So sorry to my one lone reader. that was a very long post last night. I am thinking "short" tonight.
I'm excited that my patients are getting discharged...hoorah! Fewer follow ups. And I only have 2 more days of consult left. Anyways, my highlight of the day was finally discharging my "favorite" patient.
She has a history of drug abuse, e.g. alcohol, benzos, opioids, etc. She comes to the hospital for overdose of her suboxone (a partial opiate) and seroquel. Anyways, the history on her was never clear. She had an altered mental status, and she kept changing her history, she denied having visual hallucination, except I saw her hallucinating the day before her. Anyways, she hated me. She had good rapport with my attending, but with me..she was very uncooperative. I dreaded going through the mental status exam. She just gave me those mean gaze, answered my questions very tersely...I was frankly very scared of her. I just didn't know what to say...and wanted to run out as soon as I entered the room.
Anyways, I stopped by her room in the morning knowing she was getting discharged. She was out of the hospital gown, and wore her flannel shirt and trucker hat.
So I said, "I just wanted to say bye, good luck, and follow up with your outpatient psychiatrist."
And then she's like "I want to apologize to you."
I asked, "for what?"
"Oh for the way I treated you. I was rude, mean.."
"Oh no...no...don't worry about it."
"No I truly mean it. I wasn't myself.."
"Don't worry about it...just wanted to wish you the best of luck. Take care."
Anyways, gosh...it was so good to hear. I mean I wasn't really taking it too personally the way her attitude was towards me after all, she was in an altered mental state. But it's still good to hear...that it wasn't me. And she knew that she wasn't nice to me.
Oh and I just wanted to pay homage to my favorite 80 yo pt with lewy body dementia. She was the very first patient I met on C/L.
Her Chief Complaint: "I think I got kinda old."
On mini mental status exam: for short term recall (remembering 3 objects), she needed clues:
clue 1) it's a fruit?
answer: apple? no orange...orange (it was actually "apple")
clue 2) it's something you sit on?
answer: stretcher! (in an emphatic way; btw, it was "chair")
clue 3) it's something kids like to climb on? it's outside?
answer: Potato! (her roommate starts to laugh. btw, it wasn't "potato" but rather "tree")
and in the middle of the interview...
"Can you please tell her I'm sorry?"
-"Who?"
"For the person I'm sitting on."
-"Are you sitting on her now?"
"Yes...and she's trying to get out." (Cue: laughter from her roommate and my own stiffled smile)
and for your fun medical fact of the day: patients with dementia with lewy body typically have visual hallucinations
and last thought: why can I never get to bed before midnight? ugh.
Thursday, June 11, 2009
Wednesday, June 10, 2009
hello again! welcome to C/L...
I've been owing you a post for awhile...I apologize to my dedicated reader(s). I think I've been posting less because I feel like there are fewer crazy stories to write since switching from inpatient to Consultation & Liaison (C/L), I am lazy, I've been attempting to study more (but more like watching more sports), and trying to get more sleep. But I do have a few stories leftover from inpatient (I may have told some of you already), a few reflections on inpatient and starting C/L, and my thoughts on becoming a doctor. I'll probably break it up into a few posts so those who have less time on their hand (aka shorter attention spans) can read through them.
Anyways, I'll start by sharing my most recent thoughts and experiences about finally working in a hospital on C/L full-time. I think I kinda hit a "low" a couple of days ago, where I wondered whether or not I actually chose the right profession. It was a very fleeting conscious thought, but has probably been stewing a little while in my "unconscious," according to Freud. (Btw, I think psychology theories are pointless...)
Anyways, for a little background before I delve further into that thought: what I do on C/L is wait to get paged by some medical team that needs a psych consult. The medical team (it can be GI, cardiac, pulm, nephro, surgical, icu, ob/gyn, basically any medical staff) asks the psych C/L to make med recommendation for depression, psychosis, etc. or evaluate for delirium, capacity (to make decisions, kinda like guardianship in the legal world), and a variety of psych issues.
