time is passing

I finished psych and somehow survived inpatient medicine. My very first day I cried in front of both my R2 and R3 as if one was not enough. I felt so overwhelmed by my patients problems and didn't have the slightest idea of where to begin. I scored my book trying to find an answer - at least one. the fear of failure, embarrassment, and not being able to help my patient spinning thru my head, like a mantra, that gradually wore me down to the point where I could hardly contain my tears from welling in my eyes and my there it all went i couldn't' breath and i felt my body convulsing with all the emotion I had been working so hard to keep inside. of course my poor resident didn't know what to do with me - a crying, convulsing medical student, he quickly apologized profusely, and felt horrible as if it had been his fault that i was crying. somehow i was able to stop and I he walked me thru the patients list of problems and sent me home. the days to follow were not as agonizing but difficult nonetheless. In my three weeks I had three case of EtOH Cirrhosis complicated by varices, HCC, ascites, etc. One patient with intractable orthostatic hypotension and diabetic autonomic neuropathy, and one with SLE. It was my own patients and all the patients in between that i took home with me emotionally everyday, I carried them with, and couldn't let them go. I still can't. The old man who lives alone, family and children nowhere to be found, he uses a walker to make his way across the street to where he says there is a restaurant where he occasionally eats since his arthritis is so bad in his feet, hands, back, elbows, knees he really can't do anything for himself. He tells us, they've tried everything, just let me go, there is nothing you can do. We beg him to let us call a rheum consult, to let us try to take him out of his pain. Really all we wish we could do is take him home and take care of him as our own, to feed him, listen to him, and give him love. He's so frail yet so full of spirit inside that we can see pushed to the back from being in pain. We walk away from the bed, as a team, with heavy hearts, and push it behind us, to linger in our minds for the days to come until it is replaced by yet another patient whom we feel hopeless for. On my last day of inpatient, I wanted to say goodbye to my little drunk as I liked to call him. He wouldn't wake up from sleep, so i whispered to him that I wished him the best and that I wished he would get better and stop drinking. I don't know when he'll be able to get leave, or where he'll even go to. No body wants him, and he is ready to go right back to the bottle. can you help someone who doesn't know they need help? or who doesn't want help? the days were long and arduous, climbing up stairs and downstairs, constantly on the move, constantly brimming with things to do and peole to see.
Now on outpatient the pace is much slower, my patients are on top of their health and want to be better. My patient gave me a hug today for being so patient with her because she couldn't hear. i can't wait to have my own patients, for whom I've cared for for many years and they know me in and out as i know them in and out. right now its hard to catch up on 25 years and no all of these patients problems. i am up for the challenge. and i am starting to feel smarter everyday even though i only pick up things here and there. one thing is for sure, i will never run out of things to learn.

"crazy stories"

Maybe cuz i didn't really tell you any stories - i just generalized.
lets see - there was the 21 yr artist who after a trip on shrooms said he had an epiphany god had chosen him as the angel to save the world. he expained the government is controlled by the devil and thats why if you look at barcodes, there are barcodes on everything all have 666 in them. also that shrooms, lsd and weed are good they are like brain food, and the reason they are illegal is cuz the devil controls the govt. alcohol and smoking which are bad are legal again its the devil. unfortunatly the devil gets all the best people to work for him and do his work. the pt explained that i was an angel. and so was he obviously, he was like you can't see my wings but they're there, you guys just won't let me do my work he said. he also explained to me that the world is going to end on dec 12 2012 when the aztec calendar ends, god is going to close the gates to heaven - so watch out. he refused meds cuz obviosly if i was an angel controlled by the devil then meds are bad.

lets see there was the guy who looked like a girl who kept talking in different voices. he said he had multiple personalities, one of which was drag queen. and one of his personalities had disappeared and now there was no order in his life, and the other personalities were fighting. one of the personalites was trying to come out of his back. when asked to change personas the pt convulsed and spoke in tongues.

