Thursday Born

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

Archive for the ‘Clinical Experiences’ Category

Third Year Ob/Gyn Rotation Review

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One last picture of the flower trees outside my apartment. 1) Because they’re beautiful. 2) Because the flowers have all already fallen off so I can’t take any more pictures of them. =(

I’m now on my second week of Internal Medicine, and I just wanted to write a quick post about Ob/Gyn before it’s too far off my mind. I think it’s really unfortunate how many medical students end up having bad experiences on this rotation (at my school and nationwide). It was definitely mixed among my classmates, and very heavily based on which residents you had, and which sub-rotations you had (on Gynecology Oncology for example, just about everyone is miserable). I was definitely very stressed out my first two weeks because I didn’t feel like I was clicking well with my team (and then surprise, my Chief Resident actually graded me really well and gave me some really nice feedback).

My second two weeks, working at a government funded clinic with five different Attendings, was an amazing experience. I loved all the Attendings, the patient population was interesting (never heard that much spanish in Saint Louis this entire time I’ve been here!), and I in general just really enjoy outpatient Gynecology and Obstetrics. One of the Attendings runs Centering Pregnancy groups, which is a model where you select a group of women with due dates within a relatively close range, and they do their prenatal visits as group sessions. Most of the women in her groups were under 25 (in one group only one or two of them were old enough to drink) and most were first time mothers. Young mothers who didn’t intend to get pregnant are an unfortunate demographic, but one that is really satisfying to help. And sexual education and access to birth control are two topics rather near and dear to my heart, so it was nice to see and work with the population that I want to help out and the outcomes I’d like to work toward preventing.

I’m also apparently rather good at speculum exams, for a medical student. Unfortunately, this won’t be a very useful skill for my future career path, and it’s really not much of a party trick either…

Labor and Delivery nights was another good experience (minus the night shift part), because I really lucked out and had solid and friendly Residents. I learned how to “catch” a baby, and watched how amazing and beautiful and grotesque all deliveries are, from C-Sections to births with epidurals to the “omg there is no time for an epidural because this baby is coming out NOW!” births. Unfortunately, the women who tended to want fewer interventions or who wanted to do water births always requested no medical students in the room, so I never saw those. What I learned from Labor and Delivery is that Ob/Gyn is definitely not for me, because C-Sections are one of my least favorite kinds of surgery, and vaginal deliveries aren’t something I really want to do routinely either. I love the medicine of Ob/Gyn, but not the procedural aspect. I probably could have loved being an Ob/Gyn nurse practitioner, and delivering low risk patients, but that’s not the path I’m on, and I think I’m really going to enjoy Psychiatry. =)

But as I said, sexual education and birth control are still important topics to me, so I hope someday to find a way to advocate for what I believe in, and to help make a change, even if I’m not going to be a direct provider.

Written by Aba

March 20, 2012 at 9:06 pm

Morbid curiousity

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Our chief resident mentioned that there would be a D&E (dilation and evacuation; essentially, a second trimester abortion) this morning (feels like yesterday to me!), and asked if I or the other med student wanted to watch. The other med student offered to let me go if I wanted, and I accepted, because, well, new experiences.

I’d like to write a blog post about it, except I’m not sure yet how to do so without a lot of rather sensitive, graphic imagery that I’m not sure my readers would appreciate, so I might just write one and not publish it. Or just write about other aspects of it and not about the procedure itself. We’ll see.

(It was essentially medically indicated and not elective).

Written by Aba

March 1, 2012 at 6:56 pm

Night Shift Brain Death

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I’ve finally gotten back in the rhythm of packing my food! And since I’m working night shift right now, I’m packing a little bit more than usual since when I get home in the morning, I don’t eat and go straight to sleep. They are:

1) tortilla soup
2) small tupperware of nachos& shredded cheese for the soup
3) carrots+grapes+cheese
5) strawberries
6) one yogurt
5) a roll and a half of sweet hawaiian bread with hazelnut butter to eat with the strawberries

Soon as I’m done with this post I’m going to quickly make and eat a sandwich and head out to start my ~12.5hr Labor and Delivery night shift. It’s tempting to skip eating all together but I know I’ll regret it later and end up buying something.

Sigh. I’ve had so much I’ve wanted to say these past weeks but I’ve been so busy, and now I’m busy and exhausted and completely disoriented from the sleep schedule change.

Written by Aba

February 28, 2012 at 7:03 pm

Once more, with estrogen

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It’s like I’m back on surgery except there’s a lot more women everywhere. I just started Ob/Gyn on Monday and wow, I’d forgotten how exhausting these days are! I got lucky and I’m on Benign Gynecology surgery (tubal ligations, hysterectomies, prolapse repairs, etc) instead of on Gyn Oncology (all the cancer surgeries; general far more complex operations) but the hours are fairly similar (the students maybe work up to an hour a day extra, which yes, is still significant). My schedule will be about 6am to 6pm most days, which is better than my Colorectal Surgery hours, but surprisingly worse than Pediatrics when I was averaging 10hrs a day on Inpatient.

