Growing Up

For a variety of reasons, not least of which is the yearly changeover of residents in the residency programs, I am feeling a sense of nostalgia, of stock-taking, and a sense of the start of something new.

I'm now half-way through the specialty part of my residency and lately, I'm starting to feel like this is really what I'm supposed to be doing. I'm feeling like these are my patients and I know how to take care of them. More and more, I feel like I do a really good job of taking care of them.

I'm not trying to sound conceited because god knows I still struggle a lot with learning enough material, fast enough and well enough. But I feel like the taking care part, I've really got that down.

And it's also striking me that I'm a senior resident now; I'm one of the ones that people are going to look to for decision-making, not just for patient care, but for things like administrative and political issues that arise in the residency program and the department as a whole. It's gotten me started thinking about how I come across as a professional. These are things they don't teach us in medical school. These are things I haven't had time to even be aware of, as I was just trying to keep my head above water before. But now, in addition to being a caring technically competent doctor, you want me to learn leadership skills, business practice management, yikes!

The cool part is that this change excites me; I'm really looking forward to finding out who I can become now that I'm in a position of more power, and more respect (and now that certain other people are gone, but I think I did a pretty good job keeping that bit of drama out of things up until now, didn't I?)

Sharp-Dressed Doc

I've really been getting into the daily-wear blogs lately, and the fact that my fabulous sister is behind Undergrad Fab certainly doesn't hurt my interest. She, my other wonderful sister and my mom all got me some fantastic accessories for my birthday this year that I am just dying to play with to start mixing up my wardrobe a bit. And I really would like to get some feedback on all of these things, it's just....

I get sort of a weird feeling about posting photos of myself everyday all across the interwebs. At least on facebook, I can control who sees what and when. But, keeping in good mind that I have patients and future employers who do use the internet, I think it's more prudent to post in the style of polyvore. So I'm going to try that for awhile and see how it goes. I'm not always going to promise that this will be a "daily" wear thing, either...lord knows I'm lucky if I remember to do everything I have to do, let alone extraneous things. But I want to try it and see how it goes. I'm open for any thoughts and opinions!

Grand Rounds is up!

Please check out the wonderful job that Sam at Blog, MD did with Grand Rounds. Thanks for including my submission!

TB with a side of pi

First off, happy pi day. (My geek is showing).

Next, I did something in clinic today I did not expect I would have to do...treat a 25 year old for TB. Granted it was latent TB, but it scares me because she's a recently graduated nurse, and had negative PPDs. However, her quantiferon gold test was positive, and a nodule showed up on xray. And while she's been asymptomatic, and working (!!!) per the employee health recommendations, I have now sentenced her to 4 months of fairly hardcore antibiotics. It makes me wonder what I have been exposed to.....

Thirdly, I am having so much fun buying things for my Yarn Pron Swap pal! I need to be careful to stop buying things for myself too.... :) Etsy has so many good things, how's a girl to decide?
My Cozy lace shawl is driving me nuts. I've frogged a row about 5 times, and I cannot figure out why it looks like it's in pattern at the beginning, and then towards the end, the pattern is off, and I have an extra stitch. WTF??? I think it's back to the soothing ribbing on my sock for awhile.

Toys in the Attic

I had an incredible breakthrough in one of my own biases today, and it made me feel really good about some of the personal work I've been doing this year.

A little background....

I've had an eating disorder for the past ten years or so, and recently reached the decision that I could not live that life anymore. I have been in treatment for about 8 months. Part of that treatment was the determination that I have had a low-level depression for the past few years, through which I have been functional, but not optimal (a dysthymia, if you will). I was advised that an antidepressant could be very helpful to me.

While my logical, medical brain told me that this made sense, my gut put on the brakes. I came to recognize that when I see patients who are taking psych medications/have psychiatric history, I tend to conceptualize them differently in my own mind. At least in the inpatient setting where I spend most of my time lately, it often means that those patients are more difficult to treat. They often have accompanying social issues (I swear I have learned as much social work in my intern year as I have medicine). They may be less likely to take their meds, and keep their follow-up appointments. And now, I was going to be ONE OF THEM.

To clarify, my greatest fear was that, in reviewing my "med list" someone would see that I take an antidepressant medication, and would form the same opinion about ME. That's when my bias stood up and slapped me in the face.

I have tried to keep this in mind as I have carried on through the wards the past few months, and have been able to see things through different eyes to a certain degree. Another facet of this which emerged is that I was often reluctant to talk about psychiatric disorders frankly with patients....as if they didn't know they had it, or something? I think it's mostly because it's not a field that I see frequently/am comfortable treating.

In any case, I am on an outpatient month now, and while in my preceptor's clinic this afternoon, had the opportunity to meet a 70-something lady with bipolar disorder. It wasn't something I could pussyfoot around - the reason she came in to the internal medicine clinic was to talk about her current manic episode. Ok.

The patient was there with her daughter, and both spoke frankly about it as soon as I walked in:

Dr. Raygungirl: "Tell me what brings you in today."

Patient: "Well, I'm having a manic episode. I'm not sleeping, I'm spending more money, and I have 15 projects going on at home right now. And I want to remodel my kitchen." (She meant remodel it herself, not hire someone, FYI.)

And so it went. I found I was incredibly comfortable talking to the patient about her symptoms, explaining why she was experiencing what she was, and even guiding her and her daughter in the best way to navigate the god-awful insurance coverage for mental health. I called it a disease, and the patient stopped, faced me directly, and said, "I never thought of it that way!" So I went on to explain that it was a disease, no different from diabetes or hypertension except that it was happening in her brain. And then she shared with me that forty years ago, after she had her "nervous breakdown," she and her husband moved their family to a different town because they were so embarrassed about her "problem." It felt really good to reassure her, and in doing so, reassure myself. Mental health diseases are diseases, and they can be treated and managed in a similar manner to blood pressure, as long as we are not too hung up on stereotypes or limited experience (me).

