Doctor Psychobabble

“Every portrait that is painted with feeling is a portrait of the artist, not of the sitter.”

- Oscar Wilde

I’m proud and happy to say that I officially made it through two months on a busy med-psych unit. I will forever treasure the days spent on that unit. I can’t express enough how amazing my time was there, and how many truly amazing patients I had the privilege to care for.

Today, I started a new one month rotation in forensic psychiatry. The bulk of my days will be spent participating (I can’t do them on my own, due to legal reasons) in psychiatric forensic evaluations of prisoners. The majority of the evaluations are to determine if someone is fit to stand trial or if they could be considered “not guilty by reason of insanity” (NGRI) or “guilty but insane/mentally ill.” More on that to come.

Today I participated in four different evaluations. Every single one of them was interesting. I really want to share the details of one, in particular, but of course I cannot due to the quite sensitive nature of the case. What I can say is that we determined that the defendant was clearly not “sane” at the time of the commission of the crime due to an actual medical, but not psychiatric, reason. It was absolutely fascinating.

I can tell that I’m going to thoroughly enjoy this rotation. And the hours ain’t too shabby, either.

After working all day in the court system, I had a psychotherapy session with a patient I’m seeing once a week. Soooo many things I want to share about that, but can’t. Perhaps I will HIPAA-ize some of it and share it on here.

But for now, it’s time to eat after a long day.

Enjoy the photos with this post. The first one was taken on my walk to the hospital last week. The second one is a portrait of me made by a manic patient of mine. She told me that she loved me that day and wrote me a rap poem. The very next day she threatened to kill me. Love my job.

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

“Scar tissue that I wish you saw.
Sarcastic Mr. Know-It-All.
Close your eyes and I’ll kiss you cause with the birds I’ll share.”

- Lyrics to “Scar Tissue” by the Red Hot Chili Peppers

Went for an awesome 10+ mile run today over the Brooklyn and Manhattan Bridges. It was magnificent. I started a new rotation on the inpatient psychiatric unit on Friday. More on that to come….

Photo: Taken on my walk to the hospital a few days ago.

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

“You start a conversation you can’t even finish it.
You’re talkin’ a lot, but you’re not sayin’ anything.
When I have nothing to say, my lips are sealed.
Say something once, why say it again?

Psycho Killer,
Qu’est-ce que c’est
fa fa fa fa fa fa fa fa fa far better
Run run run run run run run away
Psycho Killer
Qu’est-ce que c’est
fa fa fa fa fa fa fa fa fa far better
Run run run run run run run away”

- Lyrics to “Psycho Killer” by the Talking Heads

Today was an epic day. I mean, really great. I just got home from the hospital. It was a 15-hour day. Was on call. Not horrible. Speaking in short sentences because that works with my brain.

My day went something like this. Walked to the hospital. Got sign out. Had a philosophical conversation with my attending about achieving one’s purpose in life and subatomic particles and such. Saw an interesting consult where I really connected with the patient. Did some other things. Went to an residency applicant lunch where I got to answer some questions. Went to a great Grand Rounds on the subject of violence in first break psychosis (hence the quote above). Followed up on some patients. Consoled a family and obtained information from them. Did some teaching in between. Went on call. Saw another interesting case and possibly even did some good. Was asked by my patient if I could be her out-patient doc. Taught a medical student. Took a strange phone call. Made a strange phone call. Did some faxing. Did some follow ups. Walked home.

Yes, I’m talking a lot but not saying much.

I’m sorry, but all the good stuff is in between the lines.

Time to eat!

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

Part of My “Trash Talkin” Photo Series

“No man is so foolish but he may sometimes give another good counsel, and no man so wise that he may not easily err if he takes no other counsel than his own. He that is taught only by himself has a fool for a master.”

- Hunter S. Thompson

Today was rejuvenating. November is officially my dedicated “research month.” What exactly does that mean? Good question. Well, my residency program is actually super cool in that it provides a dedicated month during your PGY-2 year where you pretty much spend the entire month doing research. It’s actually even cooler than it sounds. You get to work with a mentor (mine happens to be awesome) on a research project, which may or may not eventually result in a poster presentation or paper. However, the real “meat” is that although you may not discover the cure to all cancer during your one dedicated month, you end up dabbling in enough research and learning enough to ignite a passion or develop a plan to continue working on research if you so desire. It’s actually a pretty awesome idea, which has served to inspire many residents before me. In addition to working on research this month, I am responsible for supporting our department’s weekly Grand Rounds, and I will be on call every Sunday night. Not a bad deal, at all.

