alarm clocks need to learn...

... how to wake me up.

Oh gosh...I almost slept through rounds today.

Yesterday was my first day on the Cardiology service and it also happened to be on-call too. I was able to get to the call room by 12:30 am...and I set my alarm for 6:45 am, for a good 6 hours, but....I missed both my cell phone alarm and my pager! Ughhh...

It wasn't until 7:15 am, that my senior paged me to put some orders in that I woke up. Sighhhh...thank God I got paged, but putting in the order took me an extra 5-10 min of my time, trying to figure out how to use the new computer system. And then, another 5 min commute to the conference room...I am now at about 7:30 am. I still haven't gone to the bathroom...hoping that the urgency to pee would make me work faster. I found all labs and vitals..taking another 5 min. Ran to the bathroom with my toothbrush and toothpaste in my white coat...another 5 min. Spent about 15 min with both of my patients. Bringing me to 7:55 for a little breather, before going on rounds.

Anyways, I think alarm clocks need to learn how to wake me up. I guess the converse is...I should learn how to wake up to alarms...

quick thoughts...

long time no post... my life is kinda the same boring story now (going to the hospital, hopefully working out, studying, eat eat eat, and little sleep), but yet with so many changes since the last post.

Psych seems like ages ago. I never offered my final reflection about the clerkship. I kinda wish I had, just so I can read back later when I'm trying to make a decision about what specialty to go into. I'll probably make a post one about it later. And crazily, I'm half-way done with ob/gyn...and I'm liking it a lot (which is what I'm afraid of b/c that will probably happen with each rotation). And as always, so much to study...but I am posting right now. (me = ultimate procrastinator)

So I just wanted to say, that it's good to be back in aa...seeing familiar faces in the hospital and just having classmates to go to when I need to bitch about something =P. But there are things that I don't like about being back with your classic UM students. There are way too many gunners here.

And...I've kinda lost my own unique procrastinator gunner attitude, partly b/c I don't believe I can compete anymore (aka a sore loser). But mostly, I don't want to turn into THAT kinda person. Always trying to get ahead, being fake, brown-nosing, trying to out-shine your classmates. It's not me.

I'm perfectly fine with being average. I think it's the first time in my life that I've felt this way. Because happiness for me is not being the best anymore (though I still enjoy the occasional win in a game...). I really think, in the future, I just want a very domestic life. I just want a family, a good career with time to spend with my kids (part-time sounds awesome!) I think that's what would make me happiest in life. Unfortunately...it's kinda hard to work towards this future of mine. It's not as clear as the blueprints in how to become a successful doctor.

Maybe I should be spending my time going to bars, mixers, and making friends who have other friends (hahaha...jk!), instead of trying to memorize these obscure epidemiology #s on STIs...

Oh...and I don't think Ob/Gyn pts. are as funny, but they're a lot of very happy moments :D.

short short short...

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.

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 :).

it's all about the cigarettes, pot, and food...

it's all you need in life right? Anyways some of the highlights of the day:

- People will stand in the pouring rain to smoke their cigarettes.
- Cigarettes are also important accessories...at least to one patient. He tied a cigarette to each of his eyeglasses's arm.

- "I don't need medicine. I have my own home remedy kit. All I need is vitamins and marijuana."

- Sanest thing I heard today:
"How do I become a doctor?"
"Well, you first have to finish high school, then go to college, go to medical school, then do a few years of residency."
"Oh...I don't think I'll do that."

and FOOD...
- fast food next to the parking lot is no good. I've been craving French Fries after work everyday
- I learned a new recipe for "firecrackers": Peanut Butter and Marijuana sandwiched between two Crackers and then baked. (food + pot...even better right?)

(hmm...I've seen to have capitalized all the food words...)

ok ok...

I've heard the complaints. My posts are too long. I understand...I have little patience to even read my own. No worries...I think I'm running out of things to say. It's my last week of inpatient, and I doubt the psychosis will be quite as severe on consults, but I guess you'll never know in tha D...

Anyways, I completely slept in. I normally set 3 alarms, but I set my pager alarm to the wrong date, forgot that I had to turned off my cell phone alarm (b/c of the 3 day weekend), and ignored my alarm clock assuming another the pager/phone would go off in 10 min. Luckily...I wasn't too late. I woke up at 8:20, when I normally leave at 8:15. Anyways, I digress.