I come home tired, and hungry, except I’m too tired to eat a meal so I snack on the nearest sugary thing and then I’m not awake long enough to get hungry again and eat a proper meal. I also come home, and wake up, with all sorts of intentions to write this email, or put up that curtain, or cook that eggplant that might have gone bad by now, but I just don’t have the energy.

I only have two weeks of surgery, followed by two weeks of outpatient (which will be better hours), but then that will be followed by two weeks of night shift on Labor & Delivery right before the exam.  So as much as I just want to come home and vegetate, I need to make some magic happen and find the will to study.

I’m really liking Ob/Gyn, btw. It’s actually what I came into medical school thinking I’d do. But ultimately, I’m not sure it’s right for me, so I’m trying to make the most of this 6 week experience! I already have some (rather tragic) patient stories to share in vague detail, but I don’t like to share them immediately after they happen.

Written by Aba

February 1, 2012 at 7:12 pm

Reverb 11, Day 10 – Beauty

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What is Reverb11?

Beauty – Describe a moment of beauty that you witnessed this year.

Happy parents of newborn babies.

I started my Pediatrics rotation last Monday, and my first block is two weeks at a small community hospital. I spend most of my day in the ER with the one or two pediatricians on duty, but since they’re the only pediatricians in the hospital, I also see any inpatients, and any of the newborn babies who are waiting to go home post-delivery.

We see the babies early in the morning, unless the ER is busy. This means that often the parents are sleepy and not in the best of moods. But there are some parents who just… They’re happy. They’re in love with each other. They’re in love with their new baby. They’re tired and I’m sure they can’t wait to get home and take a proper shower and not have doctors and nurses barging in on them at odd hours, but they’re still smiling and joking with each other and playfully teasing their baby for crying when all that’s happening is people loving on her.

I feel weird sometimes, being there. Watching what feels like such private moments. But I’m so grateful that moments like this are a part of my education.

Written by Aba

December 10, 2011 at 8:04 pm

My day? Made.

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My Psychiatry  rotation is over already, and now I’m on Emergency Medicine for my “Wild Card” block. We got to pick from a list of different ambulatory experiences, and Emergency Medicine is something that I’ve always enjoyed in theory, so I wanted to make sure I tried it. I love EM doctors (they make for wonderfully engaging lecturers) and I love the wide variety of patients they get to see.

Anyway, things that make my day include the young patient who just found out she’s pregnant again (she’s younger than me and already has more kids than I personally want), on whom I just did my third pelvic exam, saying, completely unprompted, “You’re doing an excellent job, Aba.” (And for the cherry on top, my Attending for the shift was in the room too).

Seriously,  how does your day get any better? Getting to do her pelvic exam and then hearing that was completely worth staying an extra hour after my shift.

I admit, I’m such a sucker for approval. I don’t actively seek it out, but it makes me ridiculously happy. This is not my first patient compliment, but it’s one of the most coherent and sincere. On Neurology, a post-ictal patient kept thanking me and saying I was doing a great job, but unfortunately she probably doesn’t remember me at all (post-ictal = post seizure state). I also got a few compliments on Psychiatry, one of which was actually very sweet and heartfelt, but most of the rest ranged from entirely incoherent and nonsensical (but the first time I’d seen that schizophrenic patient smile!) to somewhat creepy (random patient with pedophilic tendencies telling you that you’re pretty is … ?!?!?).

 

Written by Aba

November 12, 2011 at 10:16 am

5 Jesus Christs, 1 room

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Today we had “Professor’s Rounds,” where one of us picks a patient and presents the case to the group and an Attending doctor. Then we bring the patient in and watch the Attending interview the patient.

Today, prompted by the chosen patient’s lack of “insight” (ie, the patient believed he/she was absolutely fine and not ill in any way), our Attending shared a quick, amusing story with us.

He once had five patients who all believed they were Jesus Christ, so he decided to see if meeting each other might help them gain some insight. A couple of them got angry, “How dare these people think they’re me?!” Others who were quiet during the meeting later approached him, and commented on how sad and obviously crazy these other people were, thinking that they were also Jesus.

It’s quite fascinating what we can become convinced of, isn’t it? The psychiatric cases are the most dramatic and oftentimes entertaining stories to share, but it happens to the conventionally sane appearing too (anti-vaccinationists come to mind).

Written by Aba

October 25, 2011 at 3:45 pm

Coping

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Someone just tweeted this really beautiful article from the New York Times, called “Notes From a Dragon Mom.” It’s a very sad yet somehow uplifting piece written by a mother who has known from birth that her child is not going to live very long. And it reminded me of a conversation I had with a patient while I was on neurology.

