Thursday Born

The everyday life of a psychiatry resident (who was born on a Thursday).

Archive for the ‘Clinical Experiences’ Category

Dermatology

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Last week was my first week of Dermatology (and the start of my last rotation! Just three more weeks and I’m officially done with medical school!), and by the end of it, I couldn’t help but think of the movie “My Big Fat Greek Wedding,” because of how often patients were told to put vaseline on various bumps and rashes and ulcers. Vaseline and steroids, I guess, would be the two most common recommendations I’ve seen.

It’s been a fun, laid back rotation though! By the end of it I should be able to treat basic acne and eczema on my own, and tell people when they really should have that mole looked at.

 

Written by Aba

March 19, 2013 at 11:27 am

Psychiatry in Seattle!

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2013-03-15 11.00.17

 

2013-03-15 11.03.42-1


Written by Aba

March 15, 2013 at 3:10 pm

“My First Death”

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I went to a special grand rounds in the pediatrics department yesterday, and the topic was “My First Death.” It was a panel of five people, plus the doctor in charge of the pediatric palliative care service in the children’s hospital. Each of the five told a story of their first patient death in their current roles,  and then the floor was open to questions, or for other people to share their experiences. I’m not an easy crier, but I admit I came close to tearing up at least once or twice.

The idea of my own death still terrifies and confuses me on some level, but at the same time I am very aware of the inevitability of death, and of the extended process both dying and grieving can become. It’s interesting to me how little we talk about death in the US. When I lived in Ghana, I was confronted with death more often, but these days I think if I wasn’t in medicine, it’d be fairly easy for me to only think about it on a very superficial level.

I feel a little self conscious sometimes when talking to people outside of my family and classmates, especially on my more bleak rotations. I feel like it’s inappropriate for me to share what I’ve been going through and thinking about, like finally writing up my advance directives and assigning at least one or two medical powers of attorney, or how interesting it is to see the variety of people who are the ones standing by someone during their most trying and difficult times (sometimes not even family or romantic partners, but people whose lives have become intertwined in unusual ways), or when the death or illness of a child precipitates the end of a marriage, was the divorce inevitable someday or would they have stayed together otherwise?

I worry that speaking my mind is being a Debbie Downer, that people don’t want to hear about these things. That the stories that I find almost uplifting in a bittersweet way, like the attending who told the fellow to stop CPR so that the baby could spend the last moments of its very brief life being held instead of being pounded upon, will simply be depressing.

What was my first death as a medical student, by the way? It depends on how you define it. Was it the patient in the Emergency Department that my resident wanted me to try CPR on (I don’t remember why exactly I didn’t “get a turn”) but who everyone was just waiting to pronounce dead? Or was it the patient I followed my entire four weeks on the general Internal Medicine rotation who we had nothing left to offer and were sending home with hospice? (Or the one I had for two days who we also had nothing left to offer and also sent home with hospice? He probably actually died first).

I’ve never had a patient die in front of me, but I’ve known quite a few patients, quite a few people, adults and children both, who either died soon after I met them, or who I know will die within another year or two.

I don’t have a specific point to this post. I think that mostly I’m wondering how much it’s okay for me to talk about these things, because they’re on my mind often, and dying, death, and grieving, are all a big part of living, as much as we really don’t want them to be.

Written by Aba

January 29, 2013 at 6:24 pm

Coping with Grief

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I think that one of the reasons I’m taking this Pediatric Palliative Care rotation is because I don’t really know what to do when people, patients or their loved ones, are grieving. I don’t know how I’m supposed to talk to them. I don’t know yet when it’s okay to keep talking and when I should be quiet, I don’t know when I should leave or when I should stay. I know I won’t be able to learn all this in just four weeks, but it’s a start.

We, people, don’t talk much about grief. And when we do, it’s mostly in the context of death, not in the context of the ongoing loss that is associated with, for example, a severely ill loved one. Today I watched a young couple grieve after learning that their baby would be incapable of even the most minimal definition of meaningful life (severely under-developed brain), but as difficult as that was, it doesn’t compare to the numerous times I’ve been around parents caring for chronically, tragically ill and/or disabled children. They did not plan for this. Most people don’t ever think of the possibility of this becoming their life. And the available resources for assistance at home (or long term facilities where their children can  live) are pitifully lacking. I know I see them at their worst, when their child has landed in the hospital, again, or when they have just learned of the enormity of their situation, but still, my heart breaks for them.

I’m hoping this rotation will give me some beginning insight for how to better interact with these families. It is not, never has been, enough to sympathize with them, if I don’t know how to show that I am thinking of them. That I am proud of them for doing what they can, for living each day, for still finding things to smile and laugh about with staff. Even if there isn’t anything I can to do fix, or even help their child, there has to be some way I can be someone who adds something, however small, to their life. And if there isn’t, then I want to do what I can to minimize my footprint, to not take anything away from them.

