The Psychiatry Stuff That I Was Too Lazy To Post the Other Day

Now that I'm on my last week of my rotation, I guess I should talk about it a little bit. Sorry I've been so scarce - I've been moving (more on that later) and just busy and tired.

Anyway, I'm in psychiatry for 8 weeks - and our schedules are split into "primary" and "secondary" assignments. The primary assignment is the one that we do in the mornings, and it changes every 2 weeks. The secondary one is our afternoon stuff, and it stays basically the same throughout the 8 weeks. So for the first two weeks, I was at the "main hospital" (the one that is closely associated with the medical school) in the mornings, and we did/observed outpatient therapy and med checks for both adults and children, and covered psych consults for the hospital (along with the attending and/or the resident, of course.) The outpatient stuff work was slow, because most of the doctors and therapists were on vacation, and patients also tend to cancel appointments. But the consults were interesting - I saw a case of delirium (which I think was brought on by both a head injury and withdrawal from a bunch of substances) in a guy who had been in an ATV accident (without a helmet, of course.) I think it would help the whole "Don't be an idiot, wear a helmet when you're on an ATV" campaign if they just showed a clip of this poor guy thrashing around in his bed. He was so sad. And we saw a couple of cases of delirium, and that was about it for my consult experience so far. (I should mention that they keep our rotations "standardized" by giving us a list of procedures we're supposed to either observe or do, and patient encounters that we're supposed to have, and we have to have a certain percentage of them signed off before we can pass the rotation. So patient encounters for psychiatry are things like, ADHD-adult; ADHD-child; Anxiety Disorder; Bipolar Disorder; Conduct Disorder; Delirium, Dementia, Domestic Violence; Eating Disorder; Major Depressive Disorder; Mental Retardation/Developmental Delay - adult; Mental Retardation/Developmental Delay - child; Obsessive Compulsive Disorder; Oppositional Defiant Disorder; Panic Disorder; Personality Disorder(s); Schizophrenia; Substance Abuse/Dependence; Tourette's, etc. And for procedures, we have to do some Mental Status Exams, Substance Abuse Assessment, attend an Alcoholics Anonymous meeting, Psychological Testing, Electroconvulsive Therapy, etc.) For the rest of those mornings for the first two weeks, I observed some child therapy, some play therapy, adult med checks, and watched some DVDs of those patient encounters (like The Teachings of Jon for MR/DD Adult, or Thin for Eating Disorders, or The Basketball Diaries for Substance Abuse/Dependence.) In the afternoons, I have lectures on Monday and Friday, see my Hospice patient on Wednesday, see patients in Student Clinic on Thursday, and Tuesday afternoon I have off.

For the second two weeks, I went to a private inpatient hospital for my morning assignment. That's where things started to get interesting, because that's where I started to see schizophrenic patients, patients with psychosis, that sort of thing. We (Todd and I) would get to the hospital around 9 (okay, he would get there at 9, I'd get there circa 9:15), see a couple of patients and write SOAP notes/progress notes, and when our attending got there at 9:30 or 10, we'd see some patients with him or get a mini-lecture from him on, say, Borderline Personality Disorder, if we'd seen a patient with it that morning. This was where I started having my "I can't believe they're letting me do this!" moments - when I was grabbing charts and writing notes (in BLACK INK, for the love of all that's good and pure - I wrote in blue ink exactly once, and it was such a BAD THING that I might as well have pricked the patient's finger and written with their blood) and also talking to patients and asking them personal questions, and they'd actually TELL ME. Signing my progress notes with my name followed by "MS-III" IS fun, I have to admit. I'll bet MS-IV will feel even better, if I make it to that point. I had two really interesting patients at that hospital - one was bipolar and had been really manic for about 5 days, not sleeping at all during that time. At the end of this lack of sleep, he got one of those Nigerian scam emails, and had a little bit of a psychotic break, and believed it. He became delusional about having millions of dollars in various international banks, and insisted that he was a descendent of the ruler of a country in Africa. I got to follow him almost the entire time he was a patient there, and it was great to get to see him get better with the mood stabilizer meds. He also had an episode of acute dystonia after they started him on Zyprexa (which is muscle spasm in the neck and shoulders) - and I learned that you treat that with Benadryl, of all things. It's the anticholinergic properties of Benadryl that fix it. And then there was another patient with schizophrenia who believed that people could hear him think. He said that he was "allergic to photos" - that if he looked at a picture for too long, he would "fill it up" and that the people who could hear him think would die. I looked forward to seeing how he was doing every morning.

And then for the next two weeks, I was at a different inpatient hospital, with some very, very sick folks. At the end of my two weeks there, even these patients - who were terribly delusional and psychotic at admission or committment - are showing some improvement. That's really rewarding, even though I had nothing to do with it. :-) For the last two weeks, I'm back at the first hospital - the outpatient stuff and the consults. Yesterday I had my oral exam (on an adolescent patient in a 30-day inpatient program at one of the hospitals - on which I got a 97, woo! Thank the Lord.) Friday I have my miniboard exam, and that will be all for psychiatry.

If I think of anything else interesting from the past eight weeks that I left out (and I'm sure I will, because something interesting happens every day) I'll post about it ... well, sometime.

I has submitted an lolcat ...

... to I Can Has Cheezburger. And although I am partial to my own kittehs, Ollie & Sassy:

This one is the best lolcat I've seen in awhile:

These Are Your Heels On A Psychiatry Rotation. Or, Jessica Simpson Causes Large Fluid-Filled Lesions.

