psyyyyyych!

So here in Allentown, PA, they have my friend J-dawg and I shuttled between a bunch of different hospitals. Same hospital network, almost like different campuses. Funny we live across from the one that's the least put-together and fancy! But we get to live on "17th and Chew," and come on, Chew is THE funniest name for a street. Chew. Good 'ol Chewy.

So for the past few days I've been wondering just what is my role here. J-dawg is on Adult, and I have Adolescent; so at the end of the day we compare notes about our patient experiences. I am more of an observer of psychiatric evaluations and group therapy at this point, while she's sent in to do mental status exams by herself. Although today I did get to tutor a kid with his Chemistry homework, and we both grasped it so much better by the end of it than when we started that it was one of those near-magical times. He asked me if I was going to be around tomorrow, but of course I gotta be shuttled over to inpatient instead.

J-dawg and I definitely have stories to share. We're pretty alarmed by the fact that after only 3 and a half days, Suicidal Ideation has now been abbreviated to SI. Actually, that happened for me on day 1 and 1/2; so many of the teens had either come in for it or have it now. And we start of sentences with "So today in Group..." as if we actually are IN group therapy.

I have so many feelings fly through me when I'm there in an interview or sitting in at Group that it'd be impossible to catalogue them all. But thoughts for the day at least:
A 15 year old girl came in because of self-cutting. She's extremely insightful about it, telling us she knows it's wrong to do and unhealthy and hurtful to herself, but she's very irrational about it---if she could do it without getting caught, she would. You just feel so bad for these kids because then they say things like "I'm just a piece of shit, and I'm ok with that." You just want to hug them and say, "You are worthy of love and friendship!" As corny as it sounds. It's just such an intense emotional day each day for them; but I see how they interact in group and try to help one another with each others' problems, even though they're so depressed themselves, and I can't help but be impressed by them. And this particular rotation is a lesson in how to F up your children; because almost every single kid has a not-so-lovely family background, from bipolar parents to verbal/physical/sexual abuse. And yet you try to give them skills and medications to cope and deal with life and allow them to see that it can be liveable.

Anyway, I gotta get up at 4:30 AM or something (what is this, Surgery?) to go see Electro-convulsive therapy in the mornin'. That's right, administering a controlled seizure to treat chronic depression.

This rotation is nuts. But we are really liking it.

R.D.

So my patient, R.D., passed away today.

When I first met him, I was surprised. I tried to wake him up, but he was extremely lethargic. He was in the state when you could safely say, just at first look, "This guy is really sick." He had periodic breathing---when I walked in he actually wasn't breathing, then he started hyperventilating; and then he oscillated between the two. I called my friendly intern Tim and he came down to help with the exam. By the end, even the senior was there, asking R.D. who he was, where he was. Sometimes he'd respond, sometimes not.

R.D. had been transferred late at night to our hospital from one that was smaller, with limited equipment. He'd been rushed there because of ventricular tachycardia, and supposedly ventricular fibrillation: his heart was beating super-fast with no coordination to make his blood flow. Just spazzing out; it's extremely dangerous. He'd been shocked back into sinus rhythm. Then he was treated for pneumonia for a few days, and brought here.

I met his wife when we were on rounds. She was really concerned, but she seemed as if she knew what was going on---like she was expecting things to not really go well. Later she told me that she hadn't expected him to survive at the previous hospital. I got to talk to her over the next couple of days, and she told me a lot about R.D.

Yesterday we had her note in the chart that he was DNR for 24 hours, since his living will hadn't been transferred with him, and that's what he'd wanted. It was a solemn and profound moment that she, Tim and I shared in the hallway. Then she left to go home for the night. She told me today that she knew somehow her husband wasn't going to make it much longer.

Today when we'd rounded, his mind had actually been the clearest it had been over the past 3 days---he even gave me a half-smile. His eyes were open a longer amount of time, and he'd responded to the (new and better) attending. But soon he was back to sleep.

Rounds ended, and I updated a bunch of discharge instructions. As I sat down to start lunch, I got a page from my intern that R.D. was about to pass. I rushed over to the acute care unit, and my senior was standing at the nurse's station. He said to me, "I'm pronouncing him deceased right now." So I walked to the room and found R.D.'s wife and son there. And all I really could do was hug them. They said they'd been prepared; his wife said she was relieved. I didn't even know what to say except that I was sorry. They both thanked me for what we did for him, which I feel wasn't really that much. We'd been planning on doing a heart study to figure out how well it was working, but he passed before we could do it. She asked me, "Is this your first?" And I said yes. And she said "Oh, Kate!" And hugged me. I told her it's ok, really---and that I was glad I at least got to meet them. Her husband just passed away, and here she was trying to console me.

I really wish I'd known what to say. He didn't look real, laying in front of me. R.D.'s wife thanked me again; we held hands and talked a little bit, and then we said goodbye. I told her I'd be outside with my senior if she needed anything, and feel bad that was kind of a lie; my senior left after a bit, torn in another direction because there are other patients to see, more paperwork to update. When I came out though, he'd said "Is this your first?" and hugged me. A nurse behind the desk asked me that too, then she told me about her "first." As a nurse, though, you get to know your patient a lot better.

