airway. Before figuring out what her underlying medical problem was, we first took steps to protect and keep her airway open. I told the respiratory therapist to prepare to intubate her, pass a tube into her windpipe.

After Airway comes “B” for Breathing. Once the airway was open and protected, we would check to see if the patient was breathing well. If not, we would need to breathe for her by putting her on a ventilator.

“C” is for Circulation. Does she have a pulse? What is her blood pressure? Is she bleeding? What needs to be done so that blood is getting to her vital organs?

In Room 11 that night, I soon was able to stop worrying about “A” and “B” because, once she was out of the wheelchair and flat on the gurney, enough blood got to her head that she woke up. She started to complain of pain and asked for water. Airway and Breathing were good.

It was now obvious that Circulation was her problem. Along with the pallor I already described, her blood pressure was low and her pulse was fast. These are all signs of hemorrhagic shock. Since she was not bleeding on the outside, my assumption was that she was bleeding internally. I took a quick listen to her heart and lungs. I felt her abdomen, which was tender and distended. More orders were given in response to this new information.

As the rest of the team pressed to get IVs started and get blood work for the laboratory, I turned to find out who had brought her in. I went into the hall and found her concerned husband, a young Vietnamese man. His English was weak, but there was no time for a translator. I was able to learn that she had been complaining of abdominal pain and might be pregnant.

As soon as I heard that, I instructed a clerk to call the obstetricians and tell them to come to Room 11 immediately. I then ran an ultrasound probe over the patient’s belly and found just what I was expecting. Her abdomen was full of blood.

I called for Type O-negative blood to be rushed up from the blood bank so a transfusion could be started. This blood can be safely given to anyone if there is not time to check the patient’s blood type. The blood bank keeps some available for just this kind of situation.

About this time, the obstetricians came rushing into the room. I quickly told them what I had found and what we were doing. One stayed to help with the resuscitation and to try to get more information from the husband. The other called the operating room to say they were bringing the patient straight up.

The pregnancy test came back positive just as they pulled her gurney out of the room, headed for the operating room. There, they found her abdomen full of blood from a ruptured ectopic pregnancy.* She had a rough go of it but they were able to stabilize her by stopping the bleeding and giving her more fluids and blood. She left the hospital a few days later. She had a scar on her abdomen and was missing the fallopian tube in which the pregnancy had established itself. Otherwise, she was no worse for wear.

Reviewing this case fills me with gratitude. This lady was dying. It makes me glad I knew what was needed to keep that from happening. It also makes me glad we have the facilities to provide the care she needed. In times gone by and in many places in the world today, if this happened to a woman, she would be dead. I am really appreciative of my team. They did just what was needed when a life was on the line. I am also grateful for good luck. If the patient and her husband had delayed in coming to the hospital or gotten stuck in traffic or lost, we might not have had the chance to give her the services we trained hard to provide.

 

*If you are interested in reading more about ectopic pregnancy, here is a reference frpm my favorite medical resource: https://en.wikipedia.org/wiki/Ectopic_pregnancy

 

Two Patients with Broken Ribs

Written by Tad. Posted in Kooks

I recently went mountain biking in Moab, Utah. Unfortunately, I fell just as our ride was starting. It was soon apparent to me that I had broken some ribs on the left side of my chest. I painfully rode back to the trailhead and found a ride back into town, rather than trying to ride the rest of the 26 miles we had planned for that morning.

Since there is really no treatment for broken ribs, I knew there was no reason for me to seek medical care. I just set myself up on the couch of our rented condo and tried not to move around too much until I could head back home.

A week later, I was back at work, feeling better and was taking only ibuprofen for pain. “This has not been that bad,” I thought to myself. Little did I suspect that a surprise setback lay ahead.

I woke up on Saturday morning, eight days after my fall. As I got out of bed, I was surprised that I had more pain in my chest than I had been experiencing the previous few days.

While I was in the shower, the pain got a lot worse and any movement was now causing severe pain. Getting dressed was really tough but I pressed on, feeling sure it would soon pass.

