Archive for November, 2010

When The Going Gets Weird

“When the going gets weird, the weird turn pro.”

- Hunter S. Thompson

Phone Home

I’ve always been a bit of an oddball. In high school, this translated into an incredibly awkward experience of not fitting in or “being cool.” Eventually, I learned to embrace the fact that I don’t always “fit in.” And now I wear my peculiarities on my sleeve. Literally.

I have a very strange job, when it comes down to it. And I think this may be why I chose psychiatry as a specialty. I have incredibly strange experiences all day long at work. And I love it.

I just finished reading, “Mount Misery” by Samuel Shem. As I’ve mentioned before, I HIGHLY recommend this book, especially for people in psychiatry or those who might be interested in psychiatry. At the end of the book, he lists the “Laws of Mount Misery,” which is the psychiatric hospital at which the story takes place. Here are the “laws:”

Phone Home

1. There are no laws in psychiatry.

2. Psychiatrists specialize in their defects.

3. At a psychiatric emergency, the first procedure is to check your own mental status.

4. The patient is not the only one with the disease, or without it.

5. In psychiatry, first comes treatment, then comes diagnosis.

6. The worst psychiatrists charge the most, and world experts are the worst.

7. Medical school is a liability in becoming a psychotherapist.

8. Your colleagues will hurt you more than your patients.

Phone Home

9. You can learn everything about a person by the way he or she plays a sport.

10. Medical patients don’t take their medication fifty percent of the time, and psychiatric patients don’t take their medication much at all.

11. Therapy is a part of life, and vice versa.

12. Healing in psychotherapy has nothing to do with psychology; connection, not self, heals.

13. The delivery of psychiatric care is to know as little as possible, and to understand as much as possible, about living through the sorrow with others.

I definitely could not have said it better myself!

Photos: Taken on my walk to work. I have a new obsession with pay phones in Brooklyn.

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

Happy Thanksgiving…and Pee Pee!

Happy Thanksgiving, world! It’s 9:30 p.m. I just got home from a 12-hour call in the psychiatric emergency room. All I’ve eaten today is a (yummy) salad. While many people were gorging themselves and being merry, I was evaluating psychotic, manic, and depressed patients in the hospital. I’m hungry. But happy.

Phone Home

The highlight of my day? The patient who urinated on me during my interview. What a wonderful Thanksgiving Day present!

Now I shall eat some crappy leftovers in my fridge from days ago. And take a bath to wash off the OPP (other people’s pee). G’nite sweet world!

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

Thanksgiving With My “Other” Family

Please check out my latest post on “The Ink Blot” at Medscape/WebMD to read about how I will be spending tomorrow, Thanksgiving Day.

Click Here to View the Original Post on Medscape

The Art of Writing Orders

I continue to be obsessed with residency, and psychiatry. I truly love the fact that I actually get paid to learn. The interesting thing about residency is that you learn many different things, obviously including patient care. But I enjoy that you also learn about the real “meat and potatoes” of being a doctor.

Radio Head

One lesson that I keep learning is that there is an art to writing orders. Knowing which medication, lab, procedure, etc. to order is only one piece of the puzzle. Learning how to write GOOD orders is a whole ‘nother ball of wax. Some lessons/things to keep in mind that I’ve learned so far:

1. When writing strange/titration orders, it’s always best to clarify to the nurse EXACTLY what you mean. I learned this lesson the hard way, and a patient stopped receiving their antipsychotic medication because I/the secretary/the nurse/the pharmacist failed to clarify the order.

2. If you write for a STAT (emergency) medication, it’s always best to also inform the nurse verbally, and to also be prepared to defend why you are giving the medication.

3. There are people who have to complete the orders. There are no magical fairies who draw labs. If a patient is a difficult stick, or frequently refuses bloodwork, you should aim to get the best bang for your buck. Order all bloodwork at the same time, when possible.

Couch Surfin

4. Change of shift! Nurses are not on the same schedule as the doctors (usually). They really do not like it when you write orders near their change of shift. Good to keep in mind.

5. New/strange medications frequently have to get sent up to the unit by the pharmacy. The earlier you order them, the sooner the pharmacy can send them up, and the more likely your patient will receive them the same day.

I have some other tips in mind, but just realized that this might make a good Medscape post, so I will leave it at that for now.

Time to walk the doggies. And eat!

Part of My “Trash Talkin” Photo Series

I Walk I Walk

Today was a tiring, but fabulous day.

