Quotes from Psych

My patients...


"Don't eat my baby."

"My voices are telling me you stupid."

"You're pregnant too?!?!?!?! (i'm not)" - 60 y/o woman

"I don't take depa-mother-fucking-kote, I take DEPAKENE, bitch."

"I danced for over 20 minutes, then I got the shits."

"That's a tit pill." - referring to lithium.

OB notes.

I am currently on my most dreaded rotation of residency: OB... and I thought I'd take some time from my one day off to tell everyone what I think of it.

Bottom line: Pulling babies out is fun, but not worth the abuse, sleep deprivation and sheer agonizing terror that you feel when something goes wrong.

Nor is it worth what it's doing to my personality; ie, turning me into a bitch. I snapped at a cafeteria worker the other day, and I NEVER snap at anyone. I was pretty horrified afterwards...

And then there's the all time tragic story of the month. I was in triage the other day and had just seen a woman 25 weeks pregnant with twins. She came in with her 8 month old son and this kinda shady looking guy who she called her "uncle". She was really quiet, didn't have prenatal care records but did have what looked like the beginning of a black eye.

I ordered records from this other hospital that she said she received an ultrasound at and then stepped out of the room to look at something else. Suddenly, there's a THUMP, and the 8mo baby starts crying. One of the nurses and I charge into the room and there's the woman holding her screaming baby with a deer-in-the-headlights terrified look and the sketchy guy sitting in the chair staring straight ahead. Noone is answering a single question, then the sketchy guy starts drooling, shaking, falling out of the chair and having a "seizure". He collapses on the floor, sweeping the bed, lamp aside, upending down the supplies cabinet, and as i and the anesthiologist resident rush over thinking we have a grand mal on our hands, he suddenly lunges forward knocking us out of the way and stumbles out of the room and down the hall and out of Labor and delivery.

That was not a seizure. That was a faked seizure because he dropped a baby on it's head.

So the nurses lock the L&D doors, but 10 seconds later, he comes back and starts yelling screaming and pounding to get in. At the same time, he strips off his clothes, and pees through the door into Labor and delivery. The police finally grab him and take him away while he's still peeing, and spitting at the doors.

And the woman in the meantime doesn't say a single thing. She doesn't answer questions, now says the guy is a neighbor not a uncle and in general has a mute terrified expression on her face.

She didn't press charges and we got the crisis social worker to come and talk to her, but I was really scared for her and her baby. She was not in a good place and there were so few options. Pregnant with a infant boy, where else was she going to go?

Residency sucks sometimes

So my residency (family/psych) is a total of 5 years. 5 LONG years, but I always felt like they were somewhat manageable..I mean, sure 5 years is almost like doing TWO family medicine residencies, but I do come out double boarded and I really enjoy psychiatry.

The problem is that the reality of being in a 5 year program sucks. SUCKS. Granted, various other residencies including surgery are 5 years, but I would rather cut my wrists than be in those particular residencies.

The bottom line is, if you all have read this far, is that I'm TIRED. T-I-R-E-D. I don't have much excuse to be tired, (ie, no kids, no husband (although the live-in-bf really is about the same thing), most rotations not particularily toxic) and my work hours recently haven't been that bad....

I think that being a resident is like being in suspended anmination. It's delayed gratification taken to the nth power. It's financially and emotionally stunting and I am tired of being stunted. I've thought about switching to either psychiatry or family medicine and thereby shortening my residency, in fact, the thought pops into my head every month or so.

Is this worth it, am I going to be happy, should I just call it quits. On one hand, I would be disappointing a lot of people were I to switch. On the other hand, why do I care - Life is short - I could die in a plane crash a year from now. On one hand I really really enjoy both fields, on the other hand, I could be happy doing either one. On one hand, I feel like being dual boarded would make me a great physician even were I to decide to practice only one field in the end, on the other hand, it's not like I would be a BAD doctor with only one board.

So the conclusion to this little whine session is that there's no conclusion. As of today, I am still in this joint residency plugging away. And plugging. And plugging. And plugging.

I'm not lying, this is totally true.