As I started down the stairs into the living room, I was seized with a muscle spasm along my left spine that left me completely incapacitated. I hollered, stiffened and became unable to breath or move until the muscle spasm relaxed and the broken ends of my ribs were not being driven against each other.

The spectacle I presented on the stairs caused everyone in the house to come running. My wife, son and daughter-in-law rushed to my side, trying at the same time to understand what was wrong and wondering how they could help.

Several things went through my head as this was going on. I know enough about this sort of thing to understand, basically, what was going on. The pain from my broken rib was causing my back muscles to go into spasm. That was causing severe pain which was making the muscle spasms worse. Whenever I moved, I was caught in this terrible cycle and the only thing that helped was to not move, at all. Understanding this, I was not worried that I might have some terrible, life-threatening condition. I recognized that this understanding helped me a lot, compared to people without my training and experience who might be freaking out, wondering if they were dying or something.

I next thought that I always have to ask my patients to rate their pain on a scale from 0 to 10. In doing so, I sometimes wonder what pain I would rate at a level of 10, the most pain anyone could experience. “Now I know,” I thought.

After I was through with my clinical and analytic thoughts, my attention turned to how to get off the stairs. If I moved my trunk at all, like to take a step, the pain would come back and I couldn’t move. There was nothing I could do about it. With help from my wife and son, I forced myself down the stairs and collapsed on the couch, trying not to scream the whole time.

There I stayed the rest of the day, unable to move without triggering the same terrible pain. When it came time to try to take a nap, I needed help from my wife and son who moved me as if I were a piece of fragile furniture, trying to keep my spine from moving.

At bedtime, they helped me in the same way back up to my bed. The next day I still had pain and had to be careful but was some better. By the following day, I still had the rib pain but all of the spasms were gone. Today, I am almost pain free. I am back to riding my bike with no problems.

Now, I told you that story to tell you this one:

The next week at work, I introduced myself to my next patient. She was a lady about my age who told me a sad story about being attacked three days earlier by her mother, who suffered from Alzheimer’s Disease. She had been knocked to the ground and injured her chest. She told me she was pretty sure she had broken a rib and, knowing there was nothing to do for it, had just been taking ibuprofen and putting up with the pain.

What brought her in was that she had woken that morning with severe muscle spasms on the same side as her broken rib. The pain was so severe she was incapacitated by it and was worried about a complication of her chest injury.

As I listened to her, I had a hard time not smiling, which I knew would not be perceived well. As soon as she had a chance to tell me of her concerns, I briefly told her of my experience the weekend before. I explained what I thought had happened to both of us. I reassured her that what she was going through was completely understandable and she had nothing to fear. I also assured her that we would get her feeling better in a short time.

After some intravenous morphine and valium, she was feeling much better. She went home relieved to know she was going to be fine, happy to be out of pain and appreciative of a doctor who was able to empathize so distinctly with her suffering.

There is some irony in recognizing that she went to the emergency department and got some help while I just stayed at home and suffered.

Vicodin, Thank You Very Much

Written by Tad. Posted in Kooks

One night this week, one of my physician assistants came to me frustrated that the patient he had gone to see had run him off, saying he wanted another doctor. Matt had addressed two complaints the patient had: difficulty urinating and a nagging cough. When the patient went on to more complaints, including shoulder pain he had been suffering with for over a year, Matt recommended he take up these more chronic problems with his primary care physician. That is when the patient ran Matt off.

It was now my turn. I found an elderly man asleep on a gurney wearing sunglasses and a beret pulled down over his face. I introduced myself and went over his first two problems. When I asked him if he had any other concerns, he told me about his shoulder pain, for which his primary care doctor usually gave him Vicodin. He then said all he wanted was to be treated with sympathy.

I asked him if he had come for sympathy or for Vicodin. He calmly answered, “Vicodin would be fine, thank you very much.”

This all took place in the hall right in the busiest part of the emergency department and as soon as he answered my question, I was surrounded by suppressed laughs. I had not intended my question to be comical. I’m sure he didn’t intend his answer to be funny either, but, together, they made everyone laugh. This was especially funny to staff surrounded every day by people looking for opioids for their chronic aches and pains.