In fact, the only side effect of research month is that there are many days where I don’t actually have to leave my apartment if I don’t want to. I can work on a lot of the research from the comfort of my own home and in my jammies. This is totally awesome, however I realized today that this has an unintended side effect. If I’m not forced to get up at the break of dawn, shower, get dressed, and leave my apartment, it turns out that I don’t. I may get a lot of things accomplished, but I also miss out on “world exploration.” This occurred to me today during my walk to the hospital. I realized that I was quite rejuvenated and excited about walking to work, experiencing the world, and having the opportunity to take photos (see above).

So, today was a great day. Every Thursday, us residents have a dedicated day for didactics. In addition to experiencing some much needed human contact, I learned some cool stuff as well. For example:

1. High Expressed Emotion (EE) can involve emotional over-involvement by family members who blame themselves for a family member’s mental illness, and this can have a negative effect on the patient.

2. Treatment fidelity has to do with how accurately or faithfully a program (or intervention) is reproduced from a manual, protocol or model.

3. Antisocial Personality Disorder is considered the “grandfather” of personality disorders in that it was the first personality disorder to be identified in the DSM.

I’ve been attempting to save moulah and cook dinner for the past week. But tonight is time for celebration and hence time to order sushi (I’m very good at rationalizing). So, this is me signing off. Time to take counsel from the uncooked fishies…

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

“Our lives at times seem a study in contrast…love and hate, birth and death, right and wrong…everything seen in absolutes of black and white. Too often we are not aware that it is the shades of grey that add depth and meaning to the starkness of those extremes.”

- Ansel Adams

Today was a day full of contrast.

In our lecture on the Pathophysiology of Schizophrenia, we learned about how people with schizophrenia see a more “muted” world, and can better appreciate “contrast” with their visual systems.

On my walk to the hospital, it was cloudy. On my walk home, it was quite sunny.

My neighborhood is always full of wonderful contrasts. This is one of the reasons I love New York City, and Brooklyn. My neighborhood is predominantly inhabited by Afro-Carribean folks. But today, as I walked my dogs through the park, there were literally hundreds of Hasidic Jews in long black suits and hats singing and celebrating “Simchat Torah.” The contrast of the runners in their sporty outfits, the Caribbean folks drumming their drums with long dreadlocks, and the Hasidic Jewish folk marching in their black suits with tzitzis flapping in the wind brings me great joy.

Different. Yet the same. Shades of grey add depth.

Photo: Taken on my walk home today.

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

“I’m interplanetary, my insect movements vary
It’s kinky if it’s hair, G, where I’m from
The firehoses blow, it’s purple wind and snow
I do a hit and go, SPLIT
It’s hip, what’s hip? When hip is just the norm
Cause Planets pledge allegiance to the funk in all it’s forms”

- Lyrics to “Where I’m From” by Digable Planets

Today was a good day. On my walk to the hospital, I ran into a man who works as a “peer counselor” at my hospital and we had a nice conversation. When I stopped in a bodega on the way home, I ran into the man who recycles my trash and had a nice conversation. When I was walking my dogs in the park after work, I ran into two other folks who I know from the neighborhood. They both said, “hey doc, what’s up?” even though I never told either one of them that I was a doctor. It’s fascinating to me how they may have discovered this fact, and subsequently refer to me as “doc.”

The point of all this is that I love becoming a part of my community. I love that I know the folks who live in my neighborhood, and it brings me joy to know that I have friends interspersed throughout.

Was a busy but awesome day at the hospital today. Tomorrow is the big, yearly psychiatry residency exam. Time to eat and study!

Enjoy the photos with this post, both taken on my walk to the hospital today.

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

Part of My “Trash Talkin” Photo Series

“Walk into splintered sunlight
Inch your way through dead dreams
to another land
Maybe you’re tired and broken
Your tongue is twisted
with words half spoken
and thoughts unclear
What do you want me to do
to do for you to see you through
A box of rain will ease the pain
and love will see you through”

- Lyrics from “Box of Rain” by The Grateful Dead

I just got home from a 16-hour day at the hospital. Adolescent boys galore.

Highlights from the day:

1. I made the decision to stay on the adolescent boys unit for another month. More on that to come soon. But the staff on my unit did seem pleased.