I was seeing the patient in the emergency department, and while waiting for my Resident to come and officially do the consult, she was talking to me on and off, in a bit of a daze, about her family. Mostly I remember her because I felt so helpless to help her – there was nothing we could do but wait – yet she quite desperately wanted someone to fix her. She didn’t quite know what was happening and she kept forgetting where she was, but through it all she knew that she wasn’t well.

I also remember her because of how she talked of one of her children, who I gather only lived till her late teens or early twenties. She didn’t talk with sadness, but almost with joy. She was so happy to remember her daughter, to remember how bright and beautiful and determined of a person she was, despite her condition. She felt blessed that her daughter had been a part of her life, even though it’d only been for a fraction of the time that you want your children to be around.

As part of my psychiatry rotation, I’ll be spending a total of six afternoons in the child clinic. It has made my days long (~11 hours) since clinic runs late, but it has been a very interesting experience. I’ve seen quite the range of the autistic & aspergers spectrum, from non-verbal teenagers who spend most of the interview curled up with their mothers to highly functioning teenagers dealing with having just started college. And you see quite the range of parents. Some are handling it with more grace and good nature than others, but all are handling it. They might not have to watch their children die, but they’re faced with the knowledge that when they die, who’s going to continue to take care of their child?

I don’t find death in and of itself tragic until I’m faced with the thought of those left behind; that’s when my emotionality kicks in. I watched a patient in our geriatric ward code a few days ago. She had choked, and it took a while before they got her breathing again (she’s okay now, by the way). I felt some shock and worry and sadness in the beginning, when there were some other patients and nurses around reacting emotionally to the situation, but once they were gently escorted away, I was watching with mostly a professional detachment and curiosity.

Maybe this is why I like to hear people’s stories. I prefer to see them as people, as individuals with friends and families, with triumphs and hardships, and getting a better, bigger picture is how I do that.

Have I mentioned yet that I’m really enjoying Psychiatry? It’s definitely high on my list right now.

Written by Aba

October 16, 2011 at 12:44 pm

Denial

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I refuse to believe it’s Fall already. Now don’t get me wrong, fall is a nice season, as far as seasons go ( I grew up with just two: Rainy, or Dry. I sort of understand being attached to this whole four seasons business, but it’s still rather foreign to me), it’s just… what happened to summer? How did it pass by so quickly already?

I’m doing what I can to squeeze the most out of the good weather before winter sets in, so today, while waiting to be paged for a consult, I found myself cozying up to Blueprints Neurology in the beautiful little park area outside the hospital.

Have I mentioned before that I love socks? I’ve been rocking argyle and thick stripes for the most part, and there are several fun designs on this page that I think I’ll be splurging on soon. It’s been months since I’ve treated myself to some nifty new socks!

Written by Aba

September 20, 2011 at 8:36 pm

Longing for a sense of Belonging.

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Third year medical students are a bit like nomads, or refugees. I guess fourth year medical students are too, but I think by that point you’ve embraced your situation. During first and second year, we lots of dedicated, comfortable, official space. Third years? We have whatever space we can stake a claim to, always ready for a Resident or Attending or Nurse, someone who actually needs the computer or desk space for patient care, to displace us. Sometimes we return to the first and second year carrels, because we don’t know where else to go, or we head to the library.

What’s starting to actually get to me though, is the switching teams every 2 to 4 weeks. Sometimes you have a team of Residents and Attendings that you become really fond of, and then next thing you know, you’re working with a whole new group of doctors, and a whole new patient population. And sometimes it’s as small and simple as today, where I spent a half day in a Multiple Sclerosis specialist’s clinic, and at the end of the day she said I was welcome back anytime and that she enjoyed having me around, and I really liked her and really would love to spend more time with her, but I’m not going to, because it doesn’t really work with my schedule. This makes me kind of sad.

Also today, one of my Attendings from my PM&R rotation walked by us in the hallway, and he’s another person I really enjoyed working with (and I got a glowing end of rotation evaluation from him). I’m half-considering doing another PM&R rotation during my fourth year, just because I had such a good experience, even though I don’t think that field is for me. And I worry a tiny bit about letting down one of the ENT Attendings I got official feedback from, who asked me if I knew what I wanted to do yet, and said that if I end up considering ENT, I should let him know.

I can’t do every specialty. I’m going to have to pick someday. And for some reason it bothers me in a tiny but not entirely insignificant way that I won’t be doing what most of the Attendings and Residents I’ll work with and like are doing.

On the one hand, I think this is a great sign, that I get fairly easily attached to the sorts of people I’m going to be spending so much of my future career with. On the other hand, I’m really looking forward to finding my niche, my people, and “settling down” a bit. You still rotate around a lot as a Resident, but there’s a somewhat smaller core of people that you belong to.

Having a sense of belonging is very important to me, apparently. I’m not sure why.

Written by Aba

September 19, 2011 at 8:40 pm

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