I haven't said nearly enough about my foray into the sleepy, "I can't believe they're letting me do this!" world of clinical medical education. Now, this has been entirely different from the first two basic science years of medical school. First and most imporant, we have to dress up every day (blah blah blah professionalcakes) instead of looking like we just woke up four minutes before. And unfortunately, I'm too fat for most of my "professional" clothes, so I had to buy a bunch of new stuff (that's not the unfortunate part - the unfortunate part is that I'm quickly approaching the size of a small house.) I had to be careful in top selection - cap sleeves must be avoided at all costs, because a shirt with cap sleeves might as well say, "Look at me! I have sausage arms!" They're worse than sleeveless, even. And then we move on to shoes. Since safety requirements dictate that we wear shoes that are completely closed-toe, and comfort requirements dictate that I can't wear much of a heel or anything like that - I pretty much look like I'm sharing shoes with my great-grandmother. The very first day, I wore this cute pair of Jessica Simpson wedges (ballet flats with a wee heel - the marriage of cute and comfortable. Or so I thought.)

At the end of the day, I had blisters as big as my head (and that's BIG.) I later managed to rip the skin off of the blisters by dutifully walking a couple of laps around the park in my orthopedic-looking-but-very-comfy-and-functional Masai Barefoot Technology shoes from Bliss. Check out my scary blisters, and my cracked heels which I cannot fix despite the 1,023,872 heel creams I've tried. And when those suckers crack, they HURT - a lot more than something that small should hurt. I have a crack on the bottom of each heel right now, and I have developed this odd walk-on-my-toes mechanism, which makes me look like I might be cognitively impaired. Anyway, the blisters:

And the next day, I still had to wear shoes, because barefoot student doctors are generally frowned upon. So I ended up buying TWO sets of not-at-all-fashionable shoes with toes - a regular pair in a couple of different colors and a backless pair in those same colors. (I love shoes, though, so I can't really complain. I just wish my shoes in current rotation could be could be cuter.) I actually like being dressed up, though - I feel like a real grownup going off to work or something. (Ha ha, I'm so not a real grownup, though.)

As you know, I'm on the psychiatry rotation, which is known for being the easier one. This was a good one for me to start with, since I don't adapt to change well and it takes me a little while to get used to new routines and such. So it's better that I don't have 4:45AM-8:00PM days (see "Surgery") right off the bat. Eeeeugh, 4:45AM. I really don't know how I'm going to manage that, y'all. I have a hard time rolling out of bed at 6:30. And I've learned that my psychiatry preceptors (i.e., the psychiatrists) are not unlike me. One of them told me that he hates morning. A couple of them don't roll into the hospital until around 9:30 or 10. That's AWESOME. I might consider going into psychiatry solely for that reason. Just kidding. Although I do think this rotation has been really interesting, particularly the inpatient stuff. I'm learning a lot from my patients.

And now I'm tired. To be continued. I also need to tell y'all about my Pain Clinic experience.

This guy was obviously about to listen to Glenn Beck

Behold, Kasey Kazee, the Duct Tape Bandit, who attempted robbing a liquor store in Ashland, Kentucky:

Ah, the many uses of duct tape. I'll bet pulling all of that off hurt. Ouch.

Dreams, psychiatry, and future blogging

Y'ALL! I've missed you. I don't know why I'm not writing more - it's not like I'm at the hospital 24/7 or anything (I'm on psychiatry, for crying out loud!) I guess I'm just not feeling creative or something. Although I do have a lot to write about - speaking of that, here's the thing about HIPAA and patient talk. HIPAA, as I understand it, means that I can't talk about patients in any way that would allow them to be identified. So I can tell you about the patient who equates West Virginia with Egypt:

Me (doing a mini mental status exam): Do you know what state [current city] is in? (I was expecting a correct answer, because she did get the city right.)
Patient: West Virginia.
Me: That's corr-
Patient: You know, Egypt.
Me: -rect? Okay.

And you would have no idea who that patient was. You could even go onto the floor at the hospital where I'm currently working and still not be able to pick her out based on that. So I will not discuss patients in a way that allows them to be identified, but I may discuss them if I'm talking about a particular concept in psychiatry, or something that deeply affected me, or whatever. [/obligatory HIPAA statement, because I signed approximately 10^3 forms stating that I won't violate it or else they'll kill my kitty cats and let the air out of my tires. Oh, and chop off my big toe.]

With that said, I can't stop dreaming about my rotation. Seriously. I either dream about psychiatry, psychiatric patients, the other students on this rotation with me (which, despite popular-but-ridiculous belief, I have NO CONTROL OVER and it does not mean that I want to jump their bones in any way, shape or form), or marriage. For instance, I recently dreamed that Scott and I got married and moved to Australia, where I had to take Step One again (the horror!) and Scott's personality changed so that he was a completely different person. He was also wearing yellow capri pants, which was very disturbing. And then last night I dreamed that every person I talked to exhibited an inappropriate affect. This is when someone laughs as they tell you about the death of a person close to them, or smiles at strange points in the conversation - it also applies for crying or being sad at weird times as well. So everyone in my dream had an inappropriate affect, and I would point at each one of them and declare, "Inappropriate affect!" I don't think I'm right in the head, y'all.

Re: Future blogging - I bought a book called The Book Of Myself - A Do-It-Yourself Autobiography in 201 Questions, and I think I'll answer some of the questions here from time to time. Because y'all want to know me better, right? And I want to do a better job of chronicling my past and my thoughts about things. The questions are things like this:

• This is the profession that I often considered as a teenager and how I learned about it
• I was very hurt by this person I counted as a friend
• If I had any trouble with my mother/father when I was young, it was in this area
• This is how I met my sweetheart and fell in love

Just stuff like that. What do you think? Do you think that type of thing would make for interesting posts? Give me some feedback, please. I really wish that each of my parents would fill out one of those books for me. I love hearing about their childhood and early years together, and stories about family members - not just genealogy - I like the narratives.

All right, I'm off to a substance abuse lecture. Whee!