So I arrived about 10 min late but before my resident, so it's all good :). Went to the lower functioning floor to get the vitals and meds...when the fire alarm goes off. All the nurses were saying it's a scheduled test...but I was definitely smelling smoke. It was finally called, "this is not a test." I was then just looking around, not knowing what to do...I was kinda expecting chaos to ensue, but really it was very orderly. The patients just walked calmly over to the day room (minus Tammy), and that was about it. It was really kinda peaceful in the day room under the blaring fire alarm. Though...I still don't know what would happen if the actual place burned down...b/c we did kinda lock ourselves into a room, instead of going outside...maybe there's some special exit that I didn't see (but all the other people could see...is there a term for "opposite visual hallucination"?)

Anyways, one of my schizoaffective patients that I've had over the past week was no longer on the board. I assumed he was discharged and was excited that a) he got better and b) he wasn't around to "annoy" me (though I started to like him better after playing Madden with him on PS2...) So I told my resident..oh "Blake" got discharged? And she's like "What? Did he actually have a stroke?" ..."come again?" Anyways, apparently on Friday afternoon, Blake faked a stroke. He positioned himself exactly outside his room and when he saw a nurse walked by, he slumped in his chair and said he was paralyzed, and couldn't move his whole right side. Of course, this was a ploy to get out of the psych hospital, but my resident and the medical doctor couldn't rule out a stroke and wanted to err on the safe side, so he was sent to the hospital. He got several CT scans, angiograms, and other costly medical work-up. Since he was no longer in our care, the psychiatry dept at the other hospital was responsible for his care. His thought process is organized enough that I know he was able to confabulate a reasonable story to get him out of the hospital. Anyways, I really do hope Blake is being compliant with his meds ... and that he won't end up in the ER anytime soon.

ok...now for some randoms:
1) group therapy and interacting with other patients is good for the patients (they get good feedback from each other and feel human interconnectedness)..BUT bad when your 18 y.o. patient learns from his stay at the hospital that cutting is a good way to cope.
2) a black man wearing a large fur coat with peach colored sweat pants singing opera
3) "I need to get outta here, so I can buy a McDonald's" (and yes he meant the store, not just a Big Mac)

And a psych tidbit (in case you get pimped)...
damage to the right frontal lobe usually leads to mania, whereas damage to the left frontal lobe usually leads to depression (the right frontal lobe tends to be more inhibitory and the left more excitatory).

Not quite as short as I hoped...but I hope you don't mind (I hope you don't mind that I put down in words...)

is it bad...

that I am posting while I'm on call? I must say psych is the chillest and most awesome rotation. I think I've gone out to eat lunch more than half the time. Anyways, I am currently in the resident's room reading my email, updating my blog, and entering all those darn patient encounters that I haven't been keeping up with.

What I love about this rotation of course are the hours, the staff, and the stories that the attendings and residents have accumulated through the years. I also think watching the patients roam about in the hallways is so interesting...from a distance. I find that they can be quite scary and intimidating when they are up close. I feel like there is more entertaining than actual learning on my part. I am getting a bit more familiar with the medications, but still struggle sometimes with the interview and writing notes. I think I just need more practice...but I get slight stage fright when it's time for me to take control. But as a whole, the rotation is awesome, but in the end, I don't think I could ever be a psychiatrist. The kind of patience it takes to listen to their pressured speech, delusions, paranoias, religious extremes, etc. is something I don't have. I think I am in general a patient person, but some of my patients test me several times a day, and after awhile they just give me a headache.

Oh and the smell of shit...is so incredibly unappetizing. Maybe I can't be a GI doc (I've been toying with every specialty)... Anyways, Tammy the obese woman with trichotillosis is basically like a one year old. She never developmentally grew and is mentally retarded. Remember how I told you about the blood on the wall from her head banging? Anyways, she has been caught twice by the night staff of picking at her scab and smearing the blood. Of course when she was called out by the nurse, she then started to actually head bang. And when she was taking her shower, she smeared her blood all over the walls and door. Sigh... And she also shits in her pants too when she can't cope or wants attention, and my gosh did her room smell. She chooses to drink lots of milk and eat other assorted dairy products like ice cream. She does fairly often too, about once every day or two. Unfortunately, this is the best Tammy can be. She should have been discharged last week or so, but because of a change in insurance or something, she is stuck at the hospital until the first of June.

All right, not sucha long post today...but just a few quotes to leave you with...

"You guys laugh too much. You're going to get pregnant." from "Diane," who wears her scrub pants as overalls and a towel on her head. I forgot to mention she has obvious hirsutism (inappropriate facial hair). Her grey stubbles on her chin and upper lip would make any Asian man jealous.

"Girl, you're pregnant." sigh...have I gained that much weight? Anyways, this is from the girl who thinks I am her sister.

"I have the power to strike you down." This is the 19 year old girl who thinks she herself is a child of God, who is carrying another child of God.

I've been here 2 hours, and I have 3 more hours to go. Though the resident said I could just leave anytime...and I don't even have to tell him...