The highlights:

1. I walked 3 miles to the subway station at 6 a.m.

America

2. I walked another 1 mile to the hospital from the next subway station.

3. I rounded, I wrote scripts, I saw patients.

4. I walked another 1 mile back to the subway station.

5. I walked 3 miles to my hospital for EMR training.

6. I walked 1 mile back to my apartment.

Hearse

If you do the math, that’s 9 miles of walking today. Crazy? Absolutely. But worth it? Absolutely.

I don’t care what anyone says, I think walking/moving is the secret to happiness. If you’re wheelchair bound, you roll. If you have locked-in syndrome, you blink. The point is, you move.

I’m very determined to prove my hypothesis someday. I am.

Photos: Taken during my many walks. Priceless.

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

Dancing With My Patients

Please check out my latest post on “The Ink Blot” at Medscape/WebMD to read about how I get jiggy wid it on the job.

Click Here to View the Original Post on Medscape

links for 2010-11-15

Don’t You Wish Your Job Was Awesome Like Mine?

I totally understand that you (my readers) are probably quite tired of hearing me go on and on about how awesome my job is. But seriously, it is, I can’t help it.

I have the coolest job in the universe. Hands down.

Mural in Crown Heights

Highlights from today:

1. I had a patient who kept saying “I refuse to leave (another patient’s room) until I see the captain!” I had the pysch extern walk into the room and introduce himself as “the captain.” It eventually did the trick.

2. I had another patient insist that she was Pocahontas. I told her that I believed her, and appreciated all that she had done for America. And then I put her clothes back on.

3. I had another patient who said, “doctor, will you marry me?” I told him, “no, but I will discharge you today.” He was satisfied.

4. I had another patient who told me to eat his private parts (he used a different word) and tried to take a punch at me. He promptly received a PRN (STAT dose of medication).

5. I had another patient who told me that I was “Princess Margaret, and in charge of the Royal Conspiracy to Commit 911.” I plead guilty to her accusations, and she agreed to take her medications.

There is never a dull moment on the inpatient psychiatry ward. Never.

Photo: Taken on my walk to the subway, on my way to the hospital.

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

Living in the Moment

A wonderful article, recently published in Science Magazine found that a wandering mind is an unhappy mind. This is something that I’ve realized for many years. I always try to “live in the moment,” though I am guilty for not doing so fairly frequently.

EAGL

This is one reason that I believe in the power of yoga, meditation, running, and just about anything, which forces one to focus on the “here and now.”

I went for a 12-mile run into Manhattan today. My favorite part of my run is always at the midpoint of the Manhattan bridge, where I kick it into overdrive and focus on the feeling of the wind rushing over my skin, the smell of the water surrounding me, the pounding of my own heart, the feeling of the air moving in and out of my lungs, and the sound of my feet hitting the pavement. It gives me goosebumps, every time.

Below is the original text from the article:

Science 12 November 2010:
Vol. 330. no. 6006, p. 932

Brevia

A Wandering Mind Is an Unhappy Mind

Matthew A. Killingsworth* and Daniel T. Gilbert
We developed a smartphone technology to sample people’s ongoing thoughts, feelings, and actions and found (i) that people are thinking about what is not happening almost as often as they are thinking about what is and (ii) found that doing so typically makes them unhappy.
Harvard University, Cambridge, MA 02138, USA.

* To whom correspondence should be addressed. E-mail: mkilling@fas.harvard.edu

Unlike other animals, human beings spend a lot of time thinking about what is not going on around them, contemplating events that happened in the past, might happen in the future, or will never happen at all. Indeed, “stimulus-independent thought” or “mind wandering” appears to be the brain’s default mode of operation (1–3). Although this ability is a remarkable evolutionary achievement that allows people to learn, reason, and plan, it may have an emotional cost. Many philosophical and religious traditions teach that happiness is to be found by living in the moment, and practitioners are trained to resist mind wandering and “to be here now.” These traditions suggest that a wandering mind is an unhappy mind. Are they right?

Laboratory experiments have revealed a great deal about the cognitive and neural bases of mind wandering (3–7), but little about its emotional consequences in everyday life. The most reliable method for investigating real-world emotion is experience sampling, which involves contacting people as they engage in their everyday activities and asking them to report their thoughts, feelings, and actions at that moment. Unfortunately, collecting real-time reports from large numbers of people as they go about their daily lives is so cumbersome and expensive that experience sampling has rarely been used to investigate the relationship between mind wandering and happiness and has always been limited to very small samples (8, 9).

