Clinical Case 089: Tormented teen

Ok the format of todays case is a little different.  This is a role-playing game that I use from time-to-time with our JMOs.

It is called: “Your Next Line…” 

The case unrolls as we step through the presentation, history and dialogue – with “time freezes” – kind of like theatre sports.  In each time freeze we stop and each student has to proffer their next line, their response to the patient in tht moment.

We then consider the interaction, the psychodynamics of the situation and try to form  consensus as to which line would work best in the context of the consultation.

Obviously it works best when the stakes are high, there is tension or an inevitable conflict in the offing.

So lets get into this one…..

Meet your next patient, we’ll call him Johnny Deep.

Johnny is a 16 yo boy who has been picked up by the Police at 1 AM, Sat morning and brought to the ED
The Police report that he as been aggressive and saying “suicidal things”
The police have proffered the opinion that he might be on some sort of amphetamine – he seems to be agitated and “wound up”.
They have checked his wrap sheet – but no previous criminal history
Johnny is refusing to give any contact details of his parents or other family members
From across the room he is clearly very upset and withdrawn…
It is late at night, there is no security in this ED.  The Police have offered to stay around – in case he causes any trouble.  What do you say to them?

TIME FREEZE:  What do you say to the Police?

You find a quiet spot to sit with Johnny to have a chat.
Initially he isnot saying much, but with some effort and assurance of confidence…. he starts to talk about what has happened.
He tells you that he was caught surfing gay porn sites on the home PC by his father. [Whom he describes as a bigot.]
Johnny left home 2 days ago after argument with his Dad.
Stayed at his friend’s house (Bradley) on the first night
They went out together to a party tonight, got ‘pretty smashed’.  Johnny then got into a fight with Bradley…
“I’m not gay, but Bradley thinks I am…” says Johnny . “Now I have got nowhere to go…”

TIME FREEZE:  at this moment Johnny is seeking help.  What do you offer him?

You try and rationalise with him.  “I think your mother would be worried about you.  Do you think I could give her a call and let her know that you are OK?”
Johnny is clearly not keen to have his parents involved in this situation.  He threatens to get up and leave if you try and contact his parents.
He starts pacing with clenched fists, glancing nervously at the exits.  This is not good – he clearly feels trapped without many options.

TIME FREEZE:  What do you say to de-escalate this moment?

You explain the process for getting him a safe place to stay and outline your obligations around Mandatory Child Protection laws.  He seems to understand these concepts.
How do you assess the competency of a minor in this situation?
After sorting out the practicalities of the disposition and follow up Johnny seems to be more philosophical.
He thanks you for your help and then pauses…
“Do you think I might be gay?”

TIME FREEZE:  How do you respond to this question?

OK – lets leave it there.  Love to hear your responses and any feedback on the format.  I find it to be a useful teaching device, try it out and let me know how you go.
“Do you think I am?”

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