One of my friends (no names mentioned, but really, how many friends do I have doing residencies in the deep south) had this awesome story for me a few weeks ago:

She was seeing this somewhat elderly (but appearing older than stated age) woman who was a street prostitute for years. This woman was complaining of vaginal dishcarge/burning/itching that was just driving her crazy.

My friend did a speculum exam "down there" and noticed rather large warty-like bulbous lesions covering the ENTIRE region.

How long have you had this, my friend asked?

"oh a few months," said the woman. "They're all up in my vagina too and sometimes I pop 'um for some extra lubrication."

...(social commentary on the deep ingrained poverty of the south to follow)

This is Friends

He's pretty handsome for a stray cat. We started feeding him a few months ago.



At first he was a little shy.



But he's gotten more friendly now.




Friends brought one of his friends. We're the crazy cat people.

Riesed.

I attended a Reise hearing a few days ago. A Reise hearing is a court proceeding to obtain permission to give psych patients medication against their will. Essentially happens is an adult is stripped of the right to control what happens to his or her own body. It's a rather troubling thing to take responsibility for, despite the fact that the pt for this particular Reise hearing really did need treatment.

The ethical dilemma here is, how much of a right do people have to be psychotic. When their psychosis lands them in trouble of the law, then of course they get medicated up the wahzoo, but the subtext there is when they are disorganized enough to be a danger to themselves or other people, then they need medication. The problems lies in the fuzzy middle; which I felt like this patient belonged in.

There was also the issue of her public defender not really putting much effort into the Reise hearing. It was clear that he felt she was crazy, so he didn't try very hard. I take issue with that. I have to treat all patients to the best of my ability regardless of who they are, and so by the same logic, he should have to defend all clients with equal zeal. Of course, I understand that's not how medicine or law works, nevertheless, we don't have to purposely fall short.

Snapshot of Jail

It is 8:00am, I open the foodport located at the bottom of the 2 feet thick door of a cell at the County jail.

I peer into the cell. Unfortunately, because of the way the food port is situated and the way the patient is standing, I get an excellent view of his penis and testicles.

Yes, the patient (a flabby elderly man arrested for indecent exposure) is naked.

And yes, there IS a stale, dank odor wafting my way through the open foodport.

"MOTHERFUCKING BITCH, FUCK YOU ALL.", shouts the patient.

"Sir," i say, "that's not a nice thing to say. Why don't we talk about what's been going on?"

"FUCK YOU. I'M GOING TO SUCK YOUR BABY'S DICK," he screams through the door. A dribble of saliva slides down the corner of his mouth.

I decide to move on to my next patient. My next patient is a young woman, also naked, and also manic. She is currently squatting on the floor of her cell with her hand stuck down into her toilet. I hear water sloshing around the toilet bowl and I ALSO see bits of dark nuggety things (unmistakably poop) floating around.

I found it, she yells, holding up a squished dark brown nuggety thing.

At this point, I pointedly back away and head out of cell area for a much needed coffee break. And it's only 8:30.

I highly recommend this for all stressed out residents.

Brad and I took a little camping trip out to the coast. We sat and stared at the ocean, read some books, grille some fish....and best of all....THE CELL PHONES DIDN'T WORK.





Yes, that's me. I hadn't showered in two days, so it's just as well noone can see my face.




The place was called Salt point State Park, and it's about 3 hours from San Francisco up Highway One. Highway One is a 2 lane narrow winding road that sits on the edge of the cliffs, and is the only highway that reaches the coast.



Yup, this is one of the reasons I had to move back to California.

The Cat Showdown

I don't encourage this behavior, truly, I don't.

Death is the only guarantee.

I just came home from dinner with an old friend of mine; I knew him from junior high all the way to college and now lo and behold, we're both at at the same Medical Center.

He just told me that another really good mutual friend of ours from high school, well, his dad just died.

All of a sudden, his dad just...collapsed.

I stared into my ramen for the rest of dinner, just saying over and over, "Adam's dad died? He did?"

Because Adam's dad was only 65? And because Albert and I and Adam are only 30? And we are too young to have our parents die?

Because even as a doctor, no matter how much death we face everyday, there's a certain protective element in our psyche that makes us believe that we will NOT be the next body on slab. Because otherwise, the fear of living would make it much too hard to go on.

Life is fragile.

My first stalker!!!

