Once a medical student has graduated from medical school, he/she has earned the title of "Doctor". They are required to complete only one more year of training, once referred to as an internship (generally the first year of the residency) and completing the third part of the Medical Boards to get a license and practice medicine independently. Nowadays, medicine is much more advanced and one year of an internship is not truly considered adequate training for a person to be a solid physician but legally a person could do this. To be able to practice in one's chosen field and expect to be able to bill an insurance company, one needs to complete a complete residency. Ideally one should become board certified in that area, although this is not always necessary. (One of the reasons they warn people to be so selective about plastic surgeons is that loophole that allows physicians to practice without being board certified or board eligible.)
On "Match Day" every 4th year medical student in the country is given a letter informing them of where they will be doing their residency. During the 4th year, a good amount of time has been spent applying for, and interviewing for residencies. A very complex computer system that matches up the students' preference list with the residency programs' preference list and assigns students to residency programs. This is announced in a big party with a great deal of fanfare where each student goes in front of the class, opens up their envelope and reads where where he or she will be going and in what field. Then they cry and give a speech where they thank their mother and father for bringing them into this world and comment on their friend's Chanel Couture gown and Mariah Carey performs, and...
OK, I made that part up, but there is a lot of celebrating and balloons and banners. People cheer and the few that got stuck in some "transitional year" because they did not match anywhere they wanted try to hide their disappointment. One hopes this does not happen too much, but there are always a few. And there is a keg in the student lounge. No, I am not making that up. Some lucky people even have beers in their mailboxes. After four years of hell they figure these guys have earned it.
That is is beginning of the end. Those last few months, rotations are more lax because the students are making preparations to move, obtain limited licenses in some cases, and filling out A LOT of paperwork. They have their residency assignment so all they need to do is pass, not well, just pass. They are about to earn that long coat and no one is looking back.
And neither did I. I survived the end of the year and graduated. I recieved my four foot long hood, the most coveted of all hoods signifying I had a doctorate degree. I was a doctor now. No one could tell me that I was not smart enough, did not try hard enough or did not have what it took. No one could tell me that I was not allowed to be a doctor, that I needed to be a nurse or needed to know my place in life. I realized that it is true when they say that people can only put limitations on a person if one lets them. This time, I did not let them.
Not that residency was easy. Residency was tough. Taking call is brutal, but psychiatry is often referred to as a "lifestyle specialty" because it is not so abusive and exhausting. Nothing like internal medicine or surgery. And it was what I wanted to do.
As far as changing, I probably changed in those four years more than in medical school. Working with patients who often do not like you for no reason except that you remind them of their mother takes a lot of strength. Learning to cope with verbal abuse, threats, and statements that at times can be downright cruel can be hard to do, but if one cannot learn to do this, one cannot expect to survive in psychiatry. They will be uttered by some patients with reckless abandon. Some will be too psychotic to be able to give a history at all. Some will be violent and require a great deal of caution. I have been assaulted by a patient once, largely unprovoked and I know that it was not her illness that caused it. She was just sociopathic. They will push your buttons, insult you and refuse to cooperate. They will do just about anything they can to get you angry, and sometimes they will. They will hurt your feelings, call you stupid, incompetent, ugly and a litany of expletives that I will refrain from listing. If you let it bother you, you will not survive in psychiatry. It took a lot of changing to learn to feel good about myself and be able to endure this kind of treatment.
Ultimately, my journey through college, graduate school, medical school and residency took me 14 1/2 years to complete. Although I passed Part III of the Medical Board one year into residency and was able to become an independently licensed physician after that, it took me several years after completing my residency to finally complete the process of becoming Board Certified as a psychiatrist, which is the usual process.
Despite anyone who doubted me at some time in my life, I DID catch my dream. It took a lot of soul searching, tearful nights, pep talks by supportive friends and roommates to get there, but I did it. I had a great deal of my own self doubt to overcome and it took years of counselling to work through this and to find the strength to pull through. Many would have viewed the detour that I took through graduate school as a waste of time, but I realized that I was simply not emotionally ready to enter medical school right out of college and had I tried, I very likely would have failed. I left graduate school on good terms with a much higher GPA than I had in undergraduate school which certainly did not hurt in getting me into a more respected medical school either. I feel good about the things I have achieved in these years because I know that I was the one who did it. Maybe I made mistakes, but I fixed them. No one else was left to clean it up. And I did by myself. I am proud of that fact.
So why do I keep a dream catcher hanging over my rear view mirror? The old native American tale was that grandmothers would hang them over their grandchildrens' beds to catch the bad dreams and protect them from their grandchildren. For me it is the opposite. My dreamcatcher is a reminder that I had a dream, I struggled for years to get it, and I caught it. It is a reminder that I can achieve my goals if I really want them. It is a reminder to never give up hope, to appreciate my blessings in life, but to never give up on those things I aspire to.
Never give up on your dreams.
Friday, July 30, 2010
Wednesday, July 28, 2010
The Dream Catcher- Part IV
Surviving medical school was certainly a challenge. The first two years were tortuous in both the amount of information that was thrown at us and that we were expected to learn in a short amount of time. The entire process it to prepare the students to take Part I of the Medical Board exam. THE BOARDS are always on a first and second year medical student's mind. At the end the first two years all medical students are given three weeks to study for this exam which is ultimately the first part of the three stage process that must be completed to become a licensed physician. Learning a specialty is a separate process. Immediately after we took our boards, we were to begin our third year which was the start of our clinical rotations.
During the six week wait until we heard the results of our board exams, we not only had to go on the with the stress of learning how to actually practice medicine in a hospital setting, but worry about if we passed our boards, as if we did not, we were not allowed to continue our third year further and would have to go into remedial classes. Each year there is a specific date when every medical school in the country is notified who did and did not pass. The official scores are sent later. I recall the day that the pass/fail list was to be announced running into the registrars office (she knew us all by name) and had apparently stopped breathing out of sheer anxiety. She looked up at me and said "You can breathe now, you passed." That was when I realized that I was standing in the door holding my breath. I really did not care that much about the actual scores. I just knew I passed and did not need to worry anymore. I thanked her and left. THE BOARDS PART I had been put behind me. Now I could focus on earning that long coat. The one that if you have read my earlier posts, I refuse to wear.
The long coat meaning that I was a physician, not a medical student. Medical students were relegated to short white coats. Not that any of the medical students on the show ER ever wore short coats. There is a reason doctors do not watch ER. We get so irritated with all the gross inaccuracies that occur on that, and all other "doctor" shows that it just makes for a miserable viewing experience. So we watch the Colbert Report.