So I basically work all over the hospital. It's a bit confusing...I don't get lost per se (I still have a decent sense of direction), but I never get familiar with any one team. I don't know who the nurses, residents, staff/attending, OT/PT, etc. Working the computer system, paper charts (ppl's god-awful handwriting) is challenging. Figuring out which meds/lab results is important is so time-consuming, especially since I work on so many dif specialty floors, I never get too familiar with any set of drugs except hypertension =P. I understand that we all have to struggle a bit with acclimating to a new environment and getting used to of being a "doctor", but I think being completely alone while I wander the hospital makes it even more difficult to find the right ppl to ask my dumb questions. The good thing about not having a resident to report to (I directly work with staff/attending and have my own set of patients) is that I can take as much time as I need to complete my things-to-do list. No one ever really sees me running back and forth between the chart and computer...so that's at least one positive. I think if I were a bit more familiar with medicine/working in a hospital (like my Wayne student counterparts who are on their last rotation of their 3rd year), it'd be less stressful. But I guess I'm learning how to drink from a firehose as best as I can.
So I thought my confusion/lostness was pretty well hidden, but maybe my new very expressive face gave it away? Anyways, one of the residents keeps on asking me if "I was ok" or "overwhelmed." The first time I thought maybe he was just a caring, sympathetic psych resident, but now he asks me on a daily basis and it makes me doubt myself alot. Like...why is he asking me pretty often? do i look lost? do i do a poor job? do i give a poor verbal presentation? do i take an inordinately long time? am i sub-par? Then, I thought this was a general consensus among the residents. And that when I'm away from the conference room, they discuss how I was "sub-par." Because later that afternoon another resident asked me "how's it going?" and of course, I took that as..."do you need help?" I don't know why I had jumped to the conclusion that she thought I needed help, but she has asked me several times now, and I think finally this afternoon, I realized that "How's it going?" is a pretty benign, innocuous greeting.
(Gosh...are the paranoid schizophrenics rubbing off on me?)
More doubt was planted in my head while I was working with the attendings. Dr. D is known to be nice (he doesn't pimp) and generally pretty fast with staffing (which means reviewing the patient with the resident or med student, and giving his own impression/assessment/plan/recommendation). But I felt like when he works with me...staffing generally takes longer. So then I construed that as: he doesn't trust the data that I have, I missed key points; he needs more time because I didn't do as thorough as a job/incompetent. Sigh...
Then, the other attending Dr. R is known to pimp (in a nice way). He generally pimps so you can learn and not to make a fool out of you. So he pimps until you finally don't know something, so you learn that point. Anyways, Dr. R has only pimped me once. Making me feel even less capable as a med student because he assumes that I don't know the answer or thinks I'm not tough enough to face his barrage of questions. Also, the other day while staffing with him, I couldn't answer several questions in a row regarding the patient's history. I felt like an idiot not knowing these answers, like her baseline, what the patient is normally like etc. I had the opportunities to ask these questions when talking to the patient or her psychiatrist, but I failed to ask these pretty important questions. I can just imagine that in his mind he was placing a checkmark next to poor history taker under my evaluation.
So...all these little things added up to "Chi = incompetent". I guess some of the basis is weak, but there's some gut feeling to it too. And then for the first time, I genuinely thought...what if I didn't choose the right job? After my entire life of wanting to be a doctor, I finally get to this point of applying all that I've learned and found out that I absolutely suck at it? that I'm not qualified enough for it? that I'm not hardworking enough? that I don't have enough passion to do it?
I never thought I was a good an EMT. I never really knew how to interpret the history and physical or what to do in an emergency, except in multiple choice format. I've never really learned how to study/work hard. Maybe it's because I'm not passionate enough to want to read books about medicine. I mean...if I really love this stuff, shouldn't I find this fun to read in my spare time? I don't think I've ever felt that way about studying. It's always been tv, games, food, sports, movies for me...those things I could do all day long. Maybe at heart, I'm just a lazy person. And I will never be adequate enough to provide the standard of care for my patients.
Anyways, at the end of team this afternoon, one of the attendings said "before I forget, we need to talk about med student evaluation." I made nothing of it...I thought she was just going to make a general announcement like "don't forget to turn in their evaluations." But then 5 seconds later she turns to me and says "Can you please give us a second?" I was the only med student at team today...so I quickly packed my stuff and said, "oh yea of course." For some reason, I thought they were just going to talk about this one particular kid that had scored a 1 out of 5 on professionalism (which is not good and basically an impossible score). They only spent an extra 5 min in the conference room, so I didn't think much of it. After all, I heard it was the inpatient staff that was evaluating me, not the C/L staff. But it turns out they were talking about all the med students, including me?