We solved this problem by developing a Web application for the iPhone (Apple Incorporated, Cupertino, California), which we used to create an unusually large database of real-time reports of thoughts, feelings, and actions of a broad range of people as they went about their daily activities. The application contacts participants through their iPhones at random moments during their waking hours, presents them with questions, and records their answers to a database at www.trackyourhappiness.org. The database currently contains nearly a quarter of a million samples from about 5000 people from 83 different countries who range in age from 18 to 88 and who collectively represent every one of 86 major occupational categories.

To find out how often people’s minds wander, what topics they wander to, and how those wanderings affect their happiness, we analyzed samples from 2250 adults (58.8% male, 73.9% residing in the United States, mean age of 34 years) who were randomly assigned to answer a happiness question (“How are you feeling right now?”) answered on a continuous sliding scale from very bad (0) to very good (100), an activity question (“What are you doing right now?”) answered by endorsing one or more of 22 activities adapted from the day reconstruction method (10, 11), and a mind-wandering question (“Are you thinking about something other than what you’re currently doing?”) answered with one of four options: no; yes, something pleasant; yes, something neutral; or yes, something unpleasant. Our analyses revealed three facts.

First, people’s minds wandered frequently, regardless of what they were doing. Mind wandering occurred in 46.9% of the samples and in at least 30% of the samples taken during every activity except making love. The frequency of mind wandering in our real-world sample was considerably higher than is typically seen in laboratory experiments. Surprisingly, the nature of people’s activities had only a modest impact on whether their minds wandered and had almost no impact on the pleasantness of the topics to which their minds wandered (12).

Second, multilevel regression revealed that people were less happy when their minds were wandering than when they were not [slope (b) = –8.79, P < 0.001], and this was true during all activities, including the least enjoyable. Although people’s minds were more likely to wander to pleasant topics (42.5% of samples) than to unpleasant topics (26.5% of samples) or neutral topics (31% of samples), people were no happier when thinking about pleasant topics than about their current activity (b = –0.52, not significant) and were considerably unhappier when thinking about neutral topics (b = –7.2, P < 0.001) or unpleasant topics (b = –23.9, P < 0.001) than about their current activity (Fig. 1, bottom). Although negative moods are known to cause mind wandering (13), time-lag analyses strongly suggested that mind wandering in our sample was generally the cause, and not merely the consequence, of unhappiness (12).

Third, what people were thinking was a better predictor of their happiness than was what they were doing. The nature of people’s activities explained 4.6% of the within-person variance in happiness and 3.2% of the between-person variance in happiness, but mind wandering explained 10.8% of within-person variance in happiness and 17.7% of between-person variance in happiness. The variance explained by mind wandering was largely independent of the variance explained by the nature of activities, suggesting that the two were independent influences on happiness. In conclusion, a human mind is a wandering mind, and a wandering mind is an unhappy mind. The ability to think about what is not happening is a cognitive achievement that comes at an emotional cost.

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

Indian Food For Breakfast

I just got home from a 24-hour long day. It’s Saturday morning at 9:30 a.m. I started my inpatient hospital rotation yesterday morning at 8:00 a.m. I then travelled back to Brooklyn via subway and on foot to go in for my 5 p.m. to 8 a.m. over night call.

The Leak

I’m post-call and happy as a cashew nut right now.

I had a great night. I saw much psychosis and mental sickness. I joked around with some NYPD police officers. I caught a mistake, which involved knowing psychiatry AND medicine. I said, “Dr. Campbell, like the soup,” more times than I can count on my hands.

I truly heart night call. There is nothing more stimulating to me than walking home from the hospital in scrubs, after the sun has already risen. Seriously, it’s the dog’s bark.

I love Brooklyn. I love psychiatry. I love my job.

I’m currently scarfing down leftover Indian food right now as I type these words. Next up is some much needed hygiene and grooming (btw I love my patients, but they are sometimes a stinky bunch!), then sleepy time. It’s a beautiful day today and I’d rather spend my Saturday enjoying the weather. But my old bones can’t stay up for such a long period of time. Okay, bubble bath, then slumber…mmm shrimp saag, take me away….

Photo: Taken on my walk to the subway yesterday morning…seems like such a long time ago.

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

Next Page »