But back to the crusade for the white coat. The last two years of medical school largely involve following a resident around and slowing learning the ropes of working in a hospital. It is pretty much a junior residency without the same level of responsibility. Oh, and instead of getting paid a moderate salary, we paid out about the same amount in tuition plus room, board and textbooks. Initially we would just follow a resident and play a largely passive role. We were usually assigned some menial tasks to take care of, giving rise to the term "scut monkey" as a common one used to describe the medical student's role on the treatment team. With time, our skills would grow and we would do more of the tasks that we would need to be doing in the "real world" - writing progress notes, orders, physical exams, helping with procedures. We did have some outpatient exposure, but much like a standard residency, most of the work was based on hospital work. This has been a flaw in the training of medical students and residents for some time now as the system has for decades become reliant on the services of residents to care for inpatients. This leaves little time for preparation for what will become the final endpoint for most trainees which is office based work.
Those years did include taking call along with the residents so medical students too, suffered the 36 hour long work days. The frequency of call varied depending on specialty, surgery generally 1:3 and psychiatry 1:6. Most specialties were 1:4. Most work weeks were seven day work weeks, perhaps 6 days a week or we would get one or two days off a month, but the schedules were grueling. It was not just clinical work we were expected to do. Once we got home, we were expected to go home and study up on the various maladies our patients suffered from and review notes from the various lectures we had to attend during each rotation. Attendings varied in their personalities from very inspiring to humorous to verbally abusive and threatening. One had a bad reputation for behaviors that were on the edge of sexual harassment, but woe to the medical student that tried to do anything about it, as his power in the hospital was too great to be overcome.
It was a very trying time. Not just for the crushing workload but from the human aspect. On the first call night I ever took, I saw a severely premature infant nearly die. He had been at a higher level NICU elsewhere because his case was so unstable, while his two triplet brothers were stable enough to remain at the one I was assigned to. He had just been sent back from the other hospital to be with his triplet brothers - so he could be with them when he died. He had heart deformities and was simply too small to survive an operation to correct them. That night he destabilized and I stood there with the whole family, the mother in hysterics, holding her son who was just barely over one pound in size telling him how much she loved him and how she prayed she would see him in Heaven. He made it through that night, and I am not sure how much longer but he was not going to survive. Hard way to start one's clinical rotations in medical school, huh?
Those NICU memories hung heavy on me when I stared down at my much more stable premature son in that heating bed 4 1/2 years ago. But my son now asks me how to operate the gear shift on my car and scares the hell out of me. I think he's fine.
I survived the third year of medical school, and the forth year was not nearly as bad. There was a great deal of time for electives and not the rigid rotations of the third year. There were two months of required "acting internships" in internal medicine where the medical students were expected to take on the role of an intern with the same responsibilities of an intern and those two months were hell but most of my fourth year was much more relaxed and had more of a focus on outpatient areas and more diverse areas of psychiatry. I was even able to arrange to spend a month at another highly respected university in another state doing a rotation on the psychiatric unit there. This was one of the top psychiatric residencies in the country and was an experience I would not have missed for the world. We also had to tackle Part II of the Medical Boards during the 4th year of medical school. This one was not nearly as terrifying as Part I and passing this was not as essential as it could be retaken during residency if need be. I passed Part II without difficulty and was 2/3 of the way towards being licensened as a physician.
I had nearly reached a dream that I had had for some time and never thought I would ever see come true.
To be continued.
During the six week wait until we heard the results of our board exams, we not only had to go on the with the stress of learning how to actually practice medicine in a hospital setting, but worry about if we passed our boards, as if we did not, we were not allowed to continue our third year further and would have to go into remedial classes. Each year there is a specific date when every medical school in the country is notified who did and did not pass. The official scores are sent later. I recall the day that the pass/fail list was to be announced running into the registrars office (she knew us all by name) and had apparently stopped breathing out of sheer anxiety. She looked up at me and said "You can breathe now, you passed." That was when I realized that I was standing in the door holding my breath. I really did not care that much about the actual scores. I just knew I passed and did not need to worry anymore. I thanked her and left. THE BOARDS PART I had been put behind me. Now I could focus on earning that long coat. The one that if you have read my earlier posts, I refuse to wear.
The long coat meaning that I was a physician, not a medical student. Medical students were relegated to short white coats. Not that any of the medical students on the show ER ever wore short coats. There is a reason doctors do not watch ER. We get so irritated with all the gross inaccuracies that occur on that, and all other "doctor" shows that it just makes for a miserable viewing experience. So we watch the Colbert Report.
But back to the crusade for the white coat. The last two years of medical school largely involve following a resident around and slowing learning the ropes of working in a hospital. It is pretty much a junior residency without the same level of responsibility. Oh, and instead of getting paid a moderate salary, we paid out about the same amount in tuition plus room, board and textbooks. Initially we would just follow a resident and play a largely passive role. We were usually assigned some menial tasks to take care of, giving rise to the term "scut monkey" as a common one used to describe the medical student's role on the treatment team. With time, our skills would grow and we would do more of the tasks that we would need to be doing in the "real world" - writing progress notes, orders, physical exams, helping with procedures. We did have some outpatient exposure, but much like a standard residency, most of the work was based on hospital work. This has been a flaw in the training of medical students and residents for some time now as the system has for decades become reliant on the services of residents to care for inpatients. This leaves little time for preparation for what will become the final endpoint for most trainees which is office based work.
Those years did include taking call along with the residents so medical students too, suffered the 36 hour long work days. The frequency of call varied depending on specialty, surgery generally 1:3 and psychiatry 1:6. Most specialties were 1:4. Most work weeks were seven day work weeks, perhaps 6 days a week or we would get one or two days off a month, but the schedules were grueling. It was not just clinical work we were expected to do. Once we got home, we were expected to go home and study up on the various maladies our patients suffered from and review notes from the various lectures we had to attend during each rotation. Attendings varied in their personalities from very inspiring to humorous to verbally abusive and threatening. One had a bad reputation for behaviors that were on the edge of sexual harassment, but woe to the medical student that tried to do anything about it, as his power in the hospital was too great to be overcome.
It was a very trying time. Not just for the crushing workload but from the human aspect. On the first call night I ever took, I saw a severely premature infant nearly die. He had been at a higher level NICU elsewhere because his case was so unstable, while his two triplet brothers were stable enough to remain at the one I was assigned to. He had just been sent back from the other hospital to be with his triplet brothers - so he could be with them when he died. He had heart deformities and was simply too small to survive an operation to correct them. That night he destabilized and I stood there with the whole family, the mother in hysterics, holding her son who was just barely over one pound in size telling him how much she loved him and how she prayed she would see him in Heaven. He made it through that night, and I am not sure how much longer but he was not going to survive. Hard way to start one's clinical rotations in medical school, huh?
