Wednesday, September 15, 2010

Pa-pa-pa-poker face

Just got done with rotation number one, psychiatry. In-patient. Lock-down floor. Veteran's hospital. It is a shame some rotations are not longer than 4 weeks. I felt like I was just getting the hang of things when it was time to leave. It is interesting what specialties medical schools choose to make a requirement and which ones they do not. Four weeks is not long enough for someone to decide they want to do something for the rest of their life in my opinion. Some thoughts:

-The employees of the hospital dubbed their electronic health record, "the best in the world" and I am surprised if that is as good as it gets. It is my first run-in with an EHR, but I had many suggestions for improving it. While it may improve time when compared to paper charts, it is by no means fast. It still took time to gather the information needed to be caught up on the patients' current care, diseases, medications, labs, vitals and any other pertinent information. I know most of it has to do with the fact that it is my first rotation and I have no idea what I am doing. What I did like was that we could see any visit the patient made to any VA hospital in the country. That was clutch.

-The hours were nice. Essentially 8-4:30 every day, but the call for residents was every 4-5 days which isn't the greatest. I still had to get there early to navigate the EHR so the hours for me seemed longer than they should. Still, the hours were very nice and precise. I foolishly tried to meet with a secretary to get some papers filled out at 4:15 on a Friday. Struggled to find someone who could tell me, "Don't ever try to get anything done at 4:00 on a Friday." Thanks chief.

-I was blessed with an amazing attending, and wonderful resident and an awesome staff to work with. Everyone was very laid back and helpful. My resident was constantly making sure I was not overwhelmed or stressed out which I appreciated but never crossed the line to treating me like a baby. In med school we constantly hear the horror stories of attendings who are rude and residents who make you feel like a piece of crap. Not this rotation. Call me "weak" or "soft," but I know I will not do well in certain situations with certain personalities. Sorry for all the residents who have a resentment towards students, puppies and laughing children because somewhere along the way you got a massive chip on your shoulder. I am convinced that residents and attendings can be pleasant, thoughtful and respectful and still be wonderful teachers and mentors. The snide comments, standoffish teaching approach and temper tantrums will never help me. For instance, a resident on another team was constantly grouchy, passive aggressive, and rude to everyone, especially his students. I was helping one of his students navigate the EHR, the floor, the procedures, etc. during his first day and after five minutes the resident privately asked me if his student was getting it yet in the most condescending tone. Getting it yet? Getting what yet exactly? Yeah buddy, he has the whole "doctor" thing mastered in five minutes. He actually just left to apply for Harvard faculty. I am willing to give people the benefit of the doubt a few times, but at some point you cross the line from "bad day syndrome" (my new addition to the DSM-IV) to "I want to kick you down stairs" jerk.

-I loath gunners. Direct quote from another student: "When the attending was asking me questions, I thought it was because she didn't know the answer." Seriously? You really thought that the attending uses medical students as her wikipedia medical reference. The trained and licensed physician wanted you to enlighten her on medical practice protocols during your first rotation. The more and more time goes on I realize most gunners just flat out don't get it. He doesn't understand what just came out of his mouth enough to understand how absurd it is. This same student also decided it would be a good idea during rounds to point out that another student forgot to check his patient's labs. My hat goes off to the attending who corrected this guy by simply stating "It is bad form to take over another student's patients and correct them. Nobody likes it." There needs to be more attendings like that. This guy is a nice guy, it is almost as if he doesn't think through actions and things that come out of his mouth. Glad he wasn't on my team.

-There were underlying themes to mental illness. This by no means is a attempt at politics or judgement, but the patterns are clear. Combat experience, drugs, broken families and abuse jack people up. All political and religious beliefs aside, I have a huge appreciation for the sacrifice military men and women make for us. The illnesses that can come from a result of serving not only mess the servicemen up, but can destroy their family's lives as well. I was saddened at many of the people's lives as a result of their service commitment.

-The human mind is so sensitive. There is so much unknown about mental illness and the brain and I am amazed at seeing some of the sicknesses first hand. Reading about schizophrenia is one thing, but seeing a person believe people are going to try and kill him to the point his heart is racing is eye-opening to say the least. Hearing voices that are so real to them that if they cover their ears, the volume of the voices diminishes. I feel like there is such a fine line between our brains and the brains of the mentally-ill. I often wondered if someone were to really listen for voices (I mean really listen and try to convince yourself you can hear them) what might happen. Or if something really bad/traumatic were to happen to me, would my coping mechanisms be enough to keep me sane?