there was the old black man who said he heard voices that told hiim to get naked and run in front of a train.

the woman that thought she had bugs all over her body and had gone to numerous drs even going as far as to save her feces in tuperware to prove to her dr that she indeed had a bug. eventually she had collected so many tuperwares of feces she didn't know what to do with them.

and there are a ton of people who think someone is out to get them, they are a dime a dozen.

the girl who cut her wrists then tried to say that what really happened is that she had a n itch on her arm and she was just trying to itch it wit h the edge of opened can.

the woman who had no idea where her family was - they found her on the beach totally sunburned and clueless. no drugs invovled and no brain tumor. she's just totally confused. and very sunburned.

and ofcourse ur random scabies. i totally thought i had caught them like three times, i was itching all over.

the guy who chased some people with a machete because he said they were tyring to attack him because he is a major film director, in fact he is the director of the director.

and one of the funnier ones, a man who said he heard cholos i n his head making fun of him and his conversations with other people. can you imagine - cholos in ur head? ur own peanut gallery?

anyways that is all i can think of right now. psych has been great, i learned a lot. and despite the entertainment that somepeople derive from these strange encounters there a lot of people who just sincerely want help. and it happens to everyone not just the poor or the rich or the white or brown.

to trust or not to trust

today i was sent to 8900 to see all the patients decide who can be discharged and kept on. So many of these guys have sad stories and you can see how there social status has put them thru a winding spiral downwards exacerbated by their mental diagnoses. schizo - drug abuse - major depression - bipolar. who is drug seeking? who isn't? did your wife REally die 5 days ago? and you knew her forever? Why aren't you crying? why are you laughing?

Why do you drink? why don't you know the answer? are you agitated because of your disease or because of these conditions?

why doesn't everyone treat you like a human? why are you treated 2nd rate? Not everything you say is crazy or unreasonable. If i were in here I would be just as mad. I would be mad if you told me i was leaving and then turn around and tell me I have to stay.

Doctor says better to be conservative - better to neither trust or distrust -merely protect yourself. we're just shuffling these people around. their problems are much greater than the meds we can prescribe - I don't feel like I'm helping.

Pts:
back pain, depression, wife died plus SI
DUI alchoholic depressed SI
schizo, drinking, noncompliant
schizo, noncompliant homeless
depressed, homeless, agitated

sunburned, confused, sad, worried, want answers.

etc.

the end of the week was really slow. I saw a total of 1 pt in two days. My armenian man continued to stay the same. i came in to the ER to find him naked in one of the seclusion rooms. I told him to put his clothes on and they finally let him out. Its frustrating to me that i can't figure out what's wrong with him and he wants our help so much. i left the hosptial on thrusday feeling bad that i could not help him more. when i came back on friday he was gone. i miss the continuity - i want to know what happens to these people when they leave and how they keep coping with everything.
on friday i went to see ECT - which was pretty i interestesting not as brutal looking as it is in the media. on the other hand i wouldn[t want to try it unless ineeded it.
this weekend was great - i just relaxed. today i am attempting to study but we'll see. i am on a night shift tomorrow. should be interesting.

lessons in patience

today - lets see...i can't even remember what i did yesterday or the day before. today i saw homeless guy pretty depressed he didn't want to eat because he wanted to starve himself to death. It lulled - then i had a pt in the ER sweet old man, he hears voice from cholos in his head that critique conversation and make jokes. like having the peanut gallery in your head. I gave a presentation about MELAS - crazy disorder. it went suprisingly well. passed my boards. hmm....i was so hot during my presenation my cheeks were on fire.
ON some down time one of the pts called me over, a young good lucking kid, only 21, who explained that we're all angels, and that he is the chosen angel. He had a revelation while on shrooms and is now ready to save the world. its sad cuz he's so convinced of all this he doesn't want meds. i don't know if they''ll let him out. and he's so "rational."
After that I calmed down a panic stricken, disorganized Armenian man. I was proud of myself, even though the pt was so agitated, i remained calm, and I kept the pt calm. by the time i was finished with the interview and the physical we'd shared a few laughs, and he trusted me. by the time we were all done he just passed out on his bed.
i find it incredibly easy to talk these people. and i actually somewhat enjoy it. i don't know. we'll see.