Those NICU memories hung heavy on me when I stared down at my much more stable premature son in that heating bed 4 1/2 years ago. But my son now asks me how to operate the gear shift on my car and scares the hell out of me. I think he's fine.
I survived the third year of medical school, and the forth year was not nearly as bad. There was a great deal of time for electives and not the rigid rotations of the third year. There were two months of required "acting internships" in internal medicine where the medical students were expected to take on the role of an intern with the same responsibilities of an intern and those two months were hell but most of my fourth year was much more relaxed and had more of a focus on outpatient areas and more diverse areas of psychiatry. I was even able to arrange to spend a month at another highly respected university in another state doing a rotation on the psychiatric unit there. This was one of the top psychiatric residencies in the country and was an experience I would not have missed for the world. We also had to tackle Part II of the Medical Boards during the 4th year of medical school. This one was not nearly as terrifying as Part I and passing this was not as essential as it could be retaken during residency if need be. I passed Part II without difficulty and was 2/3 of the way towards being licensened as a physician.
I had nearly reached a dream that I had had for some time and never thought I would ever see come true.
To be continued.
Thursday, July 22, 2010
The Dream Catcher- Part III
My interest in psychiatry had been growing during my first year slowly although it was something I never put much thought to when I first entered medical school. My first year was tough and I had been through enough treatment of my own by that point to realize several things about psychiatric treatment. #1- It worked. A patient really could be happy after years of depression and sadness. #2- It was not just witchcraft. There was serious scientific data to back up the treatments used and with neuroimaging a growing science, data showing changes in the brain function and structure in mental illness was becoming quite prominent. #3- People did not have to suffer, so why should they? The treatments available were growing rapidly, bringing the promise of much better qualities of lives for patients who received the right care. I wanted to be a part of that.
Psychiatrists do not talk about their personal lives as they are not there to burden their patients with their issues or bias them in any way. Truth be told, though, a large percentage of them have struggled with mental illness at some point or dealt with it in family members. This is part of what drives them into the field. They know how it feels to hurt. They know how it feels to be told "just get over it" or "you just need to pray more, you're a bad Christian" or "you're weak" and so on. They understand the pain their patients feel when they hear that, and how much harder it makes recovery from illness become. So they know how to listen to their patients and empathize with what they are feeling.
I am no different having struggled with depression on and off for years and finally found myself in the hands of a competent psychiatrist who helped me lock the pain away and move on. The world became a different place, more beautiful, less angry. One that I could more easily separate myself from the negative parts and enjoy what I had. Does that mean that I do not worry about the wars in Africa? Or the unspeakable acts of cruelty that occur in Darfur and the Congo and ask why did I deserve such happiness and why to those women suffer so? No, I still ask that, I still give money to Doctors Without Borders, and hope someday I can take a sabbatical to work with them. But it does not rule my life. I can enjoy the things I have and consider myself blessed.
So I had found I field that I felt called to but was still unsure as I knew that most of my patients were not going to be depressed medical students. I applied for and was accepted to an internship in a program in my city that placed interns in sites that helped underserved populations. I had requested and was placed at a facility that provided housing for homeless mentally ill people. This is one of the finest facilities providing for the homeless that I have ever seen. More than a shelter, they provided permanent housing to persons who were far too ill to be able to tolerate more structured settings and ensured that they were safe, warm and fed. They did monitor their medications although they tolerated medication refusal to some degree. Many of these patients without this facility were wandering the streets, living in boxes, sleeping on grates for heat in the winter. They were leaving themselves open to assault, rape, the elements, and starvation. These were the sickest of the sick patients out there.
I spent the summer helping out with various activities, monitoring the front desk, helping residents out with tasks, but much of the experience was to introduce me to the services available to the needy in the city. I learned a lot there. Like the Antichrist is really a pretty nice guy who will always offer to buy you a pop. Like schizophrenic patients often tell you about having past careers in fields they did not have to fill the void of their empty past. That a patient who is catatonic looks scary, but is pretty much harmless. That mentally ill women who have gone homeless have often been raped, assaulted, mistreated in terrible ways adding PTSD to their already disabling list of diagnoses. That a homeless women without legs who has her wheelchair stolen may get no help from her "sane" neighbors, but that a mentally ill friend may go to the to ends of the Earth to make sure her friend gets a new wheelchair. That just because a patient is mentally ill does not mean they are just crazy and do not deserve respect.
That was when I was certain that I wanted to pursue psychiatry. That was my dream.
To be continued.
Psychiatrists do not talk about their personal lives as they are not there to burden their patients with their issues or bias them in any way. Truth be told, though, a large percentage of them have struggled with mental illness at some point or dealt with it in family members. This is part of what drives them into the field. They know how it feels to hurt. They know how it feels to be told "just get over it" or "you just need to pray more, you're a bad Christian" or "you're weak" and so on. They understand the pain their patients feel when they hear that, and how much harder it makes recovery from illness become. So they know how to listen to their patients and empathize with what they are feeling.
I am no different having struggled with depression on and off for years and finally found myself in the hands of a competent psychiatrist who helped me lock the pain away and move on. The world became a different place, more beautiful, less angry. One that I could more easily separate myself from the negative parts and enjoy what I had. Does that mean that I do not worry about the wars in Africa? Or the unspeakable acts of cruelty that occur in Darfur and the Congo and ask why did I deserve such happiness and why to those women suffer so? No, I still ask that, I still give money to Doctors Without Borders, and hope someday I can take a sabbatical to work with them. But it does not rule my life. I can enjoy the things I have and consider myself blessed.
So I had found I field that I felt called to but was still unsure as I knew that most of my patients were not going to be depressed medical students. I applied for and was accepted to an internship in a program in my city that placed interns in sites that helped underserved populations. I had requested and was placed at a facility that provided housing for homeless mentally ill people. This is one of the finest facilities providing for the homeless that I have ever seen. More than a shelter, they provided permanent housing to persons who were far too ill to be able to tolerate more structured settings and ensured that they were safe, warm and fed. They did monitor their medications although they tolerated medication refusal to some degree. Many of these patients without this facility were wandering the streets, living in boxes, sleeping on grates for heat in the winter. They were leaving themselves open to assault, rape, the elements, and starvation. These were the sickest of the sick patients out there.
