Facepalm

Read In a chart: "very mildly thickened aortic leaflet valves..." ... So, is it very thickened, or mildly thickened? I'm very incredibly amazed at the repetitive redundancy.

Kvetching...

Seen in a note...actually a weeks' worth of notes: "Last heroine use..." I keep wanting to ask did the patient shoot up Wonder Woman?? Or did they mean heroin...the drug.

Somebody just tried to bring a duck onto the psych ward...

Geriatrics...I got a right to sing tha blues...

This month is a month of geriatric psychiatry for me. Frankly, I do not like it. It feels much like an extension of internal medicine, which I've ever-so-affectionately labeled Interminable Medicine, but its in a population that is aging, is in very bad shape, and in general it just saddens me to see people living in such a state. Shoot me please should I ever get like that. Other patients are so angry about their circumstances that they inadvertently get in the way of their own treatment. There's no sunlight where I work with the medical students--and dadgummit I need my Vitamin D!! It's not my cup of tea, and it has made me uncomfortable and feel depressed, and to be honest it's a little boring just sitting around asking people about their mood. I've much preferred consult-liaison work, where I'm constantly busy and working on high-acuity cases.




Also depressing is the situation with a recent foster pup. In July we adopted Freddie, only the best greyhound ever. We wanted two hounds, but they only send first-time adopters home with one at a time, which is fair. We became interested in a second hound, whose story broke my heart. The dog was being kept in a hoarding situation by a whippet breeder in another state, kept outside year-round. It was months before he could be put up for adoption. He came home with us, and the first few days were predictably slow. Then this dog bonded so hard and fast with me that it melted my heart. Unfortunately, the closer he bonded to me, the more hostile he became to others in the house. Given my ever-changing schedule, we cannot have a dog that doesn't respond well to everyone in the home. Which is a real shame because he could be a very sweet hound. So, there's that.


The long and short of it is I'm having a bad week, and I'm kvetching.

Oy...

Read in a nursing note: "Patient's weight today: 220lbs. Yesterday's weight:117 lbs. Patient gaining weight." ...facepalm. 

Close to you...

I have an anorexic patient on my service at the moment. While rounding this morning I had the brilliant thought of whether or not a continuous loop of Carpenters songs would be therapeutic or torture. 

You can't make this up

We have a patient who calls himself Joker. He set himself on fire under the influence of a guy whom they call Penguin (who also encouraged the patient to jump out of 3 and 5 story buildings). They were filming this to put on YouTube. They have a friend whom they call Batman. But sadly Batman is in jail. I win. Forever. 

Why...

Why is whole acorn squash being sold in a hospital cafeteria??

Close to you...

I have an anorexic patient on my service at the moment. While rounding this morning I had the brilliant thought of whether or not a continuous loop of Carpenters songs would be therapeutic or torture. 

Second Year

Second year started intensely! I started on consults, which was predictably busy every single day. I like it. I'm considering doing a fellowship in C/L. It would certainly be a good lifestyle.

This month I'm back on inpatient. Which is about as not-as-exciting as I remember.

I can say that I feel a lot more confident in my abilities to handle situations. I still don't feel that I'm at the level I want to be in terms of diagnostics and treatment...but then again if I were I wouldn't need to be doing residency.

Part of second year also means doing buddy calls with the new residents. Which is really weird. One year isn't a lot of time and it's mind-boggling to see the difference, because at this time last year I certainly felt completely incompetent and inadequate.

Intern year over!!!

Well it's been a while. My most recent month was internal medicine...which I refer to as interminable medicine. I hated it just as much if not more than before. But it's done. I'M NO LONGER AN INTERN!!! The next notes I sign with be signed PGY-2!
wooohoooo!!!

Hmmm

During a (very emotionally draining) call yesterday I was told by my attending that I was working too hard. How does one take that when you're trying to help a patient whose child had just died after a dresser fell on him??

Impatient Psychiatry

I feel like in in "The Others" sometimes on the unit. One door is never opened before the other is shut!!!

Lately

Still on night float for two more months. Still hating it. I don't get to see many people, and have so far spent most of my evenings sitting in the depressing little call room watching Netflix. I think I've watched All About Eve four times alone... I loaf around the house in a haze most of the day, telling myself to stop eating. Moving this past weekend did nothing for my energy levels. I've been called four or five times about the same patient that the day team has certified for inpatient psych once medically cleared. This patient is one of the few people that I would call cookoo. If Bob Marley and Stevie Nicks had a child, this patient is it. 

Somehow this evening I ended up in a Facebook chat with one of my parents' long-time friends back in Georgia. She asked me when I was coming back to Georgia, and before I could answer she said "never, right?" To which I replied, "never is a long time." It got me thinking, though. I don't have any pressing urge to move back to Georgia. I wouldn't complain should circumstances take me there (I've very much become a go-where-life-takes-me kinda guy) but at the moment I associate the place with attitudes, habits, and institutions that I have emancipated myself from (though the word is far more dramatic than the process). Perhaps it's because I grew up in the WASP-y suburbs and later lived in a distinctly rural area; the political environment of both being dominated by IMHO religious zealots. I was not happy there, though I cannot say with certainty if I was unhappy because of where I was physically, or where I was emotionally. Either way, I find the environment outside of the South much more pleasant to be in, at least socially. For a region that loves to prattle on about simplicity and the down-home unpretentious character of its people the South is an incredibly dandified place. It's a quagmire of unspoken, unwritten, contradictory rules, face-saving pretenses, and a whole bunch of "you just do/don't do that" with no explanations. It drives me crazy, and in retrospect it was a bit smothering to an inquisitive kid who always had a hard time fitting in with convention. While other kids were woofing at the Dawgs because their parents did, I was playing tennis, reading books about Germany, the Holocaust, and the Cold War. I read the Hardy Boys and Goosebumps but I also read Jules Verne, Dickens, and Gone with the Wind. I listened to Garth Brooks, but I also listened to Patsy Cline when I was ten. In college while most people went to Florida for spring break and summer vacation, I was doing research in Armenia, and riding the rails in Germany. Now, I have some wonderful memories of childhood, so it certainly wasn't all bad. But being an adult with, ya know, thoughts, instead of repetitive rhetoric doesn't go over very well with people who weren't taught to think. Perhaps if I lived in Atlanta proper things would be different...a door I may always leave open.