I get this page from the family medicine admin room earlier this week so I page them back thinking it's a refill problem or something like that.

No. It's a "pt" who earlier had come to the office asking to talk to me. According to the admin lady, this patient was very jittery, talking rapidly and impatiently (is everyone thinking MANIC?) and asked for me by name. The patient appearently said he "knew" me previously, insisted on seeing me, named my high school, and gave a list of phone numbers for me to call him back at.

I think I have my first stalker.

UPDATE: so uh, did a little investigation, and this guy has schizoaffective disorder and I seem to remember taking a late night phone call in psych triage a few months ago where this patient was screaming into the phone that he was GOING TO FUCKING BLOW HIS BRAINS OUT. lovely. guess he never blew his brains out.

At 3 am in the morning ...

...I think about quitting this stupid dual program and just becoming a psychiatrist instead.

...I really miss my cats.

…the newly dead body looks like a limp sack of meaty potatoes.

… I feel like crying.

I am a doctor. I am better than you, and you, and you and you….

So I've noticed this interesting phenonoman since I've had this MD attached to the back of my name. I have been attracting snobs like flies to honey.

Now, I am distinctly unsnobby. Granted, I do love the occasional Michael Kors purse and I swear to god I AM GOING TO BUY THAT LOUIS VITTON BAG when I finish residency if I have to use two credit cards to charge it, but really, I can hobnob with anyone. My best friends have no pretensions whatsoever, and the reason I got into medicine was because of my work at the SF AIDS foundation. I am not in medicine to cater to the rich or to be rich myself. So much to my surprise, as soon as I mention I am a doctor (and I only do so rarely when pushed to be specific) that the snobs in the room start striking up conversations with me as if just by being a doctor I have something worthwhile to say.

I rarely have anything worthwhile to say.

Like there was this one time when Brad and I were at this rather posh wine bar in Napa guzzeling some Cab Franc and somehow we get into conversation with the bartender about how happy his job is and how sad my job is.

"oh, and what do you do," he says, while shaking up another cocktail designed to chase away all my MICU anxiety.

"uhhh, well, I'm a doctor, resident actually……just doing the training thing up in Davis," I say.

At which point, the blond woman next to me swivels in her chair,

"OHHH, I finished residency TOO, in NEW YORK, but I REALLY didn't like it, the people were so DIRTY. " She shudders.

I blink. I really don't have another response. But I do notice that she has on some pretty ginormous diamond jewelry.

"it just WASN'T the right career for me. LUCKILY, my husband is in FINANCE, and he said, Honey, why don't you just QUIT. So I quit."

"uh. Huh." I say. I also notice that her face doesn’t move when she talks.

"of course, ALL our friends are DOCTORS or LAWYERS, and we have this weekly cocktail thing going on with this DERMATOLOGY COUPLE… so nice to hang out with them".

Brad has since moved slowly away from the table…leaving me to fend off the vultures by myself.

I could go on. But suffice it to say that I couldn't find a polite way to leave for another 1/2 hour, and not until after she had raved on about her cosmetic surgery last year and how her surgeon was SUPERB, just SUPERB, and only then, could I sidle away thinking GOOD GOD, please tell me I'm not going to turn into this shallow bitch...

The resident from HELL.

I'm on MICU right now, a rotation that can be hell if the people around you are unsupportive, nasty or rude. I tried going in with an open mind, but thanks to the worst resident I've ever had to work with, my experience has so far bordered on unendurable.

My resident (a wanna be cardiologist) has so far insulted everyone on the team. He bashed the anesthesiologist resident in front of the anesthesiologist intern, he denigrated the ER residents daily, in particular lingering on the words "lazy" and " ill-trained" and he yelled at one of the nurses in front of the patient's family.

He screwed up a very important discussion with a family on code status (and yes, I offered to talk to the family instead and was rejected), is quick to lose his temper and curses frequently when frustrated.

My resident exhibits no eye contact, stammers when he talks, REALLY STAMMERS when he yells and has caused me to screw up 2 A-lines thanks to his incessant lecturing while I was trying to place the line.

He has also threatened to call my program director after learning that I still had to do clinic during this month…but quickly backtracked when I volunteered the director's pager and called him on his bluff.