I spent the summer helping out with various activities, monitoring the front desk, helping residents out with tasks, but much of the experience was to introduce me to the services available to the needy in the city. I learned a lot there. Like the Antichrist is really a pretty nice guy who will always offer to buy you a pop. Like schizophrenic patients often tell you about having past careers in fields they did not have to fill the void of their empty past. That a patient who is catatonic looks scary, but is pretty much harmless. That mentally ill women who have gone homeless have often been raped, assaulted, mistreated in terrible ways adding PTSD to their already disabling list of diagnoses. That a homeless women without legs who has her wheelchair stolen may get no help from her "sane" neighbors, but that a mentally ill friend may go to the to ends of the Earth to make sure her friend gets a new wheelchair. That just because a patient is mentally ill does not mean they are just crazy and do not deserve respect.
That was when I was certain that I wanted to pursue psychiatry. That was my dream.
To be continued.
Sunday, July 18, 2010
The Dream Catcher - Part II
The whole idea of going to medical school in the first place was a fairly radical idea when I first came up with it. In the early 70's girls went to nursing schools to be nurses and boys went to medical school to be doctors. That was the way it was. Girls did not like science, boys did. All the resistance I got from the people around me made me even more determined to pursue a career in a scientific field. And it would NOT be a "female oriented" field at that. Nursing was out. In my years, I have grown to realize how skilled and talented nurses really are, but at that time they were undervalued andlargely held back in their ability to achieve by the system and the sexism in said system.
Entering college to study chemistry probably raised more eyebrows than medical school did as this was the 80's and there was still the relative prohibition on women entering scientific fields. By the time I entered medical school in the ninety's, 40% of our entering class was women and that trend was being seen nationwide. Not to say that I did not experience some attendings and instructors who obviously favored my male counterparts. There were some, but for the most part, I did not see the resistance that I would have expected.
Entering medical school was one of the most nerve wracking things I have ever done. Certainly I was excited, but the was far more intimidating than college. Unlike undergraduate school where I made every effort to avoid attending orientation activities, preferring to socialize and party, I went to every one here. I had no idea what to expect but from having roommates who were medical students, I knew it could be Hell. We were told numerous times during orientation that medical school is a life changing event. I scoffed at the idea, believing that once we were adults, our personalities were fundamentally set in stone and while maybe we would be modified, nothing could fully change us.
I was wrong.
I was still shy when I entered medical school, but not as shy as I was as a child. I was still moody, emotionally labile but certainly more mature than I had been at the age of seventeen when I entered college. By then I had sought out help for my moods and was on a much more even keel and more prepared to take on a challenge like this.
Medical school has a lot of ways of breaking one's spirit and hardening one's stomach. Weak stomachs just do not fly well in medicine, even in psychiatry. Gross anatomy is the most obvious example. In pretty much every medical school that I have ever heard of, the very first day starts with a gross anatomy lecture for one hour, then the class is sent up to gross anatomy lab to begin their first cadaver dissections. Three hours later, an instructor comes in and says something to the effect of "Time's up! Take an hour for lunch and be back in the lecture hall for biochemistry lecture." Formaldehyde and meat do not make for a very appetizing combination. Formaldehyde and anything for that matter do not mix well but meat, especially attached to bones is pretty nauseating. Like chicken. I did not eat meat for weeks. I still do not particularly like chicken legs and that was 18 years ago.
I did not enter medical school with the intentions of being a psychiatrist. I had actually wanted to be a trauma surgeon, something with is pretty much the antithesis of a psychiatrist. I was told of the long hours, grueling call schedules and emotionally abusive training techniques used in surgery residencies, but I was sure that I had what it takes. I knew that to have any hope to get into a surgery residency, one would have to be at or near the top of one's class. I was doing fairly well early on although the long hours of studying was getting to me. I am not good at rote memorization and the early classes like gross anatomy were basically that. I did my best to keep up but near the end of my first semester received the word that a close friend from college who had been quite ill from cancer had taken a turn for the worse. I had been able to spend only a few minutes with him in the hospital, 200 miles away from home while attending a friend's wedding. As usual, the pressures of medical school were always there and I had to rush home to resume my studies.
It was only a few days later that one of my roommates left me a post it note on my door stating that my friend had passed away. It was just a few days shy of his 31st birthday. Another trip back to my old college haunt with a quick exit back home ensued leaving my friends from college disappointed but there was too much at stake to sacrifice any more study time than I already had. As expected, my grades plummeted along with any hopes of being a trauma surgeon.
I had been a lucky person to have never had to deal with a lot of death in my life up until then. Only two great-grandmothers who I did not know well when I was quite young and a couple of hamsters. Losing a friend so young was devastating to me. It gave me nightmares. I carried all my books and spent the next few nights at my mother's, making the much longer drive to class for her comfort. My late friend had always pushed me to go into hematology-oncology to help people like him. Seeing my friend who was once a healthy army reserve corpsman who still went on active duty in the summer reduced to skin and bones with no energy and his eyes sinking in his head made me all the more determines that I was not going to go into heme-onc. I could not watch my patients leave the world like this.
I never failed a class in medical school and despite this setback pulled through intact. My emotions were shot, I went through countless antidepressants and when I went to the end of semester parties, I went overboard. But I eventually pulled myself together. With time I came to the realization that I had been changed after that experience, though. I was stronger, I knew how to keep my composure when I was internally a wreck, but I also learned that medicine was sometimes rather cruel to the providers.
Save for that outlying event, the first two years of medical school for the most part were a blur. We would go to class, go the lab, study, repeat. Then we would take an exam and repeat the process. It was exhausting, very damaging on our relationships with our friends and families outside of medical school but so constant that one did not really notice time passing.
During that time, I did start to realize that I did not want to be a surgeon. Not only were my grades not high enough to pull it off, but I started to realize that I really did not want to become a lifelong slave to my job. I love my work, but I have a family and a life that I love also, and I want to live it. I knew that the seven or more years spent in medical school and residency were a sacrifice in my life that I would make for my future, but once completed, I really did not relish the idea of working 80 hour weeks for the rest of my life. Even if that did mean not ever owning a Ferrari like the ones that show up on the doctor's lot at work. My little Audi makes me quite happy and is a lot more than many people will ever have. I am thankful for it and the many other things I have in life. Sure, I earn significantly less, but I work a 40 hour work week, and I am home to have dinner with my family every night.
So I was still on track to be a physician, just a different kind, and I was still out to catch that dream.
To be continued...
Entering college to study chemistry probably raised more eyebrows than medical school did as this was the 80's and there was still the relative prohibition on women entering scientific fields. By the time I entered medical school in the ninety's, 40% of our entering class was women and that trend was being seen nationwide. Not to say that I did not experience some attendings and instructors who obviously favored my male counterparts. There were some, but for the most part, I did not see the resistance that I would have expected.