friday's

I was so exhausted on friday i didn't even write. it was a crazy morning. it started quiet with our regular rounds of the current patients and then by 2pm it was a mad house. there were so many police admissions and three juvenile cases. everyone was running around - except for me. i don't know how but i ended up with no patients. my ist admit took forever. he is a abuser of the system - who declared he wanted to committ suicide who knows - as a means of getting to stay the night somewhere with food for three days or becuase he really is depressed? hard to say. my attending came down on him pretty hard and the patient turned to me and said - what did you say to him? what? why is he being so mean to me? i know you said something to him. and later - i don't even want to look at you right now. you are a back stabber. And in all honesty i didn't say anything to the attending i barely had a moment to present my patient. in any case it made me feel bad that my patient was 'mad" at me. but later i saw him, he got admitted, he was eating and he seemed very happy. They say, if anybody thinks the ER is better than where they live, they must really need help. and we always have to give them the benefit of the doubt.
patients -
young 22 year old, possible SIBD, PNOS, or Schizoprenia early onset
42 year depressed malingerer? homeless?

although not my patients
young woman self diagnosed "bipolar disorder"
homeless latino schizoprenic smelled really bad, PNOS
hippie schizoprenic
screaming woman put in restraints
old man brought in by daughters for dementia

Day two of Psych

Today was better than yesterday. i saw three patients on my own. I was all proud of myself because my patient cried with me - but i think its just part of the business. its not hard to get people who are depressed to cry. i've mastered sigecaps. just gotta learn the drugs now. i was scared to be a lone in the room with one of the patients, the nurse's note said "wants to kill other people" but when i met the guy he was small, tatted up and rather calm. he was what they call a typical patient. homeless, in an out prison, heroin user, and of course, the diagnoses to end all diagnoses - Depressed. I have yet to meet anyone on the ward who isn't! i'm having a hard time reconciling all this drug pushing. i don't see how when someone has depression secondary to a medical condition that giving them a med is truly the answer. does everyone REALLy NEED a med? or are we just fulfilling their desire and not doing what is truly in their best interest? maybe i should have been an DO.
pts> guy depressed after gf dumped him
tatted up excon heroin and voices - psychosis
woman who lost children to cps - depresson and panic disorder

First Rotation ever

TOday I started on PSYCH ER. I was nervous, anxious, excited, scared all at once. I worried I wouldnt' know an answer, not know what to do. All in all it was ok. Lots of sitting, standing, waiting, and pacing. All for the few moments we get to spend with a patient. The first part of the morning we met with the attending, ate breakfast, and then an hour later ate again at the staff meeting. The rest of the day i shadowed one of the 4th years. when it was finally my turn to interview a patient under her supervision i totally bombed. the patient was talking a mile a minute, fidgety and jittery, and i just didn't konw what to say or do. after the 4th year walked me thru the write up i had to present to the attending. He kept saying - no i don't need to know that, what else, ok what else, as i frantically scrambled for words, thoughts, from the sheets in paper in front of me. My patient was drug seeking - and i had not a clue. how did the attending konw? am i so naive? i have a lot to learn. nothign crazy yet. and there are so many acronyms and words and terms and things to keep track of. the physical exam was a joke . listen here listen there feel here feel there and oila done. seems like a lot of bad habits are being learned as we lazify the physical exam it took us two years to learn in medical schoool. Who percusses anymore? who actually saw what they wrote in the chart? its a blur. when i got home i felt so emotional, drained, confused and just brain dead. and i didn't even do anything today. i know tomorrow will be better but wow. so much to learn. ok gotta read about depression now.