I welcome any other resident from hell stories.

This is insanity.

You have metastatic breast cancer. You are intubated and obtunded. You have lytic lesions in your spine and a fungating mass growing out of your right breast. Rad Onc has told you you will die. So has Heme Onc.

Why are you a full code?

How Weird am I, REALLY?

I was talking to this IM attending I really like and respect a while back, and she mentioned to me that I was abnormally NORMAL for a psychiatrist.

"really," my fellow co-intern said from her computer, " go ask Serena the names of her cats."

"Kittywum and Pittypat," I sort of mumbled from my desk.

"HaHa,", the attending said, " I take that back. You're not normal."

Which brings me (finally) to the point of this post: Am I strange? Weird? PSYCHIATRICALLY WEIRD? Because while surgery has the reputation of being assholes and OB's have the reputation of being bitches, Psych has the reputation of being….ODD.

And while I try my hardest to stay grounded and sane, there's no denying that I have, um, quirks. Is this the reason I chose this joint program? Is the sane part of me battling with the crazy part of me? In 10 years, am I going to be wearing organic cotton skirts and "energy beads" while sitting in my office chair asking patients, "Tell me how you REALLY feel about that. I sense a lot of disquiet and anxiety coming from you."

Any thoughts from the peanut gallery? I'm pretty screwed, aren't I.

I am sad and pathetic.

I went to philly this weekend to visit friends and so forth. Most of my friends are med students/residents and so naturally, like the pathetic, homogenous non-individualized people we are, we talked a lot about medicine.

Now, having known these people for a number of years now, I feel qualified to say that there has been a significant amount of disenchantment and jadedness (is that a word?) that has occurred over the last 9 months since we all graduated from med school. The initial "ohh ohh ohh, I'M A DOCTOR IN A LONG WHITE COAT feeling" has worn off and what is left Is more along the lines of " I don't believe I voluntarily chose this shitass career".

There is very little glamour in the life of a doctor, folks. There is very little excitement (except when you're about to crap your pants because your patient just stopped breathing) and lots of paperwork. There is a parade of patients, nurses, attendings, family, demanding things from you at all hours of the day until you feel like you want pull the plug on the emaciated, ventilated (for two months) patient yourself.

I was walking into work one day and saw one of my diabetic, COPD patients wheeling her IV around and having herself a smoke outside. "Hey doc, " she called out when she saw my coffee, " where's my latte? You make a lot of money. Go buy your patients coffee."

For the record, I have never worked so hard for so little money. I am overeducated, unpaid, and quite bitchy as a result. Welcome to the glamorous life of being a physician.

As long as I am making lists for blogs….

Here is a list of places Brad and I are considering for my next vacation. Now granted, my next vacation (well, other than the one in a month where I'm visiting philli) is not until October. NEVERTHELESS, one must dream.

1. Italy - now, I really want to go for two reasons: DRINK WINE AND EAT. Plus I would like to avoid the worst tourist crowds. So. I am thinking not Rome, but maybe Florence, Naples?
2. Spain - another food/wine mecca, but we don't have to fly an extra 3 hours to get there.
3. Back to London - because Brad and I just LOVE London. Plus you can take the Eurostar across to France.
4. Thailand - cause it's gorgeous. I actually want to go to Malaysia, but Brad doesn't want to because he's already been there…on a cross Atlantic booty call.
5. China - true, I've been there multiple times, but it really is a disgrace that Brad hasn't been there yet.

Why Internal Medicine annoys me. (and why I am a family doctor instead)

1. Excessive pontification leading to 4 hour rounds.
2. Excessive testing resulting from excessive pontification.
3. Too much intellectual masturbation. (please see excessive pontification). Let's all do the ego stroke....
4. Inability to talk TO the patient, not AT the patient.
5. The lack of DOING anything that involves a scalpel, or needle.
6. Let me repeat, the LACK OF DOING ANYTHING.

AiYiYi

So here I am, a new year, a new rotation.

I was listening to car talk on NPR today and suddenly had the thought that those two guys had a much more interesting job than mine.

I'm off to the CCU (cardiac care unit) to save lives of men (this is in the VA) who are just going to die in the next month anyways. yipee.