I don’t want these families to fall into the same category as “starving children in Africa.” I don’t want their place in my life, in my work, to be a simple reminder that there are people out there dealing with harsher realities of life than my mundane concerns. And I don’t want to minimize their lives to this one thing, however big and consuming it is, because they are more than the parents of a sick child, just like Africa is more than just a continent full of corruption and poverty.

It feels somewhat trite writing an entry about this, almost like I’m exploiting their situation to write a good blog post. But these families do affect me, and there are many I will never forget. Not all these memories are sad either; some are bittersweet, and some are actually downright pleasant.

Written by Aba

January 17, 2013 at 7:26 pm

Winding Down

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The end is in sight! 60 days till my Match Day, and exactly 12 weeks left of rotations. Today I started Pediatric Palliative Care, then I have Special Topics in Reproductive Health, and then I end with Dermatology.

I still have Step 2 CS to take (mid-February, unless I find an earlier date that has opened up), and my Dermatology rotation has a small test at the end, but I’m essentially done with the more stressful parts of medical school (minus the match, which is a different kind of stress; it’s more just disorienting).

There’s two other medical students on my current rotation, and I hadn’t realized it, but I had missed being around my peers. I’ve been mostly on my own during my rotations this entire year, with just a few exceptions. It’s nice being able to commiserate  about things like Step exams, and being behind on thank you emails, but it’s also nice for the shared joy aspect, because we’re all very excited about this Pediatric Palliative Care rotation (strange as that may seem).

Here’s to another exciting four weeks!

 

Written by Aba

January 14, 2013 at 6:04 pm

Children’s Hospitals

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The category of things you find on the bottom of your shoe in a Children’s Hospital apparently includes random plastic gems.

gemsole
Things you find in the stairwell? Strangely obnoxious encouragements to keep doing what you’re already doing.

2012-12-07 16.31.12

(I’m not entirely sure why the campy nature of these doesn’t quite sit right with me. I’m not usually the sort to be easily annoyed by things.)

I really like Children’s Hospitals though. All the ones I’ve been in are well decorated, and I wish adult hospitals were generally even just a fraction as nice.

Written by Aba

December 12, 2012 at 9:43 pm

Fourth year check in

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What I’m doing with my life right now:

  • Pediatric Neurology rotation. Two weeks of consults (today’s the last day) followed by two weeks of outpatient. I’ve been surprising a lot of people, because summer fourth year rotations are usually in the field you’re applying into, but many people told me I don’t need to do much psychiatry this year (and actually, I’m doing a lot with four. I wanted to do one at the beginning of fourth year, I wanted more than just three afternoons of exposure to Child Psychiatry, and I’m doing two away rotations for personal reasons) so hey, why not do Pediatric Neurology? I had zero exposure to it as a third year medical student, we only learn a little bit about it by default, and, Neurology, Psychiatry, it’s all about the brain, right?
  • Studying for Step 2CK (CK=Clinical Knowledge). Remember the Step 1 exam? It is so named because there are, indeed, more steps! Before I graduate medical school, I get to take both halves of the second part. I’m taking Step 2 on August 28th, and it’s another 8hr, 9hr multiple choice exam. Step 2CS (Clinical Skills) is a 12 Standardized Patient exam, which I have yet to schedule.
  • Residency Application! I’ve finished a first draft of my CV, which I now need to format, and after I take Step 2CK, I’m going to focus on writing my Personal Statement. Hoping I can get it done in two weeks! The application goes out to schools on September 15th. So far away and yet really, so close!
  • Not running or exercising. =( My hours right now are about 7am to 5pm, which is not bad except that doesn’t include the time it takes to get there and get home, and then there’s things like showering, eating, studying (44 qbank questions every day now, 88 if I have magic extra energy), trying to fit in a quick conversation with my boyfriend (ah, long distance relationships), working on my written assignments for this rotation, and oh yeah, sleep. Don’t get me wrong. I could make the time to exercise, but I’ve decided that right now I’m going to prioritize other things.
  • Speaking of sleep: Waking up between 5am and 5:30am without fail, even though my alarm is set for 6am. =( I don’t mind doing this 6 to 7hrs of sleep business when I have to, but when I don’t? Seriously circadian rhythm, what’s going on here?

Written by Aba

July 27, 2012 at 6:35 am

Difficult is not better

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Our value and our worth are not determined by how hard we struggle.

In the hospital, there is one particular nurse’s station that always has an inspirational quote written on a white board in happy, bright colors (it is perhaps relevant that this is a neurosurgery unit, and the patients are generally anything but happy and bright). This was the quote a few days ago, and it resonated with me.

I spend a lot of my life welcoming in the difficult/complicated. Long distance relationship? I can do that! Medical school? Sure, why not? Harder classes, fully packed course loads, early mornings? Psh, of course!

