Boggle

Another post that I wrote and never published. Either I thought I had more to say, or I'm really bad at the follow through.

What is with people who think that refusing treatment for their medical problems somehow makes them healthier? It doesn't make you healthy, it only makes you sick and stupid. Happy thoughts about puppies and rainbows won't cure the raging skin infection you have on your foot. And neither will ocean water, btw.  I had a patient today decline to take a short course of oral antibiotics to treat the not insignificant cellulitis on his foot because, and I quote, "my yoga teacher said that those antibiotics will cause bone thinning." Yes, because taking two weeks worth of Duricef is going to give you osteoporosis...at the age of 24. It's not that I'm opposed to not taking medications, because I would gladly never pop another pill for the rest of my life. But if there's something seriously wrong with me, then sign me up. Bring on the drugs!
Maybe it's because I have a better knowledge base about medicine and health to know what is serious and what isn't, but it boggles my mind when patients play the either-or game with their health. Why is the anecdotal threat of "bone thinning" worse than your skin infection that could progress to septic arthritis, which according to all my vast medical knowledge is dangerous, hard to treat, and hurts like a bitch? Why is the ability to proclaim that your family is proudly crunchy and anti-Western medicine and just generally more awesome than everyone else more important than giving your kid an asthma inhaler so he can properly oxygenate his body?

It's patients like these that make me want to go into forensic pathology. Their patients don't say stupid things...or say anything at all.

Here's What I Learned In Pediatrics:

aka: A post that I wrote and never published, probably because I wasn't done learning! Or because I have a short attention span and forgot it existed. So here you go.

1. It is surprisingly difficult to make a kid open their mouth when they don't want to. They have little piranha jaws and I don't want my fingers to be their next meal.

2. There is just a never-ending supply of screams.

3. If I ever want to have kids, then I needed to get married yesterday. Old mothers=Down's syndrome. Old fathers=Autism. There is no winning either way. I love Autistic kids, but what I love more is sending them home with their parents. From the way they scream, you'd think my stethoscope had been dipped in molten lava or something. It sounds callous, but I'm being completely serious. The possibility of having a kid with Autism is so scary that it makes me just want to skip the whole genetic lottery of having children altogether because its heartbreaking to watch those families in the office and know that they never get a break from it.

4. Hyperbaric oxygen therapy can cure any ailment if you have enough money. Diabetic ulcers? Definitely. Cerebral Palsy? Yep. Autism? There's no proven evidence, you say. Oh well, why not? Arthritis? Who knows, but we're not going to say no if you want to fork over $100 every day for two weeks to lay in a glass coffin while the magic oxygen rushes around you.

5. Fanny packs are making a comeback, heaven help us.

6. All doctors are assholes. This is what my attending told me at least once a day. I didn't quite have the guts to ask her what that makes her then.

And All God's People Said AMEN!

In the psych ward, every morning we have group. We go around, one by one, and share our name and our goal for the day. Group is its own special brand of torture that involves giving actively psychotic people a platform in which to espouse their crazy theories and delusions in lieu of just stating their damn name and goal.

My goals, by the way, are always something lame like getting my oil changed or actually studying instead of spending four hours playing spider solitaire or working out. The nursing students that show up always try to outdo each other with increasingly stupid existentialist goals like accepting myself and others, finding my inner peace, making a new friend. Kill me.

My absolute favorite goal ever came today. This patient I like to refer to as Santa shared his name and his goal. Now, everyone's goal is to get out the hospital and go home, but that's not really in their control so they have to come up with another goal. So he said his goal was to relax today. The staff member leading the group asked what he was going to do to relax. His answer: have sex. The staff member, after he stopped laughing, politely informed Santa that this goal was for today, not just in general, and there will be no sex in the mental hospital thankyouverymuch. Santa just nodded and said, "Huh, I thought that was allowed under certain conditions."

Hmm. I don't even want to imagine what those conditions might be.

Today's group was more akin to a church service than a group meeting. In the psych ward, religion spreads like mass hysteria did in Salem, Massachusetts. Last week, only one guy had a Bible, from which he would quote long (made up) passages intermingled with very inventive strings of curse words. Then a couple more people took up Christianity. But that must have gotten old fast because today everyone was Muslim. Half the group said "Allah Akbar" before they introduced themselves.

