Strange Teen

The other day I get assigned a patient who was a 15 year old girl who had been admitted by her primary care physician for anemia. I go into the room and she was lying in the bed and she had a very non-trusting look on her face that screamed out "don't even try to talk to me.......but please give me some attention!" I started off with small talk to try and gain some trust and as she caught on that I was actually interested then she started to open up.

Her history included: Her mother is in prison and her dad has not been seen for years but the last time she saw him he was sexually abusing her. About 3 months ago she got an abortion and had not stopped bleeding from the procedure and the details regarding the abortion are somewhat sketchy and we were suspicious as to whether or not the abortion had been performed in an actual clinic by a doctor or performed on the streets by a stranger. She was not forthcoming with the details of the abortion. She has had many sexual partners and all kinds of sad stories of abuse and neglect. The state took her as a guardian when her mother went to prison a couple of years ago. She has been bouncing around foster homes and state facilities for the past 2 years. She has a long history of drug abuse and has dropped out of school. 

During the history I was able to ascertain that she has been eating baking soda for 3 + years now in very large amounts. She described that she has an insatiable desire to eat baking soda and can't stop. She steals it from stores and eats nearly 4 full boxes / week. It was fascinating to hear her discuss this and then see that she had snuck in several boxes of baking soda into the hospital. I figured that we could ad Pica to her diagnosis. Pica is a disorder in which a person repeatedly eats non-food items like clay, dirt, metal, paper, feces, etc. The disorder is most common in children, pregnant women and mentally retarded persons. The cause is idiopathic (unknown). Sometimes underlying iron deficiency or zinc deficiency can lead a person to eat non-food items like clay or dirt. This patient had a low serum iron which was most likely due to her persistent bleeding from the abortion. Pica is fairly uncommon but it is seen and most often considered a psychiatric disorder.

I consulted OB/GYN due to her bleeding and I consulted Psychiatry for the Pica. The psychiatrist said that he will see a couple of cases of Pica each year. I also got social workers involved to find her a group home or program that she could attend to get help for her psychiatric issues. What a fascinating case but also sad. This poor girl never really had a chance. Here genetics and her environment were both stacked against her the day she was born. Who knows where she will end up? I discharged her today as we were able to stop the bleeding and get her anemia in control.