-There were really odd situations. Like the guy who kept peeing himself and attempted to play the dementia card, and the stroke victim card at the same time. Was he demented, was he a stroke victim, we couldn't figure out what he was trying to have us believe. After extensive metabolic tests which came back negative we did physical exams and mental aptitude tests. Once the tests came back severely different in the matter of 4 hours, we were pretty sure he was faking it. Why? I have no idea. Maybe he doesn't want to go home. I have no idea but were were extremely confident nothing urgent was wrong with him so we discharged him. There were many people who came to the floor to avoid being homeless and facing legal issues. Utter the magic phrase = "New England Clam Chowder" "I want to kill myself" and you are in. The cycle of people coming in at the middle of the month when they run out of money and then miraculously getting better near the first of the month when their disability/service check/welfare check was due to be delivered was like clockwork.

-Another odd situation was a gentleman who had antisocial personality disorder. My attending stated he would pass a lie detector test because he legitimately doesn't have feelings of remorse. He could look you in the eye and lie to you and have no problem with it ever. This same gentleman was caught selling drugs from the patient floor on the ward. Nice.

-I had to figure out techniques for not laughing. Pretty much worked on my poker face for a month. It is seriously hard to do in certain situations. I did not want to be unprofessional or insensitive, but at times it was really hard to not laugh as some things patients said and did. How do you not laugh when advising a grown man that masturbating on the ward is probably not a proactive approach to get himself discharged. And dude, I know you were not "dry" down there so don't try to play it off that you were "moisturizing." As close as I came to laughing at times, I never cracked. I was also accused of the following:

  • Having a second wife and three current girlfriends. After all, the patient's lawyers had been following me for the past 6 months.
  • Changing my name repeatedly
  • Having a small device to make the patient fall over when she was talking to me. She had my attending search my pockets.
  • Putting thoughts into a patients' head
  • Starting rumors that a female patient had a penis. Seriously how do you not laugh when a conversation goes like this:

Me: "Good morning Ms. X, how are you feeling today."

Ms. X: "Not good, you started a rumor I have a penis and I don't!"

I had to learn to anticipate odd comments so they wouldn't come as such a surprise and at times had to bite the inside of my mouth so I wouldn't smile. Worked pretty well.

Overall it was a perfect first rotation. I got comfortable interviewing real patients and had plenty of time to do interviews. By not being in a office setting I didn't feel the need to rush through patients. I can't say that I am sold on psychiatry. I felt at times there was not enough procedural action. It was a very interesting field, but I am not sure it would be the best fit for me as a career.

Next rotation: Family Medicine

P.S. Don't be afraid to click some ads

Tuesday, August 17, 2010

How does it taste?

I am so sick of the word 'boards' I could puke. USMLE this, boards that, First Aid, etc. Med students have the tendancy of incessantly harping on one topic after another. It's like the flavor of the week. You want to know who bought pogs, pokemon cards, magic cards, yoyos, silly bandz and whatever else the middle school craze is? Future med students.

So let's get to the meaning of the title, the meat and potatoes if you will. Get it? I used a title referring to eating and then used 'meat and potatoes' to refer to it. Get it? Unfortunately what I am asking is how socialized medicine tastes. You know, the health care is a right not a privilege mantra. What's that you say? Obama-care hasn't started yet? Hmmmmmm.....Imagine the following interaction:

Week: Want some bread?

You: It has been in the pantry a long time, how does it look?

Week: Looks ok.

You take a big bite and start chewing...

Week: Ooops, I don't think I quite looked over it as best I could, there is a spot. I am sorry, I shouldn't have just assumed it was ok by looking at only one side of it. It doesn't seem to have spread to the area where your piece is from, but there is mold on the loaf, look.

I flip over the loaf and there, almost mocking you, is a dark green and white mold spot...
You, being the clever person you are realize that mold is microscopic and the fact that it is visible tells you the mold has spread and affected every piece of the loaf...You now have the option. If you are me, you go by taste and smell. I would keep eating. However, you have the option of spitting it out or swallowing. As you spit it out (you softie, you) you say you wish you had a crystal ball to see how it would have ended up if you kept chewing. Would you have puked, had diarrhea or died? Too bad you don't have that crystal ball...