 

Susana

Written by Tad. Posted in Kooks

A sixty-year-old woman came in by ambulance. The nurse entered “abdominal pain, flank pain” as the chief complaint. The nurse advised me that the patient was deaf and only spoke Spanish, so I grabbed some paper and a clipboard before going in the room.

I introduced myself and showed her my name badge so she would know my name. She motioned that she was deaf. I smiled, nodded, and pointed to my “Hablo Español” button as well. I then wrote on the paper, “Que pasa?” (What’s going on?)

She took the clipboard and started writing. “This isn’t going to be too bad,” I thought to myself.

When she returned the clipboard, I saw she had written, “Susana,” which was her name. That was about the best we did. With her reading my lips and using her sketchy Spanish, I was finally able to learn that she was, indeed, deaf. She only spoke Spanish and didn’t know any sign language. She also had never gone to school and didn’t read or write. On top of that, no family member had come in with her; someone who, I hoped, would be better able to communicate with her than I was.

Usually in medicine, we rely a lot on the history to start figuring out what is the matter with someone. In this case, through lip reading and pantomime, I was able to understand that she was having pain in her lower abdomen and flank. That was about the best we could do. I examined her and ordered tests, doing more tests than I might normally have to do since I didn’t want to miss something.

The tests all came back normal, her pain was controlled with the medicine I gave her and we were finally able to get hold of a family member who came in and helped get her discharged.

When it comes to communication challenges, it is hard to beat a non-English speaking patient who is deaf and doesn’t sign, read or write.

Diabetic Type II

Written by Tad. Posted in Kooks

Some people really want their doctor to know the exact details of their symptoms. This often leads to extended written accounts of details patients believe will help with their diagnosis. Here is a reproduction of a written note a patient brought in to help outline his symptoms. If you have a hard time following it, I do to. In the end, we found nothing wrong and the patient left without a diagnosis. As I sent him off to follow up with his primary care doctor, feeling sure he had no emergency, I wondered if someone, someday, will find a strange medical condition to explain the symptoms or if it was all just mental. This is not an unusual thought as I discharge people. It seems mental to me but I don’t know everything.

 

Diabetic Type II
Off meds long time
#’s run in 200’s

Wed 7/6

3:30 AM

-woke up dizzy
-sat on edge of bed
-got online and video chat so people could watch me, make sure I was OK

4:00 PM

-eyesight got strange
-couldn’t see part of right side of vision. close one eye can see OK. close other eye see OK. both eyes – missing right side view

4:30 PM

-right side of lips (top + bottom) went numb for a little while. right arm and leg got weak and shaky
-only lasted a little while then lips ok again + arm/leg ok too (no shaky)

4:45 PM

-nauseas – didn’t throw up – just wretched

5:30 AM

-headache left front behind eye
-took Naprosyn Sodium (just one)

6:00 AM

-went to sleep
-eyesight still messed up

10:00 AM

-woke up feeling better
-no headache
-eyesight ok (but bright spots)

Wed

-bright spot/line in right eye fading but still there
afternoon       -small headache
-took Naprosyn – headache faded away

1 periods of dizziness

Crazy Brother

Written by Tad. Posted in Kooks

A young woman brought her brother in for psychiatric evaluation. She told me he had been acting strangely and gave me her written account of what had been going on. She was a bit compulsive in the way she documented things and, you can tell, was not primarily English-speaking. Still, if you can be patient enough to read through this, you will get an interesting insight into this man’s mental illness and the trouble it caused his family.

When the sister said she was comfortable that they were all safe with him at home, we discharged them with information on how to get him some psychiatric help.

Here is a recreation of the “log” she kept and shared with me:

Log – JC (I am not using his real initials) – Summary

One Page Summary – August 2016

Patient Info:

Name:            JW

Age: 37

Phone:

Address:

Weight: 150 lbs.

Height: 5’8”

Education: BA degree Nuclear and Computer Engineering from UC Berkley in 20–

Career: Started working for S——— in 2016

Lives with: Wife, 4-year-old son, mom-in-law

Medications: none. Currently refuses to see any doctors.

