Goodbye medicine!

Wow, so the last entry...I talked with my resident just after that day and she talked with the intern and fixed everything. Turns out, dealing with things works, despite my best efforts to not deal with my life sometimes, it always works out better when I do deal with issues that come up.
Anyways, so this past Friday was the last day of medicine, completed with the awful shelf exam. My final thoughts on medicine. Overall, very enjoyable. I liked the patients, I liked the aspect of working with medical colleagues (via consults and team stuff). I liked the working up medical illnesses, working with patients for a few days or even a couple of weeks for the acute management purposes. I actually found working with families, even when the loved one was near death, to be very fulfilling. Negative thoughts: dealing with social issues SUCKED. I have a feeling this will be an issue in all the specialties. The team dynamic could be very frustrating, especially if some members were incompetent in their role. I'm sure there is more...but overall, I found great satisfaction in IM. We shall see.
Ob is next up! Nervous and excited. What if I don't like it? Then I suppose I will do something else. What if I absolutely love it? Then I'll have to do it, and it will be super difficulty to deal with ethical battles, for my entire career. Yikes....

Arghh!

9 weeks into my 3rd year, and today was the first day that I just absolutely hated. My feeling of discontent was not caused by a patient, or some delay in a meeting, or being in the wrong place, but by the simple fact that I was trying to see patients(and for once we had patients) and trying to learn, and the intern did not really have time to even assign me a patient, or even send me in the right direction. I love this year, almost exclusively b/c I get to ask questions all the time, I get good answers back immediatley and I get to spend time with different people on a daily basis and share in part of their life story. People say 3rd year is all about adjusting to new people and new circumstances and still manage to learn how to be a doctor in the middle of everything. Dealing with frustrations is just part of the 'doctor skill set'...I guess.

Honestly

Honestly, my decision to go into the medical field was multi-factorial, but one of the features of the field I found so attractive was the ability to find an ultimate diagnosis for someone with symptoms they are not all too familiar with. To find clarity to a puzzle that seemed all together impossible to solve.
What's causing that burning pain in your chest after you eat a large burger and fries?
Oh it's reflux, caused by your weak LES and your love of smoking and beer. We can help you with a PPI and counseling for your 'risky behavior.'
But so many problems are not cut and dry....so many!
My current pt. has a lot of different and newly onset medical problems, and his major problem we cannot even properly diagnose. We performed the proper diagnostic test, an LP, and the results were negative, but we are still treating him for presumed GBS. I thought so much more of medicine would be- here are the symptoms- here are the test to do- and then this is how you treat the disease.
Not the case- just like in life, there is are so few black and white things---everythings in shades of grey. There are no more +/-; just 1-99% confidence with large error margins.

Hospital Depression

I am the kind of person who does not immediately pick up on sadness or depression in another person- I don't want to attribute this to my general aloof character, but rather to the many manifestations of depression- anger, over compensation, denial, out right sadness...human emotions can be tricky. The hospital is a place people can easily become depressed- being around illness and death all the time can bring a person down. The hospital is also a place that attracts lonely people with depression. There is evidence somewhere in some journal that probably makes the conclusion that depressed people generally have more health complaints. Don't quote me, but it makes sense- people just don't care for themselves when they are sad. Anyways, there are a lot of lonely people out there.
Dr.- Do you have any family here?
Pt- No.
Dr.- Do you have any close friends that can help care for you?
Pt.- No, it's just me.

How depressing and lonely! I'm very fortunate to have been born into an amazing family that I truly love! I cannot imagine being in a situation in which I would rather be alone than near my family! Very sad.

obs

My observations of the day:
1. Storms here don't just happen quickly; they often brew and brew, and then maybe the rain falls, but sometimes the stormy part dies out before it begins. I love it. I love the rain, but I could just watch the storm build all day. The anticipation of the downpour, the lightning, the thunder is like waiting for Christmas morning to come to see what is in the small box under the tree. Love it!
2. Healthcare= Social work. Most people go into this field because they have a true desire to help people. But what happens when people are lazy, unkind, don't want you to help them and just want to be fixed without any strings attached? What happens when people think they are entitled to unlimited welfare and healthcare, but do not want to be burdened with any responsibility? Less than six weeks in, and I am finally getting the cold hard truth about healthcare. But that still leaves us with an enormous burden of trying to make sick people better, even if they are not currently able to or wanting to be helped. How do we change the hearts of people that are so unhappy with themselves that they appear stuck in a vicious cycle of absolutely rejecting help with their health? Many things for me to think about over the course of the year, and unfortunately probably plenty of patients to remind me of this problem.
3. I love the hospital in the early AM hours. It's quiet, patients are resting, people do not seem as sad to be in the hospital, and the entire day awaits to solve medical mysteries and restore people to health. At the same time, it is a little creepy- lots of zombie- like students standing around the hospital corridors in green scrubs and white coats. Nurses checking in at the tele station. The flicker of a light from a patients hospital bed. All together, it's a very creepy place. But then the sun rises and the craziness begins.
Some days it's just nice to take in the little blessings when they come your way.