Entering medical school was one of the most nerve wracking things I have ever done. Certainly I was excited, but the was far more intimidating than college. Unlike undergraduate school where I made every effort to avoid attending orientation activities, preferring to socialize and party, I went to every one here. I had no idea what to expect but from having roommates who were medical students, I knew it could be Hell. We were told numerous times during orientation that medical school is a life changing event. I scoffed at the idea, believing that once we were adults, our personalities were fundamentally set in stone and while maybe we would be modified, nothing could fully change us.
I was wrong.
I was still shy when I entered medical school, but not as shy as I was as a child. I was still moody, emotionally labile but certainly more mature than I had been at the age of seventeen when I entered college. By then I had sought out help for my moods and was on a much more even keel and more prepared to take on a challenge like this.
Medical school has a lot of ways of breaking one's spirit and hardening one's stomach. Weak stomachs just do not fly well in medicine, even in psychiatry. Gross anatomy is the most obvious example. In pretty much every medical school that I have ever heard of, the very first day starts with a gross anatomy lecture for one hour, then the class is sent up to gross anatomy lab to begin their first cadaver dissections. Three hours later, an instructor comes in and says something to the effect of "Time's up! Take an hour for lunch and be back in the lecture hall for biochemistry lecture." Formaldehyde and meat do not make for a very appetizing combination. Formaldehyde and anything for that matter do not mix well but meat, especially attached to bones is pretty nauseating. Like chicken. I did not eat meat for weeks. I still do not particularly like chicken legs and that was 18 years ago.
I did not enter medical school with the intentions of being a psychiatrist. I had actually wanted to be a trauma surgeon, something with is pretty much the antithesis of a psychiatrist. I was told of the long hours, grueling call schedules and emotionally abusive training techniques used in surgery residencies, but I was sure that I had what it takes. I knew that to have any hope to get into a surgery residency, one would have to be at or near the top of one's class. I was doing fairly well early on although the long hours of studying was getting to me. I am not good at rote memorization and the early classes like gross anatomy were basically that. I did my best to keep up but near the end of my first semester received the word that a close friend from college who had been quite ill from cancer had taken a turn for the worse. I had been able to spend only a few minutes with him in the hospital, 200 miles away from home while attending a friend's wedding. As usual, the pressures of medical school were always there and I had to rush home to resume my studies.
It was only a few days later that one of my roommates left me a post it note on my door stating that my friend had passed away. It was just a few days shy of his 31st birthday. Another trip back to my old college haunt with a quick exit back home ensued leaving my friends from college disappointed but there was too much at stake to sacrifice any more study time than I already had. As expected, my grades plummeted along with any hopes of being a trauma surgeon.
I had been a lucky person to have never had to deal with a lot of death in my life up until then. Only two great-grandmothers who I did not know well when I was quite young and a couple of hamsters. Losing a friend so young was devastating to me. It gave me nightmares. I carried all my books and spent the next few nights at my mother's, making the much longer drive to class for her comfort. My late friend had always pushed me to go into hematology-oncology to help people like him. Seeing my friend who was once a healthy army reserve corpsman who still went on active duty in the summer reduced to skin and bones with no energy and his eyes sinking in his head made me all the more determines that I was not going to go into heme-onc. I could not watch my patients leave the world like this.
I never failed a class in medical school and despite this setback pulled through intact. My emotions were shot, I went through countless antidepressants and when I went to the end of semester parties, I went overboard. But I eventually pulled myself together. With time I came to the realization that I had been changed after that experience, though. I was stronger, I knew how to keep my composure when I was internally a wreck, but I also learned that medicine was sometimes rather cruel to the providers.
Save for that outlying event, the first two years of medical school for the most part were a blur. We would go to class, go the lab, study, repeat. Then we would take an exam and repeat the process. It was exhausting, very damaging on our relationships with our friends and families outside of medical school but so constant that one did not really notice time passing.
During that time, I did start to realize that I did not want to be a surgeon. Not only were my grades not high enough to pull it off, but I started to realize that I really did not want to become a lifelong slave to my job. I love my work, but I have a family and a life that I love also, and I want to live it. I knew that the seven or more years spent in medical school and residency were a sacrifice in my life that I would make for my future, but once completed, I really did not relish the idea of working 80 hour weeks for the rest of my life. Even if that did mean not ever owning a Ferrari like the ones that show up on the doctor's lot at work. My little Audi makes me quite happy and is a lot more than many people will ever have. I am thankful for it and the many other things I have in life. Sure, I earn significantly less, but I work a 40 hour work week, and I am home to have dinner with my family every night.
So I was still on track to be a physician, just a different kind, and I was still out to catch that dream.
To be continued...
Wednesday, July 14, 2010
The Dream Catcher- Part I
Hanging from my rear view mirror is two items. In the state of PA, hanging things from the rear view mirror is apparently illegal, but a minor infraction that I have chosen to commit for my own reasons. I figure if I get called on it, I will probably be answering to a much worse offense likely involving excessive velocity, and will be too busy kissing major butt of the police officer to even worry about it. If he calls me on it, I will play the stupid Buckeye immigrant and state that I am from out of state and I was never made aware of such an ordinance but I will immediately comply, yes sir, no sir, whatever you say sir, and so on. I once pondered doing the "right thing" and removing them, but both these items carry meaning to me and are more than just mere decorations. To remove them would be to remove an important reminder of the journey I have taken in life and an important symbol in my life.
According to "The Official Preppy Handbook", the only appropriate item that may be seen hanging on the rear view mirror of a truly preppy car is "nothing, ever." "The Official Preppy Handbook" was a popular book when I was in high school, meant to be the ultimate resource for all that was the prep culture. Of course, it was quite tongue in cheek. It was the first book that introduced the idea that preppy was more than just their clothes. It was the entire culture of the old money network in this nation that has built up over generations. The preppy style of clothing was all the rage at the time. Of course, few of us really knew what it meant to be a true "Prep" as it were. We just all lusted after Lacoste polo shirts and Lilly Pulitzer bags. My mother bought me this book which is where I learned the true meaning of preppy. For some reason, I always remembered this quote, along with quite a few others, but this one is the one relevant in this case.
I do not recall all of the cars that were listed as appropriate preppy cars, but I do remember that Volkswagen was listed, and as an Audi is the luxury line of Volkswagen, I will assume that it could count as a preppy car. (Not that an Audi is to any degree an expensive Volkswagen.) So I do have what would probably pass for a preppy car, save one element- the violation of the no rear view mirror decoration prohibition.
Not that I could be interpreted in any way shape or form as a preppy. I was raised on a steady diet of middle class fare- public school education, car vacations stuffed in the back of a two door Chevy Chevette, and boxed macaroni and cheese for dinner. I would occasionally be able to compel my parents into buying me an article of clothing from the designer du jour but for the most part, it was no name brands for me. At around age 15, I was told that I would be responsible to buy all of my own clothes so if I wanted expensive designer clothes, I had better be willing to beg, borrow or steal a lot to get the money for them myself.