I was frank, upfront, and I was helpful. I feel today that I've been more helpful to that one patient than I've been to all the patients I did blood pressure checks and well-woman exams on all month so far. And she, in turn, has helped me. I know that mental health issues are still stigmatized in our culture, but now, I'm not going to be part of the stereotyping and stigmatization. Next time I see a chart with psych meds or diagnoses, I won't jump to my previous conclusions. And maybe, next time someone sees my chart, they'll show me the same respect.

Knitting with the Plague

I've been hit by the plague, othgerwise known as a fabulous little respiratory virus that is not influenza, and therefore not covered by the little shot I got a few months back. It has me down and out for 5 days. I don't think I've been this sick as an adult. Every time I'm feeling better, it starts up again with the fevers and chills, and aches and sore throat. Ugh. This is getting complicated at work, as Healthcare Conglomorate terms any sick time greater than three days a "leave of absence."

Are you kidding me? I took one day as a vacation day, two as sick days, and now I need a NOTE FROM MY DOCTOR to go back to work. Oy vay. It makes me want to just hang a shingle out front of my house when I have my own practice, and keep the linear accelerator in the basement. Or at least remember not to get to close with Healthcare Conglomorate. Too much paperwork.

At least I've finished my Big Bad Baby blanket and a calorimetry to compliment my sister's scarf in time for their various events. Pics to follow.

Ice Princess

Good mother, it's freezing here. My weather.com page tells me it feels like -18 degrees F. I am shivering away in my computer room right now, drooling over lovely wool yarns that I ought not buy, but I want to. I want a stash. N would argue that I already DO have a stash, but it only takes up one little square area in a bookshelf. So not a stash.

If I had a stash, I think I would snuggle up under all the balls of lovely warm wooly yarn goodness tonight, and not come out. That's just how damn cold it is. It is certainly too cold to go traipsing out to see my friend's band tonight, what with the dearth of downtown parking, and the smoky bar, and the cold, cold me. Sorry guys, I'll catch ya next time.

We do have to go out to the Superbowl party tomorrow, not because I'm terribly enamored of the Superbowl, but party because our friends throw this party every year, and next year we'll be in Ohio, and therefore not able to attend, but mostly because I am making an AWESOME black bean dip. It's called a black bean dip, but really it's mounds of melted cheesy goodness with some jalapenos and black beans thrown in for good measure. It's from our favorite hole-in-the-wall restaurant. I shall post it later, after I dig it out. Yum.

I was on call last night, for the first time in the last month that I will ever do general medicine wards. It struck me how much more comfortable I feel doing this now than at the beginning of the year. I think I've learned more in the six months of my intern year than in my last two years of med school, at least as far as amount learned per period of time goes. I can figure out what's wrong with a patient, I uaually have a reasonable idea of how to fix it, and if I don't I know who to call to get a specialty opinion. This does not mean that I have learned all that there is to learn about the art of internal medicine, of course not. But I've become a much better diagnostician and know how to handle patients in the inpatient setting. I suppose that's what this transitional year was all about. Ok, great, so can I be done now? I'm totally ready to move on to RadOnc and start treating cancers, my true interest and career. I'm over pneumonias and diabetes, I tell you.

Big Bad Baby Blanket

I'm very excited....one of my friends from work is pregnant with her second baby, and she's due in about 6 weeks. Which is of course very exciting. BUT. I am excited because I decided to knit her a baby blanket from the Stitch 'n Bitch book. It will be my first knit gift to anyone, but it's a relatively simple pattern, and I've got all that on-call time next month to knit (when I'm not admitting and taking care of my patients, that is. Right.) I think she would appreciate it, too, as she's very into stuff that's not mass-produced chain-store. Her daughter right now is always dressed inthe cutest little-girl funky stuff, so I know I can get away with making it in a cool variegated blue-green yarn, rather than pastels. I'm getting yarn today!

Crazies in the ER

Usually I joke about how unrealistic the ER-type TV shows are...ERs are never that busy, that crazy, and very rarely have gun-toting nut-jobs. I know. I've been in quite a few ERs at all hours of the day, and it never happens.

I may have to eat my words today.

I worked an 11-11 shift, and my god, I am spent. I had two people in florid congestive heart failure, one guy with an infected leg...all the way up his leg, and a lady who was eating dinner in a restaurant, and collapsed, with a huge bleed in the left hemisphere of her brain. Those were just the interesting patients. Then I went to reach for a chart, glanced at the name, and recoiled in horror, as if it were a snake.

It was a patient who is what we call a "frequent flier." All the other ERs in the city know not to admit this guy, except ours. We have a few docs who have the CYA-complex, and he keeps getting admitted. I know this because he was admitted to my team back in August, and we could. not. discharge the man. He knows how to manipulate the system, he knows how to fake symptoms, he steals from other patients, he pleasures himself in his hospital room in front of nurses.....he's a disaster. Luckily, as the resident, I have the ability to cherry-pick the "learning cases," and did not go see him.

So when I heard the deafening crash from one of the other hallways, imagine my surprise to find out it wasn't him. No, this time the suicide-attempt patient, who was guarded by at least two cops, broke out of his room, knocked over all the storage carts in the hall, and invaded the room of another patient, threatening her. Then, the cops tackled him, cuffed his wrists and ankles, and the attending snuck up from behind with a shot of Haldol.

So, to all the Doc-dramas out there that I take such great pleasure in shouting at while my husband rolls his eyes at me, today I eat my words. Today. I can't promise that when Grey's Anatomy comes on tomorrow I won't shout "that's not how you do it!" at the screen, but for tonight, you were right.