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...