Kids say the darndest things...

"He called me a slave. So I called him a Dorito head, because his head looked like a triangle."

About this time Dr. Luckyone completely lost his composure and started laughing. After he regained his composure, he apologized for laughing and clarified that he was not laughing about his patient being called a slave, which is never OK.

Psychobabble

41M. Extensive trauma. No meds. Bookoos of therapy. He's talking existentialist psychobabble so far over my head I don't even pretend I've ever heard of any of it. As is required, I call the attending in. She's also boarded in integrated medicine and does a lot of alternative stuff and huge into therapy and it's like watching Yoda and Mace Windu giving a lecture. Ok. I'll be the little psych resident over here when yall are done. Prozac??? Ok. I can do that.

Dr. Luckyone's Migraine

It started at Mariano's. I was looking at a bottle of wine (kosher if you care, thinking that it was a richer type of grape juice which should've been the first clue). I saw this greenish yellow wavy light, thinking that it was the reflection off the glass. My eyes were bugging me while we were at the checkout line. By the time I got home my head was pounding. While waiting for some friends I was watching Star Wars, and they kept saying "Jedi" and I kept repeating it like some stoner moment because even though I've seen Star Wars 8,000 times--I wasn't sure if I'd ever heard the term Jedi before. Then my hand started to tingle. I got a bit freaked out, but thankfully that passed after a few minutes. Two aspirins, and thirty minutes later I didn't feel like my head was in a cloud, but I still felt weird. Being a paranoid doctor, I was going through the differential in my mind (seizure, stroke, did somebody slip me something...).  At one point I was in the mirror testing my cranial nerves--anyone who happened to see that probably would've thought I was nuts. Thankfully the headache lifted after about three hours, but the whole evening was weird. 

A day or so later, I'm processing this, and I realize that I had a migraine. (I confirmed this with a few neurology friends, and friends who actually have migraines regularly). I've had one, maybe two migraines in my life, but they were both close together, and occurred about twenty years ago when I was a kid. It's very strange, the whole thing. 

Psychotherapy

As the title suggest, the subject is psychotherapy. What is it? Well...I'm not entirely sure, though I'm supposedly supposed to be well-trained in it come the end of residency. Doesn't that bode well...


I had a rather lengthy, and involved discussion with my psychotherapy supervisor this morning, about what exactly psychotherapy is supposed to be. Because again, I haven't the foggiest. We discussed my uncertainties about the modality and how I feel as though I'm not really doing anything concrete or useful. I think that I'm actually a very good listener, but perhaps it's ADHD, perhaps it's just personality, but I'm not overly fond of just listening for three hours at a stretch. Even more annoying is the fact that I often feel like whatever I suggest they don't want to hear, and they want to continue doing the same things that brought them into therapy in the first place---yes Dr. Luckyone that's the point, I'm sure you might be saying. Perhaps it is. But it's annoying. I feel constrained by how engaged I can be, and how much help I feel I can actually be. Perhaps it's inexperience. Perhaps it's having to sit down all day. Perhaps it's having to see a few patients over and over again, that I really do not like as people. Counter-transference is a big deal in therapy.

Kvetching

Dear Pharmacy: on what planet does "Invalid NPI" (itself not true, try google) for one medication equate with "Send Dr. Luckyone pre-authorization requests for every medication but the one where there's a problem"?????

Really...I mean really...

Walking (nay, speed walking) back to my office so I can scarf down some soup and a salad before my afternoon clinic begins I walk past three (or maybe four??) obviously not medical staff seated in a corner by the elevator in one of the nooks of the hospital. They were clearly important people. With a lot of important things to talk about...

"...I mean really, I think Rihanna is better than Beyonce."

Child Psych 101

One morning a week I see nothing but kids. It's never boring. But the best part of child clinic? Parents who defer giving their kids the sex talk...and just sit there and point and say "Listen to the man" after they ask you to do it

Grumpy Face...

Who doesn't love schlepping to work for an 8am appointment....only to find that said patient moved 1000 miles away...8 months ago....

Kvetching...Time flies when you're strung out

The last month or so has been a very stressful time for me. If I'm being completely forthcoming it's been longer than that, but I've been acutely aware of it for about a month. Quite a bit has contributed. I've been feeling in general unsettled and quite anxious for a few months now, much of which has to do with a personal situation--how ironic, no?? 

Professionally/academically it has also been challenging. During the course of the past six months, I have been in a different rotation every four weeks. And all but one of them was a new rotation. This meant that I had a constant back-and-forth with myself about feeling comfortable in the rotation and feeling like I've learned what is appropriate vs. taking vacation time and not getting admonished for not using my vacation days. Add to the mix Step 3, which was a month of studying following by two days of MCQ purgatory. Who wouldn't be excited?? Perhaps unique to me, I was annoyed about having to take the thing because more than 80% of the thing is related to medicine, and the management of medical patients...It may bear mentioning that I'm a psychiatrist. I haven't seen my stethoscope in months because I don't need it. I think it's buried in the trunk of my car. Yet I'm required for licensing purposes to be able to not only diagnose things like gallstones, but also recommend the appropriate intervention and treatment. For hell's sake...I'm a facking psychiatrist. I am not trained for surgery, much less licensed. Yes, in medical school a medical student has 8-12 weeks of required surgery rotation. What that ultimately means is you stand there and hold retractors in ergonomically unsound positions for three hours while an asshole surgeon (that may be redundant...) asks questions to which only he/she knows the answer. During intern year, I handled one, exactly one GI patient--and that, pardon the pun, was a shit show as soon after admission (on a senior-less Saturday morning, no less) Smuckers jam started exiting this poor man's rectum, and GI and the MICU experts assumed his care. So, fast-forward several years and the meshuganna psychiatry resident is taking Step 3 and being asked questions regarding patients he's never seen, and in reality would have deferred out to a consult service. But never mind. What is one to do about this? Could we have a separate board exam for each service? How fair would that be? Probably not very fair, or manageable. So, like many a psych resident before me, I did thousands of practice questions and faked my way through Step 3, which thank God I passed. Now, on to 3rd year and outpatient clinic!!

Friday night I spent two hours on a patient who not only attempted to overdose on Xanax and gabapentin, but also required Narcan for heroin intoxication, which the ED missed. While it's easy for me to say...uh, you actually believed her when she said she hadn't used in months? there's so much going on in the ED and the patient wasn't obtunded until I was called that I can easily understand why they missed it. Now, having said that, the patient's spouse said that she had used heroin yesterday, so the key here is that drug users lie and collateral is key--SHOCK AND AWE!!  After having her opioid reversed, only then did the patient admit to snorting a bag of heroin. Still, she lied because her UDS showed cocaine and marijuana, which she had denied. So all-in-all, a very time consuming but simple consult. 

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. 

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. 

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