Crazy Day

I think, or at least I hope that I always remember my first patient. On neurology inservice I was assigned one patient, Bob, a man with a recent stroke and global aphasia. Every morning at 6:45 I go into his room, talk to his nurses and then wake him up to make sure the neurologic exam has not changed. Some mornings he cooperates, but most mornings he is just too sleepy. There is something endearing and tragic about a grown man that is returning to the ways of a child. Sometimes the deficits of the stroke frustrate Bob to no end, and other times, it seems like he barely notices them. I wonder what he was like before the stroke, b/c it seems to me that he has been altered in more than just physical defecits.
I also saw another patient this morning- classic Hispanic older guy. As I was getting his knee reflexes he told me I would have made a good Geisha. I told him I was not in that line of service. Note to self- never get on knees to test ankle jerks or knee reflexes.
One of our patients is homeless and recently diagnosed with a progressive terminal illness. He has no contact with his family, although he does have several kids, he does not know much about them including where they might possibly be living. It's very difficult for me to imagine facing death alone like he must. And, since he is homeless, he really does not have any options of places to go. Very tragic...

Tacos

Some days demand a long sweaty cathartic run to help let go of the stress and sadness that filled the day. Today was one of those days. Probably the first of many of my 'hospital' days. People die and people get bad news, but to be merely linked to the bad news, really just passing by in the corridor, can weigh down the soul. Cathartic runs help.

Altered

In neurology, we get a lot of consults on mental status changes. Once the metabolic stuff has checked out, the patient is checked for infections and toxins, they call in the neuro team to see if maybe the patient has something going on with their brain to explain why they are still 'out of it.' On Friday our team saw two patients with altered mental status. Both had loved ones watching over them, and in both situations, the patient could not completely remember who their loved one was. Like in that Nicholas Sparks novel about the lady with Alzheimer's, except this was such an abrupt change in the patients. Just a few days prior they could recognize their spouse, their daughter, and now, they were lost. I know people can muster courage in these situations, but they must be experiencing the worst kind of sadness and loneliness to suffer such an abrupt abandonment. These patients certainly made me sad.

Naive

Yes I am naive- when a patient comes in with symptoms, then they have something wrong with them; seems logical enough for me. But what if they are faking, and what if on top of that, they don't even know they are faking? double yikes! A much more complicated situation than my mind is ready for. I'm also very shocked and sheltered. I saw a woman today with numerous children, a husband she regretted and an 8th grade education- she was almost 40! In America?!?! How can this be- education is virtually free (well at least through 12th grade, after that it costs more than a middle class persons home.) Just baffles my mind! Not everyone is meant to be a doctor or an astrophysicists, but some level of education is important just to be a productive, contributing citizen or at least people able to participate in society(and this in no way is a slight at the MR and special needs populations.) How will she be able to prepare her own children for the world when she cannot hold a job that requires one to do complex calculations or construct a well written paragraph? Today I was shocked and I believe this will be a year of uncovering how little I know about people and the world in which I live.
Also, something wonderful is happening....perhaps...

Quotables

Consult service really is like the ideal service for skeptics- the entire day our small team- two residents and two medical students- went case by case ruling out our patients as neurology cases. Does this patient have Parkinson's, or is his tremor just a side effect of his severe liver failure- not a tough one there! Is this lady having an unusual headache/stroke or are her symptoms merely a manifestation of the stress of unemployment and her upcoming divorce- also pretty obvious!

We did have one interesting case, well I suppose that is relative to who you talk to. A lady came into the ER and her family was afraid she had suffered a stroke- however, she presented with none of the classical symptoms, no strength deficits, no language impairment, just a short history of tingling in her face that she denied upon admittance, because she did not want to be in the ER any longer. Her nephew helped translate and then filled in some missing pieces to her story- he started by telling us, "Oh, she's just being Mexican about the whole thing." Yes- he said that! I almost started laughing, but did not, luckily. In the end, she probably did not have a stroke, but it was nice to see how close families are here. The nephew came, probably because he knew his own mother could not emotionally or physically bring her sister to the ER for what might of been a very scary diagnosis. It's so wonderful to see families so close!

There might be a PVS case...yikes!

Day 1

So maybe it wont be that bad...ha! Well at least today was not bad- start at 8am, orient myself to the newness of third year, then off to observe pediatric neurology clinic for the afternoon. And not just any pedi neuro clinic, this place was like 'the place' that people get referred to when they have an unusual or difficult case. For example- I would think I had a highly unusual afternoon, just based on the fact that I saw two children with Lesch Nyhan syndrome, a child with severe tourettes AND a child with epilepsy actually have a seizure in the clinic!!! But for this clinic, it was just a typical day.

I'm expecting that tomorrow will involve more activity on my part, but today was a fun introduction and a nice way to get my feet wet before I am pushed off into the deep end.