Drugs or Alcohol uses: none. No history of drug or alcohol abuse

2013-2016

When he was working at a computer chip company, he said to the family that his boss taps his phone, knows where is was going, someone is watching and needs to close the blinds and install security cameras. Family had talked to him and lay out all the reasons why his boss would not do such thing. He was convinced at first. Family asked him to quit and he quitted, and stayed home with baby son and mom-in-law for about 2 years. He seemed fine most of the time but every few months, he will bring up issue of being watched and his phone being tapped.

June 2016

Started telling family that his in-laws are hurting-poisoning him and irritated that rich people controlling everyone and buying everyone’s mind, so everyone is scared to speak up. We talked to him but he cannot be convinced. He has these strong feelings about one week and increased to couple of times per week. He then said that it is his wife, B, who is hurting and poisoning.

July – August 2016

J has symptoms of bipolar disorder which includes: daily extreme mood changes, strong feelings of irritability and anger, avoid friends and social activities, decline sleep, having delusional thoughts, persecutory paranoia, episodes of hypomania daily and mania almost every other day. He refuses that there is anything wrong with him and everyone including doctors are all against him. He said he does not have paranoia because he is not that type of people. He now strongly feels that his wife is harming him, including poisoning him, throwing stuff to his head. He yells at her almost daily for hurting him and threatens to hurt her and the son if they try to hurt him.

6/6/2016 Sunday 12 PM

He held down P (the son) to put alcohol on his scraped knee. He insist that there are microwave length that controls all this. We argued very loud and he accused me of killing people, accused B of using atomic bombs and army trucks.

7/15/2016 Friday 10 PM

He took a picture of his scraped knee and insisted that it was serious, badly swollen, internal, microwave laser tissue penetration. Need to report to Obama. Everything is bought and everyone else is scared to say anything, everything is cover up including doctors. Everyone needs to be educated to a high-level and accessible. I don’t want to live a scared life like you all. You are all brainwashed.

7/16/2016 Saturday 8 AM

He posted on Facebook “Imagine life in a country that is constantly at war, surveillance, and creates artificial news. There’s gotta be a better way and I know I’m not the only one that feels this way.”

7/17/2016 Sunday 9:30 PM

He posted on Facebook “Thank you everyone for your care and kindness. I will keep a positive thinking going forward.”

7/18/2016 Monday 2 PM

Posted “Feeling cool about Usesome” which is an article about high-ranking intelligence officer making artificial news and destroying massive mankind.

7/20/2016 Wednesday 4 PM to 8 PM

He posted on Facebook “Got sick? Got resistors, capacitor, F T?”

7/23/2016 Saturday 12 AM to 3 AM

He and I talked for over two hours about various topics from “What do you think of B, rich people ruling everything, interviewing for the new job is beneficial because involve learning new thing, what if Mom and Dad and I were taken advantage, what would I do?” I told him that “That must be a scary feeling.” He said “Never mind” and changed subject. I asked him how his knee, what did the doctor say. He did not answer me.

7/24/2016 Sunday 12 AM

He posted on Facebook “<3ing.” Kicks bathroom door open and held up fist to B, eyes wide open. He said “You poisoned me, you and your coworker poisoned pool water and made me go into pool with P. My legs are handicap now. I don’t want to you.” B said violence is not going to help and sat down to talk to him. He calmed down and B was able to talk to him in a calm way. He listened and talked, lasted over an hour, then went to sleep.

7/25/2016 Monday 9 PM

He mixed cement and worked on the basketball hoop at 9 PM at night, shouting to B to help and asking mom-in-law to stay inside. At midnight, posted on Facebook a bunch of Chinese sentences that no one can make any sense. Like random Chinese words being put together to try to say something evil inside of someone.

8/2/2016 Tuesday throughout the day

P is sick. He said someone pressed button. J asked P to eat, P has no appetite and didn’t want to eat. He told P if he didn’t eat, he can die. He said at one point to P that P only needs to learn math and English and don’t need to learn anything else because he can teach him everything else.

