Thursday, August 29, 2013

Mania, Grandiose, and other things hard to imagine

As a 6 year med student you are required to rotate in several different "core" clerkships in your 5th year which includes Surgery, OB/GYN, internal medicine, psychiatry, and pediatrics. Basically it is 2 months(except for psych which is 1 month) where you learn all the basics to a field plus some obscure facts for your national exam while freaking out about what you are going to specialize in. After a long, stressful, and difficult 6-10 weeks of studying for step 1, I started my first clerkship at the beginning of August: Psychiatry. Before starting I thought I knew what mania was like, a general idea of grandiose would be like, and had a certain idea of what a month in psychiatry would entail. I couldn't have been more wrong. Nothing in a textbook can really prepare you for what the extremes look like and the frustrations that come with being in psychiatry. You are diagnosing patients who are having a break from reality or are overall difficult and though you may want to say "you stop that and cooperate." It would do you no good. They simply are not capable of the impulse control and decision making that those of us who are not suffering from mental illness take advantage of every day. These are some situations which stick out from the month.

The Manic with grandiose ideas: my first interaction with him was nothing short of memorable. Cursing at the staff physician and resident to get out of his room, shouting he had written the DSM and he was a physician who had diagnosed the attending with being a sociopath, and promptly refusing any medication. Through his 96 hour hold his list of grandiose beliefs grew and eventually landed him in a 21 day hold. He believed that he had served in the korean war and on the USSR(though he had not been born yet), had created the internet, had 5 doctorate degrees from any ivy league university before he was 5, owned his apartment building and the buildings on each side of him, that the staff were all foreign spies who had infiltrated the system and were keeping him against his will so he wouldn't warn the military that they were trying to steal the US reserve, that the officer that brought him to the ER was a russian spy, his neighbor a child molester, he had written the DSM and created all 3 tiers of psychiatric medications, and the list goes on. A meeting with him would surely end in him declaring you a nazi and sociopath. Did you know that Hitler ended up in a zoo? Yeah me either.

The Praying Schizophrenic: each schizophrenic has different delusions and hallucinations and though it is still not clear what this person's delusions and hallucinations are it is sure to be something to do with religion. He is also a diabetic which causes other special concerns, but a week ago he decided to start refusing all medications. Both psych meds and medication for his hypertension and diabetes. He also stopped eating, drinking, and sleeping. He simply sits in the same spot all day praying in a different language. Anytime he is disturbed, he becomes aggressive. He will get a long term injection and hopefully come out of his psychosis.

The "normal" suicidal patient: most people don't want to be in the mental hospital. It is a locked facility where you are checked on every 15 minutes if someone isn't constantly with you already. Your time outside is limited and otherwise you are basically in your room or the common area or groups. It is a very structured environment which is great for psychotic patients, but for others it can be terrifying. Your freedom is taken away and you are locked into a facility with others who are having a break from reality. I called this patient "normal" because she wasn't having a break from reality, however there is nothing normal about being suicidal. The attending physician was discussing personality disorders with us when there was an urgent knock on his office door. She came in sobbing and demanded to leave. To her dismay the answer was of course no. She then demanded to know if we could legally hold her against her will and the answer of course was yes. She was distraught. She had a career, a house, a dog, but she was depressed about not having a family and not being able to have children which eventually led to her to being admitted. After a 96 hour hold(which does not include weekends so more like 140 hour hold) she was release with resources, new medications, and an eye opening experience.

So what did I learn in psych? They have the most unpredictable patients, spend a lot of time dealing with legal issues, and are tested on a daily basis. I have no idea how much money they make, but I am sure it is not enough. Bless their hearts for being able to care for people who need it the most.

Today was my last day. I am curious to see how the patients who are just now starting medication and treatment will progress, but onward I go. Next week is the beginning of pediatrics. Wish me luck!

Thursday, August 22, 2013

What the Heck is an FMD?

I first heard the term FMD as an 18 year old eager/stressed/overwhelmed first year medical student. I'm not sure if the person had made it up or heard it somewhere else but I still remember it. FMD=Future Medical Doctor. I thought it was super clever perhaps that is why I remember it. I was so easily impressed and had just begun my long journey as a FMD. There was nothing else in the world I wanted to do more than to be where I was at that moment. I had decided that I was going to be a physician when I was probably 8 years old and whether it was my passion for helping people or my hardheaded determination to stick with what I decided on, I never changed my mind. I learned about the 6 year medical program when I was a Freshmen in high school and from that moment on everything I did was to get into that program. When my acceptance letter came, I cried. Calling my grandma(who is by far one of my biggest cheerleaders) while crying, her first words were, "Oh honey, I'm so sorry." It was the tears, they confused her. Choking back my sobs, I said "grandma I got in." She of course was ecstatic and proud. Neither of us knew what the hell I was getting myself into. That first year of ups and downs and then just downs, I never really could picture myself as a doctor. Actually it probably wasn't until I got back my Step 1 score a couple of weeks ago that I really could see the light at the end.
It seems so surreal that in less than 2 years I will be writing prescriptions, getting even less sleep, and going by the title Dr. It was probably just a few months ago that I realized how lucky I am to have the experiences and opportunities that I have. I have been writing a crafting blog for a year and half now and it hit me while writing this last entry that I should write about my experiences. If for no other reason than to encourage those who are in my shoes when things don't go right, to keep some kind of correspondence with my family who barely see me, and just to look back on for a laugh when that FMD is just a MD.
I hope this blog will be entertaining, humorous, encouraging, inspiring, and above all worth the read!
Fall of Year 1

Spring of Year 1

Moving into the dorms...Do I have enough pictures???