I also knew that I was going to be going to college from as far back as I can remember. I also knew that I was going to be paying for it myself. I recall as a young child being told to save the checks I received as gifts on my birthday or holidays for my college fund. I grew up with a very steady reminder of how expensive college was but also how important it was to choose my major wisely, to study hard to get into a good school, etc. College was never not an option for me. I never questioned the idea and never really wanted to do anything else. I wrote in my school memories book about wanting to be a doctor in my early grades, quite scandalous for a girl in the early 1970's, actually. My choice of vocation changed through the years, but there was never any time when my favored choice did not involve a college education.
I remember one fateful day in the middle of August when my mother and I managed to pack up most of my belongings into the back of a Volkswagen (the non-preppy kind) Rabbit and drove me off to a 10' x 15' dorm room 180 miles away from home. I was 17 years old and very nervous but at the same time, indescibably excited. This was the start of the best five years of my life. I was immature, emotionally unstable, prone to depression and insecure, but what I learned there far exceeded the information in the textbooks I read. I entered college an insecure kid and came out an adult, still not fully grown, but much more ready to take on the world than when I came in.
Paying my way through college during the late 80's was not easy. The Reagan administration did not like the idea of independent students and it was extraordinarily hard to obtain financial aid. Majoring in chemistry was not exactly easy especially when part of my financial aid package included work study and there was simply no hours in the day to work a second job to bring in any more needed cash. Chemistry majors average four laboratory sessions a semester, each three hours long, but only accounting for one credit hour each so the typical 18 semester hour schedule that it took to graduate in four years was completely unmanageable. I was forced to take five years to graduate. I felt defeated and demoralized for making this choice, but in the long run, this allowed me to specialize in biochemistry, take more classes just for the sake of obtaining pure knowledge and do research for credit, exposing me to much more advanced learning than I would not have had otherwise. Not to mention lighten up the crushing schedule of work/study/sleep/repeat.
I had long given up on the idea of going to medical school years prior, being told that I was essentially not smart enough to get in. When I was in college, I started to question my naysayers. I took the blind leap of faith and went through the grueling process of applying for medical school. I was accepted at one school, not the best one, not my first choice, but I was accepted which is better than more than half of the applicants who try to get in.....
...And I chickened out. Medical schools are tough. You fail one class, you are kicked out of the school. No second chances, that is it. One chance only. The whole prospect terrified me. So at the last minute, I changed my mind and applied to graduate school to pursue my PhD in biochemistry. I love teaching, and loved the idea of being the eternal student via being a college professor. After spending 1 1/2 years doing this, I realized that college professors spend more time writing grant proposals and doing research than actually teaching. By that time, I had two roommates who were medical students at the same university as I and had convinced me thoroughly that, yes, I had the aptitude to get through medical school. I will admit that some of those discussions were held after one too many drinks at a hairy buffalo party, so were probably not that coherent, but they made their point. I left graduate school, worked as a lab tech for 1 1/2 years while trying to get into medical school and this time, got into my first choice. This time, I did not chicken out.
I was off to catch my dream.
To be continued...
According to "The Official Preppy Handbook", the only appropriate item that may be seen hanging on the rear view mirror of a truly preppy car is "nothing, ever." "The Official Preppy Handbook" was a popular book when I was in high school, meant to be the ultimate resource for all that was the prep culture. Of course, it was quite tongue in cheek. It was the first book that introduced the idea that preppy was more than just their clothes. It was the entire culture of the old money network in this nation that has built up over generations. The preppy style of clothing was all the rage at the time. Of course, few of us really knew what it meant to be a true "Prep" as it were. We just all lusted after Lacoste polo shirts and Lilly Pulitzer bags. My mother bought me this book which is where I learned the true meaning of preppy. For some reason, I always remembered this quote, along with quite a few others, but this one is the one relevant in this case.
I do not recall all of the cars that were listed as appropriate preppy cars, but I do remember that Volkswagen was listed, and as an Audi is the luxury line of Volkswagen, I will assume that it could count as a preppy car. (Not that an Audi is to any degree an expensive Volkswagen.) So I do have what would probably pass for a preppy car, save one element- the violation of the no rear view mirror decoration prohibition.
Not that I could be interpreted in any way shape or form as a preppy. I was raised on a steady diet of middle class fare- public school education, car vacations stuffed in the back of a two door Chevy Chevette, and boxed macaroni and cheese for dinner. I would occasionally be able to compel my parents into buying me an article of clothing from the designer du jour but for the most part, it was no name brands for me. At around age 15, I was told that I would be responsible to buy all of my own clothes so if I wanted expensive designer clothes, I had better be willing to beg, borrow or steal a lot to get the money for them myself.
I also knew that I was going to be going to college from as far back as I can remember. I also knew that I was going to be paying for it myself. I recall as a young child being told to save the checks I received as gifts on my birthday or holidays for my college fund. I grew up with a very steady reminder of how expensive college was but also how important it was to choose my major wisely, to study hard to get into a good school, etc. College was never not an option for me. I never questioned the idea and never really wanted to do anything else. I wrote in my school memories book about wanting to be a doctor in my early grades, quite scandalous for a girl in the early 1970's, actually. My choice of vocation changed through the years, but there was never any time when my favored choice did not involve a college education.
I remember one fateful day in the middle of August when my mother and I managed to pack up most of my belongings into the back of a Volkswagen (the non-preppy kind) Rabbit and drove me off to a 10' x 15' dorm room 180 miles away from home. I was 17 years old and very nervous but at the same time, indescibably excited. This was the start of the best five years of my life. I was immature, emotionally unstable, prone to depression and insecure, but what I learned there far exceeded the information in the textbooks I read. I entered college an insecure kid and came out an adult, still not fully grown, but much more ready to take on the world than when I came in.
Paying my way through college during the late 80's was not easy. The Reagan administration did not like the idea of independent students and it was extraordinarily hard to obtain financial aid. Majoring in chemistry was not exactly easy especially when part of my financial aid package included work study and there was simply no hours in the day to work a second job to bring in any more needed cash. Chemistry majors average four laboratory sessions a semester, each three hours long, but only accounting for one credit hour each so the typical 18 semester hour schedule that it took to graduate in four years was completely unmanageable. I was forced to take five years to graduate. I felt defeated and demoralized for making this choice, but in the long run, this allowed me to specialize in biochemistry, take more classes just for the sake of obtaining pure knowledge and do research for credit, exposing me to much more advanced learning than I would not have had otherwise. Not to mention lighten up the crushing schedule of work/study/sleep/repeat.
