I'm still in a low, funky mood tonight and therefore feel compelled to write more. Since third year started, I've experienced periods where my sleep is completely off. Not because of call schedules and long hours. In fact, I've come to love post-call days in a perverted way because the exhaustion makes for such solid, dream-less sleep. No, I think my problem is "sensory overload." Much for third year is so novel and raw. On gyn onc, it was the open laparotomies where we'd literally be digging and pulling out chunks of tumor - ovarian cancer - in 40 year olds. In peds, it was kids with anorexia, CP, kidney failure. In psych, well, psych is constantly sensory overload. Even radiology didn't spare me, as I'd spin stories from the films - patients with traumatic brain injury and the like. And it's not limited to patient experiences. Even day to day interactions with residents, attendings, and the rest of the clinical environment can be challenging.
In the hospital, it's usually go, go, go, and I end up unconsciously suppressing whatever reaction I have to a situation out of necessity. Things I don't even realize affect me at the time reveal themselves at night. Nighttime is when I do the processing, the reflection, and yes, sometimes the ruminating. It does not make for good sleep. I suppose medical training is about character building, but right now, I have yet to build a thick enough teflon coat.
Wednesday, September 15, 2010
Quick update
Feeling kind of blah today...many things that I feel pressured to do (i.e. navigate this university system and find a research project and mentor, write my psych report) and yet am procrastinating on. That, and a few worries creeping up like if I'll getting all that I can out of third year, if I'll ever be competent, and what I want to do when I grow up. Neuroses should be a DSM diagnosis, because I have many of them! Of course, I deal with all of this by doing PreTest.
The ah-ha moment (or perhaps self-admission) came today in psych didactics. We met an inpatient in psych today with schizoaffective disorder who was clearly psychotic and perhaps manic - impaired reality testing, bizarre delusions, expansive affect, pressured speech, the whole bit. Afterward, the psychiatrist said: this is a defining moment - either you think "this is utterly fascinating" or you think, "this is cool but not in my department." I fall dead in the latter camp. Fascinating, yes, and certainly amusing, but not something I could do long-term.
As an aside, this past weekend, I met up with some high school friends who I hadn't seen since high school! It was so fun to catch up. And go [big high school] - many of my high school classmates seem to be doing quite well these days, although it's not entirely surprising!
The ah-ha moment (or perhaps self-admission) came today in psych didactics. We met an inpatient in psych today with schizoaffective disorder who was clearly psychotic and perhaps manic - impaired reality testing, bizarre delusions, expansive affect, pressured speech, the whole bit. Afterward, the psychiatrist said: this is a defining moment - either you think "this is utterly fascinating" or you think, "this is cool but not in my department." I fall dead in the latter camp. Fascinating, yes, and certainly amusing, but not something I could do long-term.
As an aside, this past weekend, I met up with some high school friends who I hadn't seen since high school! It was so fun to catch up. And go [big high school] - many of my high school classmates seem to be doing quite well these days, although it's not entirely surprising!
Saturday, September 4, 2010
Psych
1 week of psych down. Finished with radiology. I'm assigned to a locked inpatient unit and am glad to be talking to patients again, although this time it's really different! One of my patients has MDD with catatonic features (so you can imagine how much talking is involved). He seemed much better today and was actually able to hold a conversation! The other has some schizoaffective features combined with anxiety and depression. Being on the ward is kind of surreal. Also, apparently our chief resident really loves squirrels and we're her baby squirrels. Psych people are nice.
Thursday, August 26, 2010
Physicians talking with one another: what a novel idea!
Yesterday, our weekly small group topic "Transitions in Health Care," referring to the process of transitioning pediatric patients with special needs/chronic illnesses from pediatricians to adult providers. The take home was that such transitions are hard and need to facilitated long before the child reaches "adult age" or age 18.
A couple examples of cases used in class: 20 yo Hispanic female with h/o Type 1 diabetes presenting to ED with out of control blood glucose after losing her health insurance at age 18 (why the heck does she have to be Hispanic??). 22 yo college student with h/o ALL treated at age 5 presenting to student health center for routine physical. Her pediatrician back home has been looking out for her before this. What issues need to be considered? How can we facilitate management of conditions that began in childhood in an adult setting?
