Doctor Psychobabble

Please check out my latest post on “The Ink Blot” at Medscape/WebMD to read reasons to reconsider calling a psychiatric consult.

Click Here to View the Original Post on Medscape

Friday was my official first day as a PGY-2 resident in psychiatry. I rotated at a new hospital for geriatric psychiatry. I was instantly dazzled and enticed by my new, lovely, elderly psych patients. Today I was on call in the psych emergency room. I was quite busy. I admitted and discharged quite a few patients, including a 13-year old girl who was a prisoner. I swear I have a lot of stories to share, but am preferring at the moment to eat the leftovers in my fridge and sip some cold, white wine.

I am happy. I am quite satisfied to be back to psych after 6 months in neurology and medicine. Psychiatry really lights my fire.

Also, I have a passion for photography, in case you didn’t notice. For me, psychiatry and photography have quite a lot in common. It’s all about the stories.

Enjoy instead the photos with this post. I think they are some nice ones. Citations below. Nitey!

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

Photos: 1) Me enjoying a night out, cowboy style 2) A nice shot from outside a restaurant in Brooklyn 3) A nice man on the street in Brooklyn 4) Me with said man 5) Cloud Surfin

“This is the end
Beautiful friend
This is the end
My only friend, the end
Of our elaborate plans, the end
Of everything that stands, the end
No safety or surprise, the end
I’ll never look into your eyes…again
Can you picture what will be
So limitless and free
Desperately in need…of some…stranger’s hand
In a…desperate land
Lost in a Roman…wilderness of pain
And all the children are insane
All the children are insane”

- The Doors, “The End” lyrics

Tomorrow is my last day of neurology consults, and it will only be a half day because I have psychiatry didactics in the afternoon. I have thoroughly enjoyed my two months of neurology. While it’s been a great learning experience, I certainly do miss psychiatry. But I see the incredible value of learning neurology, especially as a psychiatrist. There is so much overlap. And I feel much better prepared to deal with neurological conditions in my patients than I did 2 months ago.

Next up, I have two months of out-patient medicine and then one month of in-patient medicine and then it’s the end of my intern year and back to psychiatry for the last 3 years of my residency.

A random thought to share: I really do love doing “procedures.” As much as it sucks when your patient can’t get their CT angiogram because they have crappy veins and you’ve been sticking them for over an hour and can’t get a line and are frustrated beyond anything else, I do enjoy the satisfaction of a simple procedure well done. I like successfully putting in nasogastric tubes so that my patient can be fed and receive their medications. I like drawing STAT cardiac enzymes to rule out acute coronary syndrome. And I think I will actually miss some of the more routine and mundane procedures, which will be less commonplace during my years in psychiatry residency and years as a professional psychiatrist.

However, I am so passionate about psychiatry that I’m sure I will deal, and will possibly even come up with creative solutions to the lack of “procedures.”

Also, all the children are insane. (Figure THAT one out!)

Photo: My doggy Scope wearing his “Cone of Shame” and makeshift doggy-diaper-sling-so-he-doesn’t-lick-his-wounds-contraption.

I just got home from a day of neurology consults. I wasn’t on call, but ended up working fairly late. I had an older attending say today that in all his years of working as a neurologist, this is the busiest month he’s ever experienced, and that he’s seen more interesting cases than ever before. I feel incredibly lucky to have been a part of this experience. I’ve been exposed to all kinds of fascinating patient cases.

I continue to be pleased with my residency program, and in particular, the variety of clinical experiences which I’ve been exposed to. I’ve heard time and again from attending physicians and others that the hospitals at which I rotate provide a “one of a kind experience.” As a hospital in an urban and very diverse environment, we admit many patients with rare and advanced diseases. This basically ends up meaning that us residents get exposed to cases, which we would not necessarily otherwise be able to learn from. We have the unique opportunity to learn from our patients, who present with incredibly diverse and rare pathologies.

I am immensely grateful for this experience. Regretfully, the most intense and fascinating cases are generally the worst for patients and their families. So, I again thank my patients and their families for allowing me the opportunity to learn from their diseases and tragedies. It’s an immensely powerful gift.

Photos: Taken on my walks to and from the hospital.

Part of My “Trash Talkin” Photo Series

Please check out my latest post on “The Ink Blot” at Medscape/WebMD to read being upfront with patients and their families.

Click Here to View the Original Post on Medscape

“It’s late in the evening; she’s wondering what clothes to wear.
She puts on her make-up and brushes her long blonde hair.
And then she asks me, “Do I look all right?”
And I say, “Yes, you look wonderful tonight.”

We go to a party and everyone turns to see
This beautiful lady that’s walking around with me.
And then she asks me, “Do you feel all right?”
And I say, “Yes, I feel wonderful tonight.”

- Eric Clapton, “Wonderful Tonight”

It’s Sunday night. I just got home from neurology call at the hospital. I was quite busy today. I didn’t eat (although I actually could have if I had really tried). I wrote many notes. I wrote many orders. I put in an NGT, three times in the same patient. I spoke with families.