So how I found out they were talking about me was the resident told me, while the two of us were strolling, that I didn't need to worry that I was doing fine. So, in my mind, I thought that was good to hear, but nothing too exciting because I figured they said that as a general response about all the med students...after all, it only took 5 min to discuss. But then, she shared with me that Dr. D didn't like X. He thought X was too immature. The resident thought she was fine. And I was thinking...why are you telling me this. This is kinda awkward...I mean, I do enjoy "gossip," but I def. didn't ask for it. I didn't know what to make of it...I didn't know how to respond. I mean I was curious...and I wanted to know why Dr. D said X was immature and why Dr. D liked me. I def. think X is smarter than me. But of course, I didn't ask. I have enough social tact to know not to. But sigh...that just made me all antsy. Because it meant that a) they really did spend long enough in there to have a discussion, and b) they really did have stronger opinions than "fine" and "good," and c) is a "fine" performance good enough?
Anyways...it kinda gave me a good confidence boost? though kinda awkward...or maybe it was just a lie because they think I have low self-confidence and needed some good supportive psychotherapy. (I don't really think that...) Oh...and apparently my age surprised my resident, she thought I acted more mature than that (but she also said I don't look more than my age...
Oh and some resident on the floor said "did you write that note? because it was awesome." So that was also a nice boost...but I later think he only liked it so much because I wrote down so many extraneous details, so he didn't have to do sucha thorough interview. I guess that's one way to be a "good" note.
Anyways, like I said...the thought of me choosing the wrong career was fleeting. I guess it's a bit too early to tell. And I also know that I am a person who needs a bit of time to finally feel comfortable. And I think today, about 5 days worth of C/L, I do feel more comfortable getting around.
Damn...it's another long post. i stayed up late to finish it. Sorry if it took too much time of your day, but thanks for reading :).
Anyways, I'll start by sharing my most recent thoughts and experiences about finally working in a hospital on C/L full-time. I think I kinda hit a "low" a couple of days ago, where I wondered whether or not I actually chose the right profession. It was a very fleeting conscious thought, but has probably been stewing a little while in my "unconscious," according to Freud. (Btw, I think psychology theories are pointless...)
Anyways, for a little background before I delve further into that thought: what I do on C/L is wait to get paged by some medical team that needs a psych consult. The medical team (it can be GI, cardiac, pulm, nephro, surgical, icu, ob/gyn, basically any medical staff) asks the psych C/L to make med recommendation for depression, psychosis, etc. or evaluate for delirium, capacity (to make decisions, kinda like guardianship in the legal world), and a variety of psych issues.
So I basically work all over the hospital. It's a bit confusing...I don't get lost per se (I still have a decent sense of direction), but I never get familiar with any one team. I don't know who the nurses, residents, staff/attending, OT/PT, etc. Working the computer system, paper charts (ppl's god-awful handwriting) is challenging. Figuring out which meds/lab results is important is so time-consuming, especially since I work on so many dif specialty floors, I never get too familiar with any set of drugs except hypertension =P. I understand that we all have to struggle a bit with acclimating to a new environment and getting used to of being a "doctor", but I think being completely alone while I wander the hospital makes it even more difficult to find the right ppl to ask my dumb questions. The good thing about not having a resident to report to (I directly work with staff/attending and have my own set of patients) is that I can take as much time as I need to complete my things-to-do list. No one ever really sees me running back and forth between the chart and computer...so that's at least one positive. I think if I were a bit more familiar with medicine/working in a hospital (like my Wayne student counterparts who are on their last rotation of their 3rd year), it'd be less stressful. But I guess I'm learning how to drink from a firehose as best as I can.
So I thought my confusion/lostness was pretty well hidden, but maybe my new very expressive face gave it away? Anyways, one of the residents keeps on asking me if "I was ok" or "overwhelmed." The first time I thought maybe he was just a caring, sympathetic psych resident, but now he asks me on a daily basis and it makes me doubt myself alot. Like...why is he asking me pretty often? do i look lost? do i do a poor job? do i give a poor verbal presentation? do i take an inordinately long time? am i sub-par? Then, I thought this was a general consensus among the residents. And that when I'm away from the conference room, they discuss how I was "sub-par." Because later that afternoon another resident asked me "how's it going?" and of course, I took that as..."do you need help?" I don't know why I had jumped to the conclusion that she thought I needed help, but she has asked me several times now, and I think finally this afternoon, I realized that "How's it going?" is a pretty benign, innocuous greeting.
(Gosh...are the paranoid schizophrenics rubbing off on me?)