I had long given up on the idea of going to medical school years prior, being told that I was essentially not smart enough to get in. When I was in college, I started to question my naysayers. I took the blind leap of faith and went through the grueling process of applying for medical school. I was accepted at one school, not the best one, not my first choice, but I was accepted which is better than more than half of the applicants who try to get in.....
...And I chickened out. Medical schools are tough. You fail one class, you are kicked out of the school. No second chances, that is it. One chance only. The whole prospect terrified me. So at the last minute, I changed my mind and applied to graduate school to pursue my PhD in biochemistry. I love teaching, and loved the idea of being the eternal student via being a college professor. After spending 1 1/2 years doing this, I realized that college professors spend more time writing grant proposals and doing research than actually teaching. By that time, I had two roommates who were medical students at the same university as I and had convinced me thoroughly that, yes, I had the aptitude to get through medical school. I will admit that some of those discussions were held after one too many drinks at a hairy buffalo party, so were probably not that coherent, but they made their point. I left graduate school, worked as a lab tech for 1 1/2 years while trying to get into medical school and this time, got into my first choice. This time, I did not chicken out.
I was off to catch my dream.
To be continued...
Sunday, July 11, 2010
Thing You Really Hear on a Psychiatric Unit
Now for the good stuff. Weird things get said on the psychiatric unit. Patients say weird things. Staff says weird things. Weird things happen. To be honest, weird things happen in med/surg units of the hospital, but the difference is med/surg people do not always appreciate it. Sometimes it scares them, sometimes it annoys them. They do not always understand what is a threat or not but if the behavior seems grossly psychotic, they tend to get uncomfortable and want it fixed.
When a patient who always believes he is God was admitted to the medical floor for legitimate medical problems, he acted the same way he always did. He stood by the door of his room blessing people. He did not threaten anyone or do anything that could in any way be interpreted as dangerous. He just stood at the door with his hand up in the air saying things like "Bless you, my child." That seemed pretty nice to me. The nurses did not think so and called for a consult about what to do to curtail this behavior. They were not happy with the response they were given. Our response was this was a fixed delusion, and no amount of medication was going to change that. He was not a danger to himself or anyone else and there was little that could be done to stop him from blessing people. We did advise that they were free to request that he remain in his bed because he needed rest. We also advised them they had the right to make the request that he not bless people in the hall of a hospital but beyond that, they were stuck treating God. But maybe it might buy them some brownie points with the Big Guy in the future.
Psychiatric units are fraught with bizzare comments, occurences and events that the workers tend to relish and retell with great joy. Here are some examples of things that I have actually heard on a psychiatric unit:
1) Pt X gave himself a swirly in a suicide attempt. (Given in morning nursing report.)
2) You will just have to accept the fact that I am Jehovah.
3) It's the beta rays doing it.
4) Are you one of those King James politicians?
5) He's got his underwear on now - on his head. (Before that he was naked so it was an improvement.)
6) Are you sure you want to see pt Y? Because he's naked.
7) Hey, this is an emergency! I'm hearing voices and he's hearing the same ones.
8) Am I naked? (No, you are not and we thank you for that.)
9) You've got a big butt! (Said by a patient to a nurse by the way.)
10) No one brought in me a bra. Can I use two spent nicotine patches as pasties?
11) No, really man! I'm not paranoid! I've just gotta get out of here before these people kill me!
12) There's a party going on in his head. (Description of a patient who had more visitors at one time than the rest of the unit combined. The problem was that none of them were real, but that did not stop him from having ribald discussions with them at all hours of the day and night.)
13) I am having normal bowel movements and so is the rest of my family. (Good you keep the lines of communication open.)
14) I don't hear voices. I just hear God talking to me.
And perhaps my all time favorite:
15) I need your help. I am a former Agent for Special Forces and they have me locked up in here against my will. I need you to get Delta Force to come up here and bust me out before they assassinate me. (Phone conversation between patient and, most likely, unprepared receptionist at the Pentagon. No, I am not kidding.)
To fully enjoy this kind of comment requires being there first hand and does not fare so well when retold by another which is why one has to actually work on a psychiatric unit to get these kinds of stories. Even with that, I will always maintain that psychiatrists have the best stories to tell.
When a patient who always believes he is God was admitted to the medical floor for legitimate medical problems, he acted the same way he always did. He stood by the door of his room blessing people. He did not threaten anyone or do anything that could in any way be interpreted as dangerous. He just stood at the door with his hand up in the air saying things like "Bless you, my child." That seemed pretty nice to me. The nurses did not think so and called for a consult about what to do to curtail this behavior. They were not happy with the response they were given. Our response was this was a fixed delusion, and no amount of medication was going to change that. He was not a danger to himself or anyone else and there was little that could be done to stop him from blessing people. We did advise that they were free to request that he remain in his bed because he needed rest. We also advised them they had the right to make the request that he not bless people in the hall of a hospital but beyond that, they were stuck treating God. But maybe it might buy them some brownie points with the Big Guy in the future.
Psychiatric units are fraught with bizzare comments, occurences and events that the workers tend to relish and retell with great joy. Here are some examples of things that I have actually heard on a psychiatric unit:
1) Pt X gave himself a swirly in a suicide attempt. (Given in morning nursing report.)
2) You will just have to accept the fact that I am Jehovah.
3) It's the beta rays doing it.
4) Are you one of those King James politicians?
5) He's got his underwear on now - on his head. (Before that he was naked so it was an improvement.)
6) Are you sure you want to see pt Y? Because he's naked.
7) Hey, this is an emergency! I'm hearing voices and he's hearing the same ones.
8) Am I naked? (No, you are not and we thank you for that.)
9) You've got a big butt! (Said by a patient to a nurse by the way.)
10) No one brought in me a bra. Can I use two spent nicotine patches as pasties?
11) No, really man! I'm not paranoid! I've just gotta get out of here before these people kill me!
12) There's a party going on in his head. (Description of a patient who had more visitors at one time than the rest of the unit combined. The problem was that none of them were real, but that did not stop him from having ribald discussions with them at all hours of the day and night.)
13) I am having normal bowel movements and so is the rest of my family. (Good you keep the lines of communication open.)
14) I don't hear voices. I just hear God talking to me.
And perhaps my all time favorite:
15) I need your help. I am a former Agent for Special Forces and they have me locked up in here against my will. I need you to get Delta Force to come up here and bust me out before they assassinate me. (Phone conversation between patient and, most likely, unprepared receptionist at the Pentagon. No, I am not kidding.)