2. A nurse on another unit saying to me, “are you an emergency psychiatrist?” based solely on her impression of me from minimal interaction (and no emergency). That’s cool.

3. Getting accosted by a crowd of Hasidic Jews with sticks. (Lulavs are cool!)

4. Letting a kid beat me in spades as a form of therapy (no, but seriously, I could have won!)

5. Walking home in the rain. Not because I have to. Because I want to.

6. Egg and cheese with tomato on whole wheat toast sandwiches from cart guys who say to me, “hey doc, the usual?”

7. A wonderfully sweet mentally retarded (intellectually challenged) patient identifying me as “the nicest nurse.”

8. Diagnosing cellulitis.

9. Fist bumping.

10. Words half spoken.

Photo: Taken on my walk home from the hospital in the rain.

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

“Strange days have found us
And through their strange hours
We linger alone
Bodies confused
Memories misused
As we run from the day
To a strange night of stone”

- Lyrics to “Strange Days” by the Doors

It’s 9:00 p.m. I just got home from a very looooooong day at the hospital.

As I was leaving the unit (adolescent boys inpatient psychiatry), I had a sort of mind-bending experience. I was chatting with some of the boys and discussing the latest in iPhone technology, and it suddenly occurred to me how very strange my job is.

I have put in very long hours at the hospital for the past few weeks. I arrive on the unit around 7:00 a.m. and rarely leave before 9:00 p.m. I take no breaks. I rarely eat, save for a protein bar or “egg and cheese with tomato on a roll” from the cart man outside the hospital shoved into my face while writing orders. I basically live and breathe teenage boys with A LOT of emotional turmoil, behavioral disturbances, social problems, etc., etc.

It’s a crazy, strange, mixed-up world.

From the moment I arrive on the unit to the moment I leave, I’m so busy putting out fires that I rarely have time to breathe. Or think.

And now that I’m home, I’m too tired to think. Or write.

Bodies confused.

Memories misused.

This is my brain retiring. G’night world!

Quote: Dedicated to Jon!
Photos: Taken on my walk home from the hospital yesterday. 1) “The Doors.” 2) “Flatbush Corp.”

Part of My “Trash Talkin” Photo Series

Part of My “Yo Fuhgeddaboudit” Photo Series

“Hey you, out there in the cold
Getting lonely, getting old
Can you feel me?
Hey you, standing in the aisles
With itchy feet and fading smiles
Can you feel me?
Hey you, dont help them to bury the light
Don’t give in without a fight.

Hey you, out there on your own
Sitting naked by the phone
Would you touch me?”

- Lyrics to “Hey You” by Pink Floyd

Must keep this post telegraphic as it was a very long and “crazy” day at the hospital today on the inpatient adolescent boys psychiatry unit.

So many agitated and aggressive patients on the unit that I couldn’t get my daily work completed. Patients fighting each other, punching walls, running naked and having to be put into restraints. As I commented on the strangeness of the day, a nurse replied to me, “well it is a psychiatry unit, ya know!”

I have a bunch of stuff to read for classes tomorrow but not the energy to do so. Will have to stuff my face with food now and attempt to make a dent in the readings.

My job is stressful, challenging, and tiring.

I wouldn’t have it any other way.

Photos: Both taken on my walk to and from the hospital today. 1) “I locked my phone.” 2) Someone didn’t like their lunch? I have no idea…

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

Part of My “Trash Talkin” Photo Series

“I don’t care if it hurts
I want to have control
I want a perfect body
I want a perfect soul
I want you to notice
When I’m not around
You’re so fucking special
I wish I was special

But I’m a creep
I’m a weirdo
What the hell am I doing here?
I don’t belong here”

- Lyrics to “Creep” by Radiohead

Had a fantabulous day at the hospital today on the adolescent boys inpatient psychiatry unit. I’m finding working with teenage boys to be a special type of challenge. As I mentioned before, I feel a sort of bond (countertransference much?) with my teenage patients. Their angst. Feeling like a weirdo. Not belonging. Finding yourself. These are things, which I can absolutely relate to.

A patient today attacked a staff member. I jumped in to help. The staff was very grateful to have my help, and apparently was surprised to see a doctor getting “into the mix.” I didn’t think twice, although it helped even more when I was able to order some meds.

It has been pouring rain all day today. I went for a run in the rain with my doggies after work. Kinda crazy, yes. But then again, I am a weirdo. I don’t belong. And I like finding myself. Funny how things change but stay the same.

Photo: Taken on my walk to work.

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series