Then the church service began. Some lady shared with us a five minute ramble on what God wanted her to do with her life. An old demented lady started singing hymns and praising Jesus like they do on those televised services on TV and everybody joined in. And, lo, there was dancing and shouting to the heavens. And all we were missing was someone speaking in tongues and a giant snake.

Dream

Last night I had a nightmare that I was involuntarily committed to the psych ward. And then I missed the morning shower time, and they wouldn't let me shower in the psych ward. I had to be dirty the rest of the day. In the psych ward. Did I mention that I was stuck in the psych ward?

I'm still recovering.

Last week, the veteran psych medical students (from another school) left for greener (less insane) pastures, only to be replaced by two new medical students who get to suffer along with me. Unfortunately, this makes me the veteran student. You know how dogs can smell fear? Well, psych ward patients can smell when you're the only person who knows what's going on.

For some reason all the normal nurses on the floor were out today, or they all took lunch at the same time (jerks), which left me with two new nurses that had no idea what was going on. And my two new medical students (both of whom had those big anime eyes by the time the day was over). And some resident on ambulatory that was being forced to spend the morning on the psych ward. She wouldn't take off her white coat (no one wears white coats in psych, the better to not freak out the patients. Also, no one wears stethoscopes, the better to not get strangled with.) and she wouldn't do anything but refill her coffee cup.

I was trying to hide behind a bunch of charts and stay out of everyone's line of sight, but the nurses station is a square in the middle of the unit, with glass walls all around it. Basically, it's like a big fish tank. Or, probably more accurately, like one of those cages people lock themselves in to look at shark. So hiding is impossible.

In the span of two minutes, one patient came up and asked for a piece of paper. Everybody ignored her, so she (naturally) started chanting "Paper! Paper! Paper!" until somebody got some for her. Then she asked for a pen (It's like the psych version of "If You Give A Mouse A Cookie). The patients aren't allowed to have pens, I'm assuming so that they can't fashion it into some sort of shiv and injure themselves or others. They are allowed to have little golf pencils, which I can't see are any safer than pens, but, whatever. I'm not going to argue with crazy. So I tell the patient she can't have a pen, just as the new nurse hands her a pen. Of course The patient grabs it and runs off back to her room. That's going to end well, but not my problem, cause I'm just the student! Whee!

Then another patient tells me that the patient phone says it needs to be recharged but she needs to make a call rightthisveryminute but she can't make a phone call because it might die in the middle of her conversation and that would be the end of the world but it is of the upmost of importance that she make her call so what am I going to do about? Oh and also, she needs to talk to the doctor right now because she has this handy list of everything she's every felt after taking each dose of each medication she's currently taking and she wants to go over that with the doctor right now, but no one will get the doctor for her and she's upset that the doctor won't let her out because she's not crazy and she feels very unsafe with all the crazy people in here, and she REALLY NEEDS TO MAKE A PHONE CALL BUT THE PHONE MIGHT DIE!!!!!!!!!!!!

I suggested that she practice my new favorite stress relieving technique of deep breathing. She handed me the phone and told me that she'd be just right over there, waiting for the phone, and practicing her breathing. And then she sat down two feet away from me and proceeded to stare intently at the phone.

Then her friend rolls up in his wheelchair, using his legs to maneuver it (the same legs that last week he refused to move, instead using his hands to pull himself around on the floor) and he tries to tell me he wants to use the phone, except he doesn't really speak, at least not coherently. So manic girl from last minute interrupts and tells me what he wants because, naturally, she can understand him perfectly (I'm betting on psychotic telepathy). Guess what? He wants to use the broken phone too. Oh, and he doesn't know the number of the person he's trying to call.

Why me?

Then I went to exercise group where we did some aerobics that were guaranteed to get the blood pumping. I'm pretty sure my heart rate never got about 75, but it was possibly the most fun I've had on this rotation yet. I was raising the roof to Frank Sinatra, good times. Or at least good times, until the leg lifts portion of the workout, which is when the crazy penises started coming out. This old guy in a wheel chair with only an untied hospital gown on was sitting right across from me. Let's just say that I have seen more than my fare share of naked people on this rotation and it has left me to wonder why it is that we can involuntarily commit someone (meaning they are here against their will) to the psych ward but we cannot involuntarily put underwear on them?

