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.

OB/GYN

I'm currently on my OB/Gyn rotation. I don't want to say this too loudly, but I actually really like this rotation. I've always said that there was no way in hell that I'd do OB. For some demented reason, we used to watch A Baby Story on TLC during lunch in college. I'm not sure why we did that because I was always about 4 seconds away from losing my Baja Bingham quesadilla.

I very much prefer the OB part to the Gyn part because babies are much cuter than vaginas, even when they're all covered in ick and are screaming bloody murder. So who knows, maybe I'll end up as an OB and I'll finally get an excuse to use my Gone With the Wind material (I don't know nothin' 'bout birthin' babies!)

C-sections are crazy. They make this 6 inch incision on your abdomen and cut through all the tissue until they hit the uterus. They rupture the membranes carefully with the scalpel and this big gush of blood and amniotic fluid comes gushing out in a mini tidal wave.  Meanwhile the assisting physician keeps one eye on the tummy and the other on my skin color to see if I'm going to pass out or throw up while reminding me that if I feel sick to please puke away from the sterile field. I'm too preoccupied with figuring out how they're going to get that 8 pound baby out of that tiny hole to feel sick. A little foot pops out of the incision, because this is a breech delievery. The obstetritian grabs hold, fishes around for the other foot inside, grabs it too and then just begins to yank. Hard. All I can think is thank goodness that mom and dad are safely behind the blue curtain because this guy is going to rip this brand new baby's head off trying to get it out of it's little cocoon and why did you not just make a longer incision? I'd rather have a bigger scar than a baby missing a limb or two. Jeeze.

Vaginal deliveries are better, as long as mom got an epidural, otherwise the screaming is not okay.

Blowing the lid off the vagina.
Vaginas are weird. I'm just saying. I would consider being an OB/GYN if it weren't for the gyn part. The OB part is great because at least at the end of all the blood, guts, and a million pelvic exams, you get a cool prize. My attending doesn't see a lot of OB patients anymore, which is a pity, because I love those visits. They're my favorite ones because if its early enough in the pregnancy I don't have to stick my fingers in a stranger's hoo-ha and poke around and we all come out winners. Instead, I get to feel a pregnant belly for a baby head and then I get to use the fetal heart monitor to hunt around for the heart beat and we all stand around for a minute listening to the pitter-patter of a healthy baby heart and everyone is happy.
In gyn appointments I listen to 80 year old women ramble about how they're sure that cyst "down there" is actually a tick that's been causing her foot cramps. And I have to hear the word "discharge" which is something I never want to talk about. And if I have to hear the phrase "You're due for your yearly mammo" one more time, I might have to scream. Mammo sounds like some sort of maternal summo wrestler or a hippo or something. Although, these patients are more likely to bring me cookies for some reason, and I like cookies. So I can't completely look a gift horse in the mouth, or a gift hippo, as the case may be.

Why NJ is weird:

1. You are not legally allowed to pump your own gas.
2. People like to key your car when it has out-of-state license plates because they're dicks.
3. The mall has a kiosk that sells fruits and vegetables.
4. An inordinate number of people wear fanny packs, and they're not tourists.
5. I just saw someone in the mall bathroom wearing stir-up pants. Dear God, the Eighties, they are back.

Pediatrics

Here was my day yesterday:

1: Dad comes in at 5:40 pm for his 5:15 emergency add-on visit with his son:

"Your son has asthma. He's going to need to start using this albuterol pump to get his asthma under control."

"Albuterol? Are you sure? My wife isn't going to like this. She's not really okay with our kids taking medication."

WTF?!  "Yes I'm sure, he's wheezing in every lobe of his lungs, everytime he coughs he can't catch his breath and his oxygen saturation is low. He's not getting enough oxygen into his lungs."

"And that's serious?"

"Yes, not being able to breathe is serious."

"Well, I guess we can we'll try that medication. At least for a little bit."


2. Mom and 1 year-old baby are here for a well-baby visit. Mom pulls out a sheet of questions. Oh goodie.

"Is it okay for my baby to play with toys?

"Is it okay that he poops four times a day?"

"He gets three meals a day. Am I feeding him too much?"

"He's starting to walk. Should I be letting him do that?"


3. Mom to her 4 year-old girl here for booster vaccines:

Mom "You're going to get lots of shots today! Are you scared? You should be scared. It's going to hurt. A lot."

Kid: ear-piercing screams

4. Mom to 6 year-old who won't stop playing with the scale out in the hallway:

"If you don't start behaving right now, I swear I will leave you here with the doctor. How would you like that?"

Me (internally): I'm guessing your kid wouldn't mind that as much as you might think...

Is pediatrics over yet? The kids are cute, but the parents are going to be the death of me.