8/4/2016 Thursday day

He said he was hypnotized, someone shot him. Caused by phone microwave. Felt that hair had blown by wind so he was hypnotized. Must be B who used pollen. She gets pollen everywhere. She is together with high school friends and large corporations like cops, FBI. He went out with P and Dad and ran into bad freeway traffic, he said someone messed with us. Someone messed with mom too because mom ran into traffic going home after work.

8/5/2016 Friday morning

He yell at B and said to sell the house, B caused T to pull wisdom teeth, she caused T to move away from San Francisco. He stopped after P started crying. I talked to him right after this episode and he acted normal. He asked me if I have already gotten my wisdom teeth off, I told him no because it was just a consultation. He said that they are getting ready to leave the house to bring P out.

8/6/2016 Saturday

He had a long talk with Mom mainly complaining about rich people ruling everyone else. There are smart people sifting all the stupid people out. Stupid people receive small incentive, so they comply and work like slaves. He was calm and had no episode.

8/7/2016 Sunday 9 PM

On the car ride home, he complained to B about her being a betrayed person. After arriving home he and P played and P accidentally poke J’s eyes. J said to P, you are trying to hurt me, I will kill you so you can’t hurt everyone in the society. He pulled B out of bed, dragged her down two flights of stairs and pulled her into the kitchen and pointed to a cockroach and accused her of poisoning him. After B tell him that it is not an issue when there are insects around, and Mom-in-law said a few positive things to calm him. They sat down and he saw her looking through her phone and he told her not to call 911. He asked if they are going to get a divorce and whether she is contacting a lawyer. He said “we can talk about it here and you don’t have to talk to lawyer.” Mom-in law-said it’s late and they should all go to sleep. He insisted to sleep with P in P’s room. She sleeps in their own master bedroom. Everyone went to bed. From 12:40 AM to 2 AM, he texted to a Family Group chat “Be careful, and evil is acting up again. My wife just put something in my drink. The family history going back hundreds of years are all traitor. Targeting all Chinese people, kissing ass to non-Chinese people, be careful, this 200-year-old issue still happens today, don’t fight within each other, needs to collaborate together. Is everyone around just sick for a long time?” When B was getting ready for work in the morning, he came to her room and said “I’m checking what the traitor is up to.”

8/10/2016 Wednesday morning

Mom called J and first he said “Don’t worry about me. Everything is fine.” He brought P out to the playground and museum and asked mom-in-law to join too, as if nothing happened last night.

8/10/2016 Wednesday 8:30 PM

I had an hour-long conversation with him. He said B together with other unknown people from high school poisoned him for years. He asked how we feel, he said he can’t explain it, it’s just feel different. He said she brings in drugs from somewhere/someone and dosage is not severe enough to kill him but enough to make you feel different and will last 20+ years. This all came from 200 to 5000 years ago that the tradition of poisoning continues to this day. There is a group of highly educated gangster related and rich people summoned people from China to come to the US and get citizenship and turn in people for them. B is brought into that group whose job is to turn J to the highly educated people. That’s why she poisoned him. He said he already reported to FBI and Obama. He said he wants to try to make B get out of it but she is too much in already. He said he is telling me and the family because he wants us to be careful. When asked if he feels angry or frustrated, he said some time but he can’t do anything about it so just let it be. When I asked he was sad, he said no because he smiles every day. He said he wants P to be highly educated so that he will know there are people around to hurt him.

8/12/2016 Friday 3 PM

I suggested he sees a marriage therapist because his current relationship with wife, he refused and said the root cause is that she needs to stop poisoning me. Then midnight he went to her room and said she is always awake, “every time I wake up in the middle of the night, this girl is awake.”

8/15/2016 Monday 5 PM

When he came home from work, he said someone throw stuff on his head, and he went to shower right away.

Said the same as yesterday about someone throw stuff on his head. When Mom-in-law was away from the house to get groceries, he started yelling at B that she is harming his family, harming his uncle, and said parents are scared of B. And then he said to P, “if you hurt my family, I will kill you.”

8/17/2016 Wednesday 8 AM

Wrote on family group chat that someone threw stuff on his head. He said he felt something that breaks/spread apart as it lands on his head.

Copyright © 2014 Bad Tad, MD