I feel like I’m starting to sound like a broken record. But I just can’t explain enough how much I love my job. And love being tired at the end of the day, but knowing that I have the extraordinary gift of being a doctor. I am one very, very lucky gal.

Time to eat. I’m going to order sushi (yes, I am a sushiholic).

Oh, and if I owe you an email, please do forgive me. I promise to catch up on my email inbox soon.

Photos: 1) Me about to leave for the hospital. (As promised, an example of my “non-doctor-dreary” outfits.) 2) Me, moments ago, post-call but very happy. (Yes, I’m a major dork.)

“Experience is not what happens to a man. It is what a man does with what happens to him.”
- Aldous Huxley

I just got home, post-call. I actually had a great day at the hospital.

In short, I learned (not for the first time) the value of experience in medicine.

I’m sure that I learned about Still’s Disease (a not common, but not super rare rheumatological disease) many times during my years as a medical student. I could have previously probably quoted the clinical findings and maybe even the treatment.

But recognize it’s presentation in a patient who had a fever of unknown origin? Well, I failed to do so about a month ago as an intern in medicine. It wasn’t until it became a bit more obvious that I put the puzzle pieces together.

Yesterday, I had a patient who had some clinical findings in common with my former Still’s Disease patient, and I immediately thought of Still’s on the differential diagnosis, and knew that calling rheumatology and ordering certain labs and tests would be important.

I guess what I’m trying to say is that you can read about diseases in books until your eyes are sore. You can attend countless lectures and view hundreds of powerpoints about a disease. But it’s not until you have a living, breathing patient right in front of you that you actually learn how to recognize a set of clinical findings. So much of medicine is learned at the bedside, and learned through experience.

I’ve had many experiences where I was awed at my attending’s aptitude at diagnosing a patient. And I’m starting to realize that while intelligence and many other factors contribute to the ability to diagnose, experience is an incredibly important component as well.

And it brings me joy to be experiencing residency and gaining all that wonderful experience. It’s something which I treasure immensely.

I could say more, but I’d rather eat and shower!

Photos: 1) A nice “trashy pic” taken over the weekend, with Micah trying to invade my pic and make the trash cool. 2) Me in front of my computer while typing this post. I just figured out how to take photos with my computer’s camera without the flash going off. Ahhh, experience!

Part of My “Trash Talkin” Photo Series

I just got home from a long day at the hospital and I’m currently “post-call.” I actually had a great day at the hospital today.

Tonight, I counseled several patients and their families on diagnoses and various topics such as the management of hypertension and diabetes.

I was surprised to discover that several of my patients had no idea what their diagnosis actually was. I explained what it means to have a stroke, and the importance of rehab. Unfortunately, sometimes us docs get so caught up in managing our patients that we forget to actually inform the patient of our findings. Also, things which are very obvious and simple to us, are not always so obvious to patients. I explained to a patient and their family the importance of diet, exercise, and weight loss in diabetic management. I educated them on the importance of controlling the risk factors for strokes. Obvious and simple stuff for me, but less obvious and very important stuff for my patients and their families.

I really do enjoy my job.

Now, time to eat and sleep. It’s a golden weekend for me, and I plan on enjoying my time off quite thoroughly!

Photo: Taken just now. Me, post-call at my ‘puter.

“Consult: To seek approval for a course of action already decided upon.”
- Ambrose Bierce

I’m finger-deep in preparing for a presentation for tomorrow, so this post will be brief. In short, I’m in love with doing neurology consults (my rotation for the month of March). While I think I would love psychiatry consults even more, I love the whole idea of being a “consultant.” Basically, a doctor consults another specialty when they need “special” advice. (The reality is actually more complicated, but I don’t have the time to address that right now.) And then we see the patient, review the chart and make our recommendations. It’s fun and challenging and keeps me interested.

I just heard the doorbell ring. Time to eat sushi delivery. Nitey!

Photo: Me behind my “balance a salt shaker on a grain of salt” trick. Yes, I have skillz.

“Raindrops on roses and whiskers on kittens
Bright copper kettles and warm woolen mittens
Brown paper packages tied up with strings
These are a few of my favorite things”

- “My Favorite Things” from the Rodgers and Hammerstein musical “The Sound of Music”

I just got home from a day of neurology consults at the hospital. I was completely swamped today and didn’t have time to eat. But I saw so much and did so much, it was simply amazing.

The highlight of my day? A patient’s family member telling me that I looked more like a fashion designer than a doctor, but acted more like a doctor than most doctors. He thanked me for my refreshing attitude, approach to patient care, and non-doctor-dreary attire. It certainly brought a smile to my face, his face, and my patient’s face.

I finally have a few photos from my adventure a few weeks ago to the Van Cleef and Arpels Exhibit Opening at the Cooper-Hewitt museum. Nothing brings me more joy than having a beautiful balance to my life. I absolutely love being a doctor and don’t mind missing meals and sleep to take care of my patients. But I also absolutley love taking time to enjoy art and the rest of the universe. I don’t think I’d be happy if either component were subtracted from my life.

Now, it’s time to eat, shower, and work on a presentation for this Thursday. These are a few of my favorite things….

Click Here to View the Photos