But I digress, this conversation reminded me of another conversation I had with the same individual (we call her CB, short for Church Bulletin because she is an excellent source of information) either just before, or not long after I had moved to Chicago. She privately told me that while she halfheartedly talked with my mother about me moving back to Georgia after I finished medical school and wherever I did residency, she felt that "once he leaves, he's not coming back. I think he's gone." I wonder now what she knew then that I still don't know...and how despite years of trying to hide myself, it may have been obvious to others than I needed to spread my wings. This was about three years ago now, and at that point in my life I had lived in two countries and two (three?) different states in the span of less than two years. I had made no concrete plans about anything other than hoping to wake up the next day and finish this exercise in indentured servitude called medical school. 

As a result of such a whirlwind, I do not feel that I identify with a place or group anymore. I used to identify as a Southerner, who never wanted to leave or do anything else; very much "American by Birth, Southern by the Grace of God" mentality. Now I identify as someone who was born and raised in the South. But as a result of my experiences I don't feel I can call myself a full-blown Southerner. I have many Southern characteristics and mannerisms. I have an accent that comes and goes--though to my chagrin hear myself more and more throwing in nasal Midwestern vowels. Unlike a great many Southerners I'm perfectly happy to explore the world outside of the South, and not as a tourist.

Nights

I'm on nights. The call is completely hit or miss. It's not my favorite, busy or not I'm literally the only psych person on campus and I end up handling annoying bullocks like patients punching the wall. Then there's this....this morning I was woken up an hour before I would've preferred because a patient's blood sugar was....drumroll please...88. EIGHTY-EIGHT. Which is....totally FACKIN normal. 

Adventures in CTAing

Decided to take the train to work today (I'm on nights, which means my normally reverse-commute is now reversed, making the train much more pleasant during morning rush hour when I haven't slept). On the platform, waiting for the train, was a guy desperately trying to make a buck playing he trumpet. Totally butchering "Rolling in the Deep," it was still an amusing 90 seconds before my train (mercifully) arrived. 

Reading...

Yes I read Gone with the Wind. Here's an interesting quote from it that is oh so insightful to our current political climate:

"All wars are sacred. To those who have to fight them. If the people who started wars didn't make them sacred, who would be foolish enough to fight? But, no matter what rallying cries the orators give to the idiots who fight, no matter what noble purposes they assign to wars, there is never but one reason for a war. And that is money. All wars are in reality money squabbles. But so few people ever realize it. Their ears are too full of bugles and drums and fine words from stay-at-home orators..."

The speaker, is Rhett Butler.

SIR!!

A medical student just called me sir.  SIR!! I feel like going all Peppermint Patty

Weather

I was sitting in an awesome little Polish diner last night (the kind where you watch Wheel of Fortune with perfect strangers) and the weather said that this is the coldest February on record. 

In lieu of the constant updates about temperature and Polar vortices, I propose we make a much simpler "Scale" easily adapted to the local level of acclimatization:

Level 1: shorts

Level 2: light jacket/sweater

Level 3: coat -- add scarf, gloves, and hat as you see fit

Level 4: Level 3 + snot freezes in nose and car makes terrifying sounds and new rattles

Level 5: May God have mercy on your soul

Lately

I think I may have the most irritating patient of all time. A patient blocking my ability to shut the door, or literally chasing after me across the unit milieu, might not be annoying if the patient wasn't so pitiful. The patient is not redirectable, and has literally fallen apart. I say this about few people, but this patient has literally lost his/her mind. It's challenging as a physician, and frustrating at the same time. The patient is very intrusive, with ideas of reference and loose associations. Everybody's annoyed. My main concern now is if the patient is going to get clocked because he/she keeps bothering all of the other patients.

In other news, Lake Michigan is a solid sheet of ice near the shore where I live. It's wonderfully beautiful. And our lives keep moving on like there's no big deal. On the other hand, Georgia, where my parents live, got less than an inch of snow and everybody freaks out. Hell's bells folks, I got through last year's 73 inches of snow with a rear-wheel-drive 2000 Ford Explorer. Mental blocks. 

Emergency

Dr. Luckyone, Psychiatry Resident has been in the Emergency Department this month, as an Emergency Department resident. I can easily see why it has such a high burnout rate. Everything is so fast-paced, which I enjoy. Half the cases are bull crap. Which I don't.

Dr. Luckyone's Volvo

For the negative two people who care, my Volvo has a new radiator. The dealership also comped me a rental car. A Jaguar no less. I felt like such a douche driving it. 

Public Service Announcement

Did you know...that cars are now so advanced that there's a sensor in the radiator, that measures the voltage of radiator coolant. If that sensor goes berserk, a light will go off in your car and make you think that either the battery and/or the alternator are going to die, and might give you a mild anxiety attack. Or at least that's what happened with Dr. Luckyone's Volvo this morning on the Eisenhower Expressway. God bless warranties. 

Um...duh?

So let me get this straight...you've bad more than twenty sexual partners this year. And you've never used protection. Remind me why you're surprised that you have syphilis???