I didn't truly know R.D., but I know that he was loved. That I know for sure.

ok, count 'em up.

In response to my previous post---the gals on the heart failure service were right about the attending. On Tuesday he let his true colors SHIIIIINE. He consistently misinterpret's people's meanings, and turns it all around to somehow make you look and feel stupid. I'm not even sure if it's intentional or what. But he could try not be completely sarcastic. My amazing intern friend Tim was equally frustrated; he and I talked about how we're supposed to be here to learn, and how can you learn if you're shot down with every question you ask? This Attending's bedside manner also leaves something to be desired---one patient's family even requested that he not be their physician. Like to his face. This occurred when I wasn't there, over the weekend; but then on Monday Bad Attending says to us "So this family is on edge right now." Yeah, that's true, but also, your acting like a D isn't helping them any.

So Tuesday was not such a good day. Bad Attending's attitude made rounds, for lack of a better word, a shit show. Black clouds over everyone. My hot fellow from the Acute service came down the hallway of the acute heart care unit, leading his massive team behind him, and he sees our little Heart Failure black-cloud service in a knot and says, OUT LOUD, "Good morning! (insert some pleasantries I can't remember....pause...then he turns directly towards me and says) You don't look too happy to be here." All I could do was look at him wide-eyed, aware that Tim was trying not to die of laughter internally, and say: "Well..thanks Bob!" Yeah, thanks a LOT Bob! Right in front of the Attending! I wasn't going to deny it. He caught my eye later on and I gave him a cross between "I'd like to kill you now, Bob" and "That was perfect comedic timing and I also thought it was funny" look.

The day was so bad that the next day my Senior Resident, loveable geekazoid who likes to teach a little too much (ahem, drags the teaching point so far that you're like "ok, ok, I get it...you're an academic!), cryptically offered to buy me coffee and then led me outside to a bench. I was scared he was going to ask me out or something, honestly. Then he says "What's going on between us?" And I say, "Well..what do you mean, Burt?...Oh yesterday?! Sorry if I was kinda edgy, it was a bad day." We'd already established that the day of, but then a misunderstanding the next day led him to confront me on if "we were cool or not."

When a bunch of people get together and have to act like a team, its success is so dependent upon individual personalities that it leads to ridiculous results sometimes. And yet the work gets done.

Looseness.
(English just told me to write that)

don't count your chickens

So guess what---the Heart Failure team was VERY different, but it wasn't as bad as the my colleagues made it out to be. Granted, I've only done it for one day; but I think it's all going to be OK. The new attending is just kind of strange; but rounds only last about 3 hours tops, so one can deal with that. I DO miss my amazing Acute Team, but now whenever I see them they joke around with me and say things like "Are you giving them a hard time?" or "How could you abandon us?!" or "Traitor!" The Attending said the last one! And there is hilarity and value to that too; they liked me. I regain some of them over the weekend, so that is nice. I'm just grateful I got to work with them all, period.

My little patient obviously has heart failure. She is just a wonderful little lady who needs a lot of support. She's been in house for over 2 weeks, and she just wants to go home---but it's heart failure, so we have to monitor her closely, and it's not like she can just walk around a ton either. She's just not completely stable yet, but hopefully she is getting there. Today I got to help her do a lap around the nurse's station while supporting her, and we talked about her family. She even gave me a prayer card, a novena to Our Lady of Guadalupe (she liked that I was Catholic...I mean, I'm a Chreaster at best, but as the Suzer says, I am from a Catholic culture anyway. You don't get rid of that).

The cool part about the heart failure team is that you have time to actually go talk to the patient. I feel bad today though, I was supposed to see my other younger and pretty anxious patient before I left too, but her family was there and talking to a different team at the time, and then I didn't go back because I'd gotten sidestracked by a meeting. I got all the way home and wanted to kick myself because I hadn't stopped back to see her as I'd planned. Tomorrow I'll just have to stop twice as much, so a collar-popper told me today.

Another day tomorrow!

heart failure failure?

So...tomorrow I switch to the Heart Failure team, leaving my beloved Acute Cardio team with its always-willing-to-listen-to-you-and-teach-you attitude behind. The reports I've received from my colleagues who've suffered through 8 days of the Heart Failure team are very discouraging. The Attending doesn't listen to you when you present, the team will see your patient in the middle of the day without even paging you, and a resident was cleverly cruel to one of the sweetest gals on the planet on a daily basis.

So for 2 days only do I have to deal with the undercover-mean resident on this wacky team. Then I get back my loveable geeky Senior and my sweetheart of an intern, who'll be switching to Heart Failure from Acute on Saturday. But for FOUR days I have to deal with the frickin lame Attending who apparently makes you feel like he doesn't give a crap about you when you're there but makes you feel like you're supposed to be there when you're not. I hear he's socially awkward. I can't wait til I'm rid of him, honestly.

