In my Alternate Profession...

.... I could wear a costume to work tomorrow.

If I couldn't be a doctor, I'd be be a first grade teacher.

Why? Kids are great, but more than that, I love holidays! I love decorating and I love the festivity of the occasion. It doesn't really matter which holiday, I just like celebrating it. I grew up in a pretty conservative christian family and Halloween was often downplayed. We were allowed to dress up but it was always as benign, non-scary things. (A strawberry, a ballerina, a hobo.) Our candy was frozen for safekeeping (i.e. taken away from us) and everyone knows that once your chocolate is placed in the freezer it is never quite the same again. But I survived and my love for Halloween and all other holidays has only grown with time. Pumpkin carving is one of my favorite traditions and I got to help my niece and nephew with their creations yesterday. So. Much. Fun!




I'd like to dress up tomorrow but I'm not sure the geriatric psych patients would appreciate my efforts and staff might think of me as inappropriate, so I'll settle for watching the Village Parade and counting down to the next holiday and one of my all time favorites- Thanksgiving!

links galore

Just a few recommendations if you are looking for something psychiatric tinted to enlighten/entertain or distract you.

LISTEN
Real 'Sybil' Admits Multiple Personalities were Fake
An NPR Segment that I stumbled upon yesterday...


READ
for the moment/hour/day-
The NY Times Lives Restores Series- Parts 1-3 now available, here is the link to the first article

for the week/month-

"Sybil Exposed" by Debbie Nathan (I'm reading this now, 1/3 the way through and so far I'm intrigued and saddened. I guess the original Sybil work is up next.)

"The Center Cannot Hold" by Elyn R. Saks (I haven't yet read this but it is on my list as well.)

"The Bell Jar" by Sylvia Plath 

This is a classic and if you haven't read it, you should. 

WATCH
In case you would rather a video, this one and the prior two in the Lives Restored Series are well done and get my recommendations as well.

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That's all for now. Two more weeks of psychiatry. My goal is to prepare for the shelf and stay interested in all of it. Now, back to my book!

how to bribe your patient into compliance?

answer: with coffee and tea. No joke!

Geriatric psychiatry is a lot of things... however holding my interest is not one of them. I tried to give it a fair shake. And for about a week I was intrigued and pleasantly surprised by just how much I liked it. But it must have been the newness, or the fun patients I had that week because my enthusiasm quickly wore off.

 Last week was rough. I didn't really want to go to work and once I was there I just couldn't wait to leave. My patients were belligerent, agitated, hostile and demented. I feel bad for them. But not bad enough to make myself bribe them to take their medications like my Attending does. I mean I guess if getting a cup of tea or buying a cup of coffee is all it takes for a patient to become compliant why not do it? But in my short experience it only works for a limited amount of time. And even if patient complies for the moment/day/week then what? Even if the patient is discharged it is not like we won't see the same patient back next week or month for the same thing.

Medication non-compliance is real. Psychiatry is a revolving door. I wish this were not the case or there was something else I could hang my hat on. But so far that is all I've got.

I only have two weeks left. And it is bearable but not exactly fun. Now the admission notes and discharge summaries just feel like scut work. Write this. Dictate that. Go talk to a patient that is laying in bed naked and refusing to take any medications or put on any clothes or eat any food. Wait for said patient to decompensate to point of needing IM meds or become so dehydrated or hypoglycemic that she qualifies for medical transfer. Type up discharge summary for transfer. Repeat.

Did I mention, I only have two weeks left? But on the upside I do have a whole entire weekend (off) to study in NYC so I'll survive. One latte at a time. Maybe I need to be bribed just like my patients. Oh my...

Adam

Adam was only hours old when I met him. He had been born during the night to a new mother following an uneventful pregnancy. He came into the world in half a days time. The mother delivered her son, without drugs but in a hospital, the norm for Grenadian women. When I met him he was wearing a blue and white sleeper and looked perfect. Tiny, sleeping, a brand new baby. Mother was resting, exhausted but awake and father had just come back with breakfast for both of them.

Adam was one of my first pediatric patients, ever. I was in Grenada at the end of my 2nd year of medical school and it was my second hospital day. After a short introduction from our preceptor on how to interview the mom we were left alone. The mother's story was like any other pregnancy. She gained weight, maybe a bit too much, 40 lbs perhaps, she didn't really know. The delivery was okay, she said it was longer than she expected but no real problems. And then we examined Adam. As we did so our preceptor came back. She asked us to look carefully at his head and eyes and where they were, how far apart there were and if they lined up with his ears. As I slipped off his baby hat I noticed that his ears did look a little low... Then she helped us take off his sleeper and we took off his tiny baby socks.  His feet were curved at some unnatural angle as if they were tomatoes staked to the ground. His hands were clenched but fingers were extended as if they had been glued into position. I listened to his heart and heard a murmur that got higher with each expiration. Another student listened and said Adam was wheezing but I'd heard wheezing before and this was not it.  No, this murmur was a discernable patent ductus arteriosum. My first.

We finished our exam and helped dress Adam. The parents asked our preceptor about his feet and hands and they were told a surgeon would come and talk to them about options. I later asked about genetic testing, it looked like textbook Trisomy 18 but our preceptor just shrugged and said that Grenada lacked such resources, it would take money and time to do genetic testing and so was unlikely...

Adam would be a year old this month. I'm just reflecting on some of my firsts.

Happy Birthday Adam.