Now imagine I forced you to eat it. It looks ok, but you aren't to sure. But as I am forcing you to eat it I am assuring you that it will be ok. Do you trust me? Did I meticulously look at every part of that bread to assure it was mold free? Could I possibly look at every square millimeter? Would it be ok if you just got a little sick? What about if you died?

Now imagine that the loaf of bread represents Obama-care. The loaf may look good, even perfect to some, but is it? While we may not have the choice, do you want to eat it? Should we take some time to thoroughly look it over? It may be one of the most important loafs of bread we consume. If only we had the crystal balls.............

Crystal Ball #1
Crystal Ball #2

Doesn't look so good does it, eh?

Saturday, June 5, 2010

Can't see, Can't (stop) Pee, Can't Climb a Tree

No, I don't have Reiter's. Let me explain...

How do you do it? Those of you who spend your work day shopping being productive in front of a computer. My 20/10 vision is in serious jeopardy as I have spent the last 2 months in front of a computer for 13 hours per day. Might as well be staring at a light bulb. Plus the screen was greasy and blurry from all the first-years putting their grubby mitts on it so everything was out of focus. My eyes are slowly regaining their strength, but spending that much time in front of a screen seems unhealthy for my eyes. Hey, maybe all those people who have the screen darkeners are ahead of the curve, just like Shape-Ups, Toddler Leashes and SARS masks. I am seriously surprised no one has won a lawsuit over getting hazard pay for computer work. Not that I would have their back on that one, I am just surprised no one has try to sue. Hey, maybe the next watered down computer Steve Jobs waves in front of your face and convinces you that you need will have some high tech screen that won't hurt your eyes. Seriously, have you watched the videos of him at conferences? I am convinced he could pull one of those old car phones out of a box and everyone would cheer and yell like he just cured cancer. They are programmed to do that. The press kisses Jobs' ass worse than a plastic surgery gunner. Maybe they are afraid he will unleash a police raid on them like he did this guy. What can the iPad do that other computers can't? I love my mac and avoid PC's like I do other med students, but I still don't need another $500 piece of equipment just because I want to flick not click through my pictures. Besides, they are way to secretive about their products and leave too many questions. Dude is like a walking Lost episode.

I have consumed more coffee in the past 8 weeks than the rest of my life combined. The day I took my boards, I got a computer with a very sensitive mouse. Shaky Hands + Coffee makes clicking answers Carnival-Game-Hard. I was waiting for the balloon to inflate or a carney to pop out and convince me I needed to upgrade to a bigger stuffed animal. Felt like I had to pee every 5 minutes for a few days after the test. I don't know how you religious coffee drinkers get any work done. Maybe that's the point, always going to the bathroom to shop on your iPhone and update your facebook pee. Didn't get any withdrawal headaches so I must not have used for long enough.

My wrist hurts. I never thought I would say this, but I think I had the beginnings of carpal tunnel syndrome. I feel like I need a wrist brace next time I go bowling. What exactly do the bowler wrist braces do? Anyways, about week 5 of my 8 week final push I started having wrist pain and a little numbness. So I switched the buttons on the mouse and used my left hand. I almost filed workers' comp, but that only works if you are making money. Day of the test, my forearm was all tight. Kind of pathetic when you think about it, not to mention the risk of a DVT from all that sitting. Seriously, med school is dangerous. Compound that with a school in the ghetto and it makes for an episode comparable to Deadliest Catch.

I've got a few weeks before I start the circus that will be rotations. Can't wait to tell you some of the stories. I know there will be some gems from some of my colleagues' mouths as well as some patients. I can just see it now, med student answering a question the resident couldn't, the brown-nosing, the putting down/proving wrong other fellow med students. I just need to remember to take deep breaths and remember I have a fragile wrist from boards studying...

Friday, May 28, 2010

Boo Hoo!!

Overheard today during the 40 minute break I had halfway through my 8 hour licensing exam at the local testing center.

Non-Med Student "How long is my test?"

Test Center Rep "1 to 2 and a half hours."

Non-Med Student "Awww you're shi**ing me."

Let's say it all together...."Awwwwwwww boo hoo."

Updates next week. I promise...