More doubt was planted in my head while I was working with the attendings. Dr. D is known to be nice (he doesn't pimp) and generally pretty fast with staffing (which means reviewing the patient with the resident or med student, and giving his own impression/assessment/plan/recommendation). But I felt like when he works with me...staffing generally takes longer. So then I construed that as: he doesn't trust the data that I have, I missed key points; he needs more time because I didn't do as thorough as a job/incompetent. Sigh...
Then, the other attending Dr. R is known to pimp (in a nice way). He generally pimps so you can learn and not to make a fool out of you. So he pimps until you finally don't know something, so you learn that point. Anyways, Dr. R has only pimped me once. Making me feel even less capable as a med student because he assumes that I don't know the answer or thinks I'm not tough enough to face his barrage of questions. Also, the other day while staffing with him, I couldn't answer several questions in a row regarding the patient's history. I felt like an idiot not knowing these answers, like her baseline, what the patient is normally like etc. I had the opportunities to ask these questions when talking to the patient or her psychiatrist, but I failed to ask these pretty important questions. I can just imagine that in his mind he was placing a checkmark next to poor history taker under my evaluation.
So...all these little things added up to "Chi = incompetent". I guess some of the basis is weak, but there's some gut feeling to it too. And then for the first time, I genuinely thought...what if I didn't choose the right job? After my entire life of wanting to be a doctor, I finally get to this point of applying all that I've learned and found out that I absolutely suck at it? that I'm not qualified enough for it? that I'm not hardworking enough? that I don't have enough passion to do it?
I never thought I was a good an EMT. I never really knew how to interpret the history and physical or what to do in an emergency, except in multiple choice format. I've never really learned how to study/work hard. Maybe it's because I'm not passionate enough to want to read books about medicine. I mean...if I really love this stuff, shouldn't I find this fun to read in my spare time? I don't think I've ever felt that way about studying. It's always been tv, games, food, sports, movies for me...those things I could do all day long. Maybe at heart, I'm just a lazy person. And I will never be adequate enough to provide the standard of care for my patients.
Anyways, at the end of team this afternoon, one of the attendings said "before I forget, we need to talk about med student evaluation." I made nothing of it...I thought she was just going to make a general announcement like "don't forget to turn in their evaluations." But then 5 seconds later she turns to me and says "Can you please give us a second?" I was the only med student at team today...so I quickly packed my stuff and said, "oh yea of course." For some reason, I thought they were just going to talk about this one particular kid that had scored a 1 out of 5 on professionalism (which is not good and basically an impossible score). They only spent an extra 5 min in the conference room, so I didn't think much of it. After all, I heard it was the inpatient staff that was evaluating me, not the C/L staff. But it turns out they were talking about all the med students, including me?
So how I found out they were talking about me was the resident told me, while the two of us were strolling, that I didn't need to worry that I was doing fine. So, in my mind, I thought that was good to hear, but nothing too exciting because I figured they said that as a general response about all the med students...after all, it only took 5 min to discuss. But then, she shared with me that Dr. D didn't like X. He thought X was too immature. The resident thought she was fine. And I was thinking...why are you telling me this. This is kinda awkward...I mean, I do enjoy "gossip," but I def. didn't ask for it. I didn't know what to make of it...I didn't know how to respond. I mean I was curious...and I wanted to know why Dr. D said X was immature and why Dr. D liked me. I def. think X is smarter than me. But of course, I didn't ask. I have enough social tact to know not to. But sigh...that just made me all antsy. Because it meant that a) they really did spend long enough in there to have a discussion, and b) they really did have stronger opinions than "fine" and "good," and c) is a "fine" performance good enough?
Anyways...it kinda gave me a good confidence boost? though kinda awkward...or maybe it was just a lie because they think I have low self-confidence and needed some good supportive psychotherapy. (I don't really think that...) Oh...and apparently my age surprised my resident, she thought I acted more mature than that (but she also said I don't look more than my age...
Oh and some resident on the floor said "did you write that note? because it was awesome." So that was also a nice boost...but I later think he only liked it so much because I wrote down so many extraneous details, so he didn't have to do sucha thorough interview. I guess that's one way to be a "good" note.
Anyways, like I said...the thought of me choosing the wrong career was fleeting. I guess it's a bit too early to tell. And I also know that I am a person who needs a bit of time to finally feel comfortable. And I think today, about 5 days worth of C/L, I do feel more comfortable getting around.
Damn...it's another long post. i stayed up late to finish it. Sorry if it took too much time of your day, but thanks for reading :).
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