I get satisfaction from knowing that I’ve pushed myself, that I’ve gone above and beyond the average person. (Average is something I was raised to see as undesirable, and it bothers me that, based on my standardized testing scores, I’m an “average” US medical student. And yet… someone has to be. And even more people are below average, and still excellent physicians). But my hard work and personal battles don’t actually make me better than other people; I know this, and it’s always good to remind myself. It bothers me when doctors think they’re special because medical school is so hard to get into, and yes residency is tough (watch me complain next year) and the hours are god awful, but it’s not like we have a monopoly on bad working conditions, and at least we’ll eventually be paid pretty well, and we’ll have good job stability (or ability to find new jobs). So in a similar way, I’m nothing special, just because I’m in a long distance relationship and “suffering” through medical school,  or because I enjoy spending part of my vacation cleaning and cooking for my boyfriend instead of kicking back all day while he’s at work.

I’m not going to stop struggling though, because in some ways, I’m lost without it. I’m on a fairly light rotation right now (yay fourth year!); I have all my weekends off and amazing hours, and I don’t know what to do with myself. I need to fill my days with actions, as much as I think I love free time. And I’d much rather fill it with actions done for other people, not myself. (A perhaps related aspect of my personality is that I hate asking for help, but love being asked for help. I love to do things for people but am often uncomfortable having things done for me, unless we’re very close. I’m either really desperate or I really like you if I ask you for a favor. Or both).

My value and worth are not determined by how hard I struggle, but struggling is a part of who I am, and I’m mostly at peace with it, and I’ve learned how not to be dysfunctional about it. Sometimes battles are not worth fighting, and sometimes shortcuts are amazing, so I’m fine buying pre-chopped or crushed ingredients for my cooking, and sometimes I’m fine buying that thing I could totally make myself for much cheaper (especially after I’ve made it once, just to prove I’m capable).

We are all worthy, valuable people, no matter how hard we do or don’t struggle in this lifetime. Some of us might still be terrible people anyway, but that’s for other reasons. =)

Written by Aba

June 24, 2012 at 6:54 pm

Introversion and Medicine

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I’ve been meaning to do a long post about what it’s like to be an introvert in medical school. It comes with its own set of challenges, especially if you’re a really quiet introvert (like me), and even worse if you’re shy too (I’m not very shy in professional contexts). But I don’t think I’m going to get around to one big post, so I’m just going to try to remember to post about it every now and then.

I just finished my four weeks on Outpatient medicine, and the Doctor I worked with was very social. When I followed him around the hospital, he was always saying hi to people: janitors, nurses, administrative people, etc. I think he’s also the Director of his division, so some of it comes with the job, but he’s also just that sort of person. At the end of every heart catheterization, he would thank each of his support staff, and they always seemed genuinely happy when they realized he’d be working in their operating room that day.

His office partner, also a cardiologist, was quite different. He seemed like a nice, friendly guy, and he often poked his head in on occasion to chat (and often about life, not just about patients). He’s good to the office staff too, but he doesn’t socialize much outside of his office, apparently. On two or three occasions I heard people ask the doctor I was with about him, and mention that he doesn’t really smile much. I think he’s just new though, and probably takes a bit of time to warm up to people.

I’m not a chatty person, and I enjoy disappearing into my thoughts. I used to hate getting my hair done as a pre-teen because my mother would always complain that I would just read and not smile at the hairdressers or talk to them. I understand her point, especially now, but at the time I didn’t want to be there in the first place, and it was tolerable because I just read throughout the experience and stayed in my own little world.

But I make an effort to be pleasant.  Especially in the hospital, but I also extend this to life in general. I’m not going to suddenly turn into the kind of person who talks to everyone about anything, but I’m quick to smile and nod a hello. To at least acknowledge them and trade generic greetings. People notice these things, and they appreciate it.

Written by Aba

May 4, 2012 at 12:23 pm

Determination and Drive

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The summer I decided I was going to medical school, I decided to take General Chemistry to catch up on the prerequisites (I still took a year off between undergrad and med school to get some more science classes in on my transcript). I enrolled into the class a bit late, maybe nearly two weeks late, but it was still within the Add/Drop period. The teacher told me that I could still take the class if I really wanted to, but the first exam was tomorrow, and she gave off the vibe that she didn’t think this was a good idea and that I wouldn’t be able to pass the test.

I got an A in that class. Best motivation ever is to have someone tell me I can’t do something that I think I can.

A few nights ago I was at a post-match 3rd years/4th years meeting, and in the Psychiatry small group, someone asked the fourth year about how people on other rotations talk about the Psychiatry residents here and what he thinks about how they seem to be less “Academic” (which he was pressured into clarifying as meaning intelligent).

So this makes me want to keep pushing myself on my Medicine rotation, even though I know I can easily get a High Pass without much extra effort. Psych patients deserve smart, hard working doctors too.

 

Written by Aba

March 22, 2012 at 8:55 pm

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