One of my astute classmates asked at the end: "Why don't pediatricians and the new adult provider pick up the phone and have a 15 minute conversation about the patient?" Duh. Seems like a no-brainer. After all, in inpatient medicine, we have sign-out at the end of every shift, right? Yet, of course, the answer lies in financial incentives: because insurance companies don't reimburse for this, then these conversations just don't happen. Grr... another piece in this frustrating reality of how reimbursement strategies often limit effective healthcare delivery!
A couple examples of cases used in class: 20 yo Hispanic female with h/o Type 1 diabetes presenting to ED with out of control blood glucose after losing her health insurance at age 18 (why the heck does she have to be Hispanic??). 22 yo college student with h/o ALL treated at age 5 presenting to student health center for routine physical. Her pediatrician back home has been looking out for her before this. What issues need to be considered? How can we facilitate management of conditions that began in childhood in an adult setting?
One of my astute classmates asked at the end: "Why don't pediatricians and the new adult provider pick up the phone and have a 15 minute conversation about the patient?" Duh. Seems like a no-brainer. After all, in inpatient medicine, we have sign-out at the end of every shift, right? Yet, of course, the answer lies in financial incentives: because insurance companies don't reimburse for this, then these conversations just don't happen. Grr... another piece in this frustrating reality of how reimbursement strategies often limit effective healthcare delivery!
Tuesday, August 24, 2010
Monday, August 23, 2010
Ants in my pants
I haven't wanted class to end so badly since high school. Something about sitting in a dark room, at 4:30 pm on Friday, at hour 8 of radiology lecture. Depressing. But I truly have nothing to complain about - I'm done by 5 pm every day on this rotation! If only we didn't have to sit in the dark...
Saturday, August 14, 2010
Please, please, please wear a helmet
I was shadowing in the ED radiology reading room the other day when we received a stat request for a CT read. 20ish female bicyclist* with severe head trauma after crashing into a car on a neighborhood road, flipping over it, and striking her head. Glasgow Coma Score at the scene was 6. She had not been wearing a helmet.
As soon as we began reading her CT scans, we knew the prognosis was extremely poor. Multiple skull fractures, subdural, subarachnoid, and intraparenchymal hemorrhages, dissection of a carotid that explained the pulsating blood coming from her ear. It was truly heartbreaking. In the words of the ED radiologist, "I have to detach myself from this. Otherwise I could never read these images."
I never saw the patient, as she was rushed off to the OR soon after arrival. A few days later, I learned that she had died that day on the operating table.
People, please, please wear a helmet. I don't care if you think you're skilled enough to not need one, or think it doesn't look cool - it's going to be way less cool if you scramble your brains. At my college, most people rode bikes to get to class, and I was always stunned that the vast majority of students never wore helmets. Biking accidents are common and while most are minor, sometimes, the terrible occurs. Remember to learn to ride safely and please wear a helmet and protect yourself.
*details of case have been changed to protect privacy
As soon as we began reading her CT scans, we knew the prognosis was extremely poor. Multiple skull fractures, subdural, subarachnoid, and intraparenchymal hemorrhages, dissection of a carotid that explained the pulsating blood coming from her ear. It was truly heartbreaking. In the words of the ED radiologist, "I have to detach myself from this. Otherwise I could never read these images."
I never saw the patient, as she was rushed off to the OR soon after arrival. A few days later, I learned that she had died that day on the operating table.
People, please, please wear a helmet. I don't care if you think you're skilled enough to not need one, or think it doesn't look cool - it's going to be way less cool if you scramble your brains. At my college, most people rode bikes to get to class, and I was always stunned that the vast majority of students never wore helmets. Biking accidents are common and while most are minor, sometimes, the terrible occurs. Remember to learn to ride safely and please wear a helmet and protect yourself.
*details of case have been changed to protect privacy
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