That’s the sound of me fizzling. I’ve missed a number of days posting on the blog, meaning I definitely can’t call this NaBloPoMo a success, and I’m severely behind in my writing, such that I’m not going to make the 50,000 words for NaNoWriMo.
But you know what? I’ve been having fun, so Pfff is also the sound of me scoffing at my own expectations.
I’ve mostly been having fun.
Except for the part about my kids coming down with what looks like H1N1 (or, as my sister calls it, the Hiney).
That hasn’t been so much fun but hey, it’ll be a week or so and then the not-so-much-fun will pass. Then I just have to hope the kids start sleeping normally again.
So, I’m in my third year of medical school now, and rotating through different services in the hospitals. Each rotation ends with a mandatory exam, usually a nationally standardized exam we call the “shelf”. The most common comment I’ve heard or read about shelf exams is, “it was a pretty hard test.” Needless to say, there’s usually a fair amount of stressing about these exams, and I don’t know anyone who would say they enjoyed any part of the studying for them, because it just feels so hectic.
Until now.
An amusing question from one of the practice exams I did preparing for my Psychiatry shelf exam today:
A 24-year-old man presents to the ED with symptoms of PCP intoxication and a positive urine toxicology screen. What is the best treatment for extreme agitation in this patient?
- Trihexphenidyl
- Bupropion
- A phenothiazine antipsychotic
- A Butyrophenone antipsychotic
- Fluoxetine
If this patient is not experiencing extreme agitation, what is the best treatment?
- Vitamin B12
- Supportive care
- Vitamin E
- Lorazepam
- cheese
(emphasis mine)
It’s a very, very good thing that question was on a practice exam, and not the shelf today, because as it stands, only my wife had to experience the laughing meltdown as I lost it after reading that question. Had it been on the shelf, I’m quite certain I’d have been removed from the room.
Now, cheese does get discussed when talking about pharmacotherapy for psychiatric issues, because it can cause adverse effects when eaten by patients taking a specific class of antidepressants, but I can’t recall ever having actually heard or read it discussed as a therapy unto itself.
Who knows. Maybe we’re missing out. The American Dairy Association certainly thinks there’s something there.
I, however, am going to go to bed tonight, still laughing at the thought of treating PCP withdrawal with cheese.
So today was my last day of clinical responsibilities for my psychiatry rotation. Psychiatry was something that, with the exception of a personality conflict with one of my instructors a couple of years ago, I’ve really enjoyed learning about, so I was excited to do this rotation and see if I enjoyed it clinically.
I do.
It’s absolutely fascinating to me to see how much mental illness can affect a person’s perception of the world, and in what ways. I’ve worked with patients with depression, bipolar disorder, schizophrenia, substance-related disorders, borderline personality disorder, narcissistic personality disorder, PTSD, and even a patient with paraphilic infantilism. I saw some of these patients get much, much better with therapy. I saw some who were unable to recognize their mental illness. I saw some who had problems they recognized, but weren’t willing to participate in therapy for. I saw some who desperately wanted help, and for whom we just hadn’t found the right therapy for. And I saw some who struggled with a therapy that ameliorated the symptoms of their mental illness, but were struggling with side-effects of the treatment.
Through all of this, I got to see people as they really were. I saw this on my pediatrics and internal medicine rotations, too, but not to the degree that I experienced it in psychiatry.
It became a great opportunity for introspection, as I worked to recognize counter-transference, and to assess what it said about me, or as I cultivated empathy for my patients, and tried to see the world as they saw it.
I think you need to have a bit of a light attitude about it all, to be able to maintain the energy you need to continue helping patients with problems that are, often, extremely depressing/frustrating/frightening for the therapist, and more so for the patient.
Ultimately, I loved psychiatry because it was, more than almost any other time of my life, an opportunity for me to focus my efforts and attention on people, in spite of their problems, because in this case, the two are not truly separable.
Tonight I was trying to study for my upcoming exams while watching my two kids and my nephew. My three-year-old son was having a good time playing around with his one-year-old cousin, but my twenty-month-old daughter decided (as she often does) that I wasn’t paying enough attention to her, so she went to her room and got one her blankets and asked me to wrap it around her, which I did. She went back to playing and within a couple of minutes she was handing it to me to wrap around her again. This continued to happen for as long as I tried to study, only stopping when she knew I was watching her. If she wasn’t sure, she’d take off the blanket and bring it to me for fixing. Once I got tired of this and took the blanket away, she just went looking for something else, eventually finding a pair of sun glasses, and resuming the game.
As frustrating as it was, I have to laugh because I’m certain I probably did similar things to my poor mom when I was little.
Well, it’s November, and I’m finding myself staring at the beginning of what might be my last chance to attempt either NaBloPoMo or NaNoWriMo for a few years, as my life will only get busier from here on.
Writing a novel has long been one of my goals. I don’t know that I ever expect to actually publish one, but I’d like to write one. In the past I’ve always kind of said I wanted to do this, but I’ve actually started planning out my progress this time, and I think I might actually manage it.
NaBloPoMo I’ve done once before, though I only barely managed it, particularly with a lot of nonsensical, filler posts. I’m not counting this one as one of those types of posts, because I’m actually talking seriously about something, even if it’s something only I would really care about.
So, if anyone is reading, wish me luck, or better yet, success. It could be an interesting month.
edit: Except I just realized, regarding NaBloPoMo. Today is the 2nd. So I suppose I can’t fully do that this year, but I can at least try to do it form here on out.