To fully enjoy this kind of comment requires being there first hand and does not fare so well when retold by another which is why one has to actually work on a psychiatric unit to get these kinds of stories. Even with that, I will always maintain that psychiatrists have the best stories to tell.
Wednesday, July 7, 2010
Things People Think Are Heard on a Psychiatric Unit But Are Not
There are a lot of misconceptions about psychiatric units in popular culture causing people to have the wrong idea about what really does occur up here. Some of these stem from what really did occur in the past, with the ongoing images of state hospitals remaining in the minds of many people. Some are perpetuated by the entertainment industry. There is a reason that doctors in general do not watch "doctor shows" and the same is true for psychiatrists. There are far too many occurrences that are completely inaccurate and we just end up getting annoyed with the blatant disregard for the truth in favor of a good story. The same goes for movies.
So we frequently experience people who have unrealistic ideas about what to expect from a psychiatric hospital and what services will be provided. The following is a list of some of the things I have run into that patients, referring physicians or family members have expected they would hear, but in reality, never will:
1) I anticipate his length of stay will be about one year. (So you can have a very long vacation.)
2) I will be providing one hour long individual psychotherapy sessions.(As a bonus, I will do this once a day, seven days a week including holidays. I do this for all 19 of my patients.)
3) She will probably need a frontal lobotomy.
4) We have had him in restraints for the past week because he will not take his medicines.
5) Homeless? Sure, we have a special budget for that and will be able to rent you an apartment for a year. Our social worker will help you with that. (Perhaps we can get you a membership to the health club nearby, also.)
6) She has a bad case of OCD and has spent ten years here as a result. She may never go home.
7) Yes, we can involuntarily commit your son to drug rehab after he leaves the hospital here. (Most likely he will stop using heroin and alcohol after he goes there forever and ever, and will marry a beautiful princess and live in a castle, too.)
8) Since you were admitted here you should qualify for the not guilty by insanity plea. We will support you on this. Have your attorney call the doctor. (She might not use any vulgar terms to describe him if he talks real nice to her.)
9) A diagnosis of bipolar disorder means you automatically qualify for disability. All I need to do is sign a form.
10) Get out the straight jacket! Pt X is talking to herself again.
11) I am taking a few blood tests to see if he has a chemical imbalance or not so we know what medicine to put him on.
12) There is a giant bird's nest in his room because he thinks he is a bird. (No, we do not have any issues about this being in there.)
So we frequently experience people who have unrealistic ideas about what to expect from a psychiatric hospital and what services will be provided. The following is a list of some of the things I have run into that patients, referring physicians or family members have expected they would hear, but in reality, never will:
1) I anticipate his length of stay will be about one year. (So you can have a very long vacation.)
2) I will be providing one hour long individual psychotherapy sessions.(As a bonus, I will do this once a day, seven days a week including holidays. I do this for all 19 of my patients.)
3) She will probably need a frontal lobotomy.
4) We have had him in restraints for the past week because he will not take his medicines.
5) Homeless? Sure, we have a special budget for that and will be able to rent you an apartment for a year. Our social worker will help you with that. (Perhaps we can get you a membership to the health club nearby, also.)
6) She has a bad case of OCD and has spent ten years here as a result. She may never go home.
7) Yes, we can involuntarily commit your son to drug rehab after he leaves the hospital here. (Most likely he will stop using heroin and alcohol after he goes there forever and ever, and will marry a beautiful princess and live in a castle, too.)
8) Since you were admitted here you should qualify for the not guilty by insanity plea. We will support you on this. Have your attorney call the doctor. (She might not use any vulgar terms to describe him if he talks real nice to her.)
9) A diagnosis of bipolar disorder means you automatically qualify for disability. All I need to do is sign a form.
10) Get out the straight jacket! Pt X is talking to herself again.
11) I am taking a few blood tests to see if he has a chemical imbalance or not so we know what medicine to put him on.
12) There is a giant bird's nest in his room because he thinks he is a bird. (No, we do not have any issues about this being in there.)
Monday, July 5, 2010
Things Never Heard on a Psychiatric Unit (or at least should not be)
I have mentioned before that psychiatric units are different from other hospital units in many ways. There are two basic other inpatient variants seen in the hospital- units that deal with med/surg issues of various types and intensities, and L&D units. Most of the inpatient units would fit into one of these categories for the most part, mostly med/surg.
Psychiatric units, unlike the above units, do not want our patients in bed, in hospital gowns and expect them to be up and about. Treatment includes groups, one to one interactions and various activities. Patients need to be considered medically stable, meaning they could be sent safely to their home if they did not need psychiatric treatment. If not, we are not able to provide appropriate treatment safely.
To illustrate the difference I compiled a list of things one would never hear on a psychiatric unit. Or if one did, there would be hell to pay.
1) Give him 60mg of morphine IV STAT.
2) Make sure she is NPO (nothing by mouth) after midnight. She is scheduled for surgery at 7:00.
3) She is showing signs of fetal distress. I think we need to prep her for a crash C-section.
4) Suction!
5) I want the patient on total bed rest.
6) Call the family. I am not sure he is going to make it through the night.
7) Forget the alcohol withdrawal protocol! Just give him a beer with each meal tray. (An intervention that I actually did see a surgical team use on a routine basis to prevent an alcoholic from going into withdrawals. Not recommended.)
8) I don't care if he weighs 300 pounds or not. You still have to do a rectal exam on all patients admitted to unit 4west.
9) Mr X pulled his foley out last night- do we need a consult?
10) Ready, one three, everyone lift!
Psychiatric units, unlike the above units, do not want our patients in bed, in hospital gowns and expect them to be up and about. Treatment includes groups, one to one interactions and various activities. Patients need to be considered medically stable, meaning they could be sent safely to their home if they did not need psychiatric treatment. If not, we are not able to provide appropriate treatment safely.
To illustrate the difference I compiled a list of things one would never hear on a psychiatric unit. Or if one did, there would be hell to pay.
1) Give him 60mg of morphine IV STAT.
2) Make sure she is NPO (nothing by mouth) after midnight. She is scheduled for surgery at 7:00.
3) She is showing signs of fetal distress. I think we need to prep her for a crash C-section.
4) Suction!
5) I want the patient on total bed rest.
6) Call the family. I am not sure he is going to make it through the night.
7) Forget the alcohol withdrawal protocol! Just give him a beer with each meal tray. (An intervention that I actually did see a surgical team use on a routine basis to prevent an alcoholic from going into withdrawals. Not recommended.)
8) I don't care if he weighs 300 pounds or not. You still have to do a rectal exam on all patients admitted to unit 4west.
9) Mr X pulled his foley out last night- do we need a consult?
10) Ready, one three, everyone lift!
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