A Whole Bucket O' Crazy

I've been on psychiatry for the last two weeks. And the best thing that I can say about this rotation is that there are only 7 days 17 hours and 13 minutes left until it's over.

I thought I was going to like this rotation, I even thought at one point that I might want to be a psychiatrist. Especially one that studied serial killers, which just goes to show that there's something wrong with my brain. Or that I'd watched too much Criminal Minds. The jury is still out. But it didn't really take more than about 20 minutes at the inpatient psych ward for me to realize that if I wanted to retain the little sanity that I still possessed, I needed to get out of there.

I've been struggling with anxiety for a long time, anxiety that has been getting progressively worse for the past year. Anxiety that, at times, makes me feel like I'm going crazy, that my body is going to explode any minute into a million little pieces. Anxiety that makes me check the locks on my car door 3 times before I can walk away, that convinces me that the whole world is going wrong and it's just better to stay inside my house, in my bed, where it's safe. Anxiety is a bitch.

Suffice it to say, on my own, on a typical day, I feel like I have a precarious hold on my own sanity. And then I had to get locked in a mental hospital with 25 psychotic people. I need to take some mental health leave from my mental health rotation. Oh the irony.

About three seconds after I'd walked onto the ward, on my first day, I was greeted by Jose, the longest standing resident, a chronic schizophrenic, whose baseline involves a lot of imaginary friends and a compulsion to converse with them in unrecognizable Spanish. Jose, recognizing that I was fresh meat, beelined over to me and said hello by dancing for me (with his untied hospital gown fluttering in the wind) and then rubbing my bare arms muttering "soft." Awesome.

Funnily enough, he's been my favorite patient so far. He just left a couple of days ago, and I was sad to see him go. He'd follow me around and sing me new songs each day while he slow danced with no one. We'd talk, too. If you can call him mumbling something in "Spanish" (which the translator said doesn't even amount to real words) and then me talking back in English (mostly requesting new songs).  And then he'd wink at me and walk away.

The real problem with the psych ward is, surprisingly enough, not the patients. It's the staff, or maybe the system, I don't know. Psych patients are hard to deal with. They have so many weird quirks, they're agitated, they're compulsive, they're brains are just plain not working right, and that makes them hard to deal with. Hard enough for a month that I can't imagine how the staff deals with them day in, day out for years.

The staff doesn't really seem to like the patients, and one of the doctors doesn't even look at her patients when they come to her office to be evaluated. The patients are often combative (you'd be too if someone locked you up in a creepy building where everything smells like week-old cafeteria food and your roommate talks to the walls). For whatever reason, the staff argues with the patients! One day the doctor spent 5 minutes arguing with a schizophrenic that "God helps those who help themselves" is actually in the Bible. The patient was right (It's not) and the doctor was wrong, but he just couldn't let it go. And all I could think was, why are we arguing with crazy? Doesn't that make us crazy too?

So I just sit in these meetings where everyone is talking at once and no one is listening (my mother calls this "Too many chiefs and not enough Indians," otherwise known as "Welcome to my extended family.") and there is so much passive-aggression (and sometimes just plain old aggression) and paranoia ("How come you're lookin' at me? Make her stop strarin' at me.) that it takes everything within me not to have a heart attack.

I don't do uncontrolled chaos well, and these meetings are like a field day for my anxiety. It's like my anxiety has just taken PCP and is now throwing chairs around the room and beating it's chest like Tarzan all while yelling "I'm the King of the World!" at the top of it's lungs (Because obviously that's what happens when someone's on PCP, just go with it). So in order to not have to voluntarily commit myself to the ward along with my patients, I sit in these meetings and do my breathing exercises while thinking about tranquil imagery like unicorns prancing in a meadow of wildflowers underneath a rainbow. It works surprisingly well, but then again, so does making finger guns and pointing them at my forehead when no one is looking.

Needless to say, I like to minimize my time there whenever possible. I show up late and leave early and talk to the least amount of patients possible. This might make me a bad medical student, but I'd like to think it's making me a better human being because I am not in the staff room rocking myself in the fetal position while mentally calculating how many Xanax is too many Xanax.

7 days 16 hours 34 minutes 17 seconds. Not that I'm counting or anything.