It's September 12th and everything is back to normal around here. Everyone seems to have recovered from the whole "Let's love everyone extra" of yesterday, which is kind of a relief because all the niceness was starting to freak me out. People in the grocery store kept striking up conversations with me. They even voluntarily moved their carts out of the middle of the aisle so I could get through , which might seem like common courtesy in any other part of the country, but here is like an act of God if you don't have to resort to pushing their cart with yours first. It was all very Invasion of the Body Snatchers.

Don't get me wrong, I think that sentiment is great, but it seems a little phoney when it only applies to one day of the year (man, this makes me sound like the hippy I desperately wanted to be in high school).

I knew everything was back to the status quo today when a transit bus decided to cut me off in rush hour traffic because he couldn't be bothered to check his mirrors before all 20 feet of him changed lanes. I was so happy that everyone was back to being rude again that I forgot to honk.

The empty lot next to my house has this stray cat and I want to adopt it. I keep asking if he wants to come home with me, but I think he's shy. He'd really come in handy this winter because my landlord has started bringing up the M-word and I don't really want to have to move out because Mickey's little cousins are coming to visit.

What I really want is one of those hairless cats that look like Voldemort. It sounds like the perfect pet because A: it's a cat, which means that it has no use for you as long as you make the food appear on a regular basis (ie, perfect for a med student) and B: because it's hypoallergenic and C: they just look hilarious. I did a little research on hairless cats last month during my radiology rotation because, let's be honest, what else was there to do. Sadly, hairless cats are the insecure sorority girls of the cat world. In other words, high maintenance. Because they have no hair, you have to bathe and moisturize them with special hairless cat soap multiple times a week. If I wanted to put in that much effort, I'd get a kid. The death of a dream...

See you in your nightmares...

9/11

I haven’t been here long, but New York City, I think, is one of those places that you either love or hate, and it doesn’t take too long to decide your position. There’s something undeniably special about the city that is hard to put into words. Despite the insane housing prices, the eye-watering smell on garbage day, never ending traffic, and the evil known as toll roads, there’s just something about this place that makes me want to stay here forever. It’s sad to know that I never got a chance to meet this city before it lost its innocence. 

9/11 is different here, more real, less theoretical. For everyone here, whether you were here 10 years ago or not.

It's a different kind of loss, and a different kind of mourning, to live here now. To know that as I drive across the Pulaski Skyway, headed home from the hospital, with Manhattan's skyline in front of me, that I've never known that view the way it was meant to be. With the Twin Towers, the tallest in the bunch, watching over their shorter companions. 

I wasn't planning on going down to Ground Zero today, given the possible terrorist threat, but this year might be the only chance I have to be there for an anniversary and it just felt wrong to sit at home and read about it on CNN when I'm a 20 minute bus ride away. 

So I went. I'm not sure exactly what I was expecting. More crying and less Asian tourists flashing the peace sign to their cameras, I guess. 

In high school, I went to the Oklahoma City Bombing memorial six or seven years after the bombing occurred. Even though I wasn't there on the anniversary of the event, the sense of loss was still palpable. 

But Ground Zero felt a little more like Times Square than a memorial. Leave it to America to turn the most devastating tragedy in its history, at least of this century, into a tourist trap. There were people everywhere selling red ribbons, and programs, a small American flags. The obligatory nut-jobs were there waving their end-of-the-world signs in the air and yelling about evils of a capitalist economy. And there were thousands of people posing for pictures in front of the new WTC building in between talking about where they're going for dinner and asking that fireman passing by if he'll pose with them.

And all I could think was, ''Ten years ago, thousands of people died here. Just a few hours ago, their families came and read their names aloud in remembrance and cried over their names etched into the new memorial. And across there street, behind the mesh fence, there is still a gaping hole in the Earth. How can you even smile, much less laugh here, today?"

I didn't stay very long at Ground Zero. I walked downtown toward the end of the island where Battery Park sits. Flags of Heroes, American Flags with the names of everyone who gave their lives on 9/11 making up the Stars and Stripes, were erected all over the park's grounds, one for each person who died. 3000 flags.

 

As I walked back to the WTC subway stop, I passed this Irish pub that, ten years ago, would have sat in the shadow of the Towers. Outside there were FDNY firemen (and women), all in uniform, milling around. The atmosphere was reminiscent of a class reunion, and it was obvious that for many of them, this is the only day of the year they get to see one another. The older generation of firemen, the ones who were most likely there that day were shepherding little clusters of younger guys who probably in middle school a decade ago. There was more celebration among the FDNY than there was a block away among the tourists. And here, unlike with the tourists, the mood felt right. Here, you get the sense that the right to smile and laugh has been hard won. Because life goes on. Even if a small part of all of us has been left ten years in the past. 

Walking past that pub was the most fitting book end to whole the day. It just felt right that a day that started in tears for what our country has lost, that was followed by unease of walking around Manhattan and seeing policemen carrying automatic weapons, ended with a display of human resiliency and hope.