I just don't understand a couple of things about this profession. First, why on earth would one accept the position of Attending if one had no interest in teaching? Second, how does trashing the med students make you "look good" as a resident? That's f-ed up. And third, if I do have a bad experience on this team, will I have the audacity to stand up for my rights and be able to do so in a professional way? I'm investing too much time and paying way too much money to waste four days.

The patients are what kept the gals on the Heart Failure team sane. I'll just have to look to them, work hard for their benefit, and do my best.

Cross your fingers kids.

step it up already!

So I've been on the Acute Service for Cardiology for a week now. And last week we had an amazing Attending--albeit a little bit slow. Last Tuesday we rounded for 8 hours...it was unbelievable. But we just had so many patients, and this Attending is so patient and willing to answer questions and not hurry people along. Now the new Attending is this younger guy who's ALSO totally amazing. But after one day of longer rounding because he had to get to know the new patients, he had us out in about 4 hours today! I was floored.

I haven't been blogging as I should lately because the Acute service is SO BUSY. People comin in left and right with chest pain and shortness of breath and EKG changes and elevated Troponins and arrythmias up the yin yang! But all in a day's work.

Today I took SO long on a note for one of my patients that two guys on a surgery team, when they were passing me by, said, "Wait...you're still here?! You were here when we rounded!" (Which is also funny because surgery rounds last like an hour TOPS) And it was true. I must've spent at least 50 minutes on this woman's exam and note. But dude she has literally 20 medications to write up, and new chest x-ray results! And abnormal things! Sheesh! Still, once I get to the point where it's seeing 7 patients in 45 minutes, I'm sure my notes will get reaaaaally crappy...along with my handwriting.

Gotta sleep! One more day of Acute service with the best Resident ever (she's just SO chill), the super-geeky-funny Senior, the dreamy Mc-dreamerson Fellow and the wise-cracking young Attending.

Gosh, how I'll miss the team!

GO TEAM!

So something I really like about Medicine is the teamwork. It was never made as real to me as it was today---when we rounded for 8 HOURS. We took a 25 minute break in between, but still. After, without our Attending, our team had a pow wow and brainstormed efficiency. We'll see how things work out tomorrow; hopefully for the better. But it was just great to see residents trying to even out their patient load and just a common friendliness and team spirit. I like being a part of that. My only problem is that I get really attached to teams very easily, and when we're done with our 7 days or 14 days or 20 days or whatever the rotation may be, you have to say goodbye. Bittersweet because you have the excitement of a new team, but you kinda miss the ties that are quickly formed between people who have to come together to make decisions about caring for other people.

Right now I have one patient; he's an amazing little guy who came in with what we think is a recent heart attack---but it had such strange symptoms that if he'd not come in for a different reason originally, we never woulda known about it. Right now he's doing so well! And he and his wife are just cute, quality people. It's still just a bit unnerving when you have your "own" patient---like ohmigosh, I don't know how to MANAGE people! I MIGHT know what the disease process is...but I gotta know how to TREAT the person?!

Of course, there is an entire chain of onlookers who have your back. So the responsibility is both terrifying and rewarding.

It helps when your Fellow (see, for a Medicine subspecialty like Cardiology, first you are a resident, then an Internal Medicine physician, then you can get a fellowship in Cardiology---to become a cardiologist. I think that's how it goes. I digress.) Ahem. It helps when your Fellow is one of the dreamiest people you've ever seen in your life. Or maybe that's a bit of a hindrance...

I'm proud of this one

Enough of this nonsense. If you click on these things you're in for a lot of wasting time! But fun-times.

The Movie Of Your Life Is A Cult Classic

Quirky, offbeat, and even a little campy - your life appeals to a select few. But if someone's obsessed with you, look out! Your fans are downright freaky. Your best movie matches: Office Space, Showgirls, The Big Lebowski

If Your Life Was a Movie, What Genre Would It Be?

who knew?

Who knew I was such a shape shifter!! Come on, you know I'm the love of your life.

Your Seduction Style: Fantasy Lover

You know that ideal love that each of us dreams of from childhood? That's you! Not because you posess all of the ideal characteristics, but because you are a savvy shape shifter. You have the uncanny ability to detect someone's particular fantasy... and make it you. You inspire each person to be an idealist and passionate, and you make each moment memorable Even a simple coffee date with you can be the most romantic moment of someone's life By giving your date exactly what he or she desires, you quickly become the ideal lover. Your abilities to make dreams come true is so strong, that you are often the love of many people's lives. Your ex's (and even people you have simply met or been friends with) long to be yours. No doubt you are the one others have dreamed of... your biggest challenge is finding *your* dream lover.

What Kind of Seducer Are You?

Samsonite?! I was WAY off!

There's not enough of an age gap between my brother and me for this to be possible. Also, turns out I should've published that 8th grade poetry of mine:

You Are Likely a Third Born

At your darkest moments, you feel vulnerable. At work and school, you do best when you're comparing things. When you love someone, you tend to like to please them. In friendship, you are loyal to one person. Your ideal careers are: sales, police officer, newspaper reporter, inventor, poet, and animal trainer. You will leave your mark on the world with inventions, poetry, and inspiration.

The Birth Order Predictor