In residency, we had a patient who has a frontal lobe injury (among other things) and the woman was frequently crying and screaming. She was somewhat controlled on Depakote, but we had to stop it for various reasons. We did a lot of fiddling with her medications with no improvement.
Anyway, my attending had me consult psych to find out what they might suggest for a medication for when she got really agitated.
The psych attending wrote a note on the patient. This was the gist of it: "May want to consider doing a frontal lobotomy. Consult neurosurgery to put her on the schedule."
At first, I thought it was a joke or I read it wrong. I showed it to our psychologist and she couldn't stop laughing. We were giggling about what the response of one of our all-important neurosurgeons would be if we actually consulted them for a frontal lobotomy.
So the next morning, my attending asked me if psych had any suggestions about the patient.
"Oh yes," I said. "They wrote a really helpful note. You should take a look at it."
I found the chart for him and waited for him to read the note. His jaw fell open, "I can't believe he wrote this." He shook his head. "He really ought to talk to neurosurgery before he writes a note like this." He looked at me, "Did you ask him about Geodon as a medication for agitation?"
"No," I said, "but I didn't ask him about frontal lobotomy either."