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.
I frequently get email forwards from various family members. Usually, they’re jokes, time wasters, amusements, and things that are otherwise intended to be completely funny. Sometimes they’re factoids, health-related information, news stories, and sometimes they’re political.
I fundamentally disagree with most of my family members when it comes to politics, particularly with my extended family members. Usually, I glance at the message, and if it’s political I peruse it for anything particularly poingnant, vicious, or blantantly false, and respond if I feel it needs responding (I think I’ve done that a grand total of 3 times in the last 5 years), but usually the political ones go quickly in the trash can.
Occasionally one of these political messages will make me laugh.
Occasionally one of them will get my dander up, and I’ll start writing an angry response about the problems with the email and why we shouldn’t ever pass things like that on.
Occasionally, though, I’ll read something that just flat out makes me sad. Today, I read one of those. Here’s the pertinent quote from that email:
We’ll continue to believe healthcare is a luxury and not a right.
It makes me sad that people really believe this. Inherent in this belief is a disregard and lack of caring for those who are in pain, have disabilities, or dying, and lack the means to secure the help they need to live a normal, everyday life.
Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed to me.
I lift my lamp beside the golden door.
I imagine most of you recognize this quote, but for those who don’t, it’s the inscription on the Statue of Liberty, one of the most prominent symbols of the United States of America. It describes people who are, in many ways, similar to those in our country who need access to health care they can’t get.
I have to wonder how many people in our country would describe this, much as I’m sure the writer of the email I quoted from above would, view this sentiment with scorn and disdain.
Most, if not all, of those who send these to me would consider themselves Christians. With that as context, a few more thoughts spring to mind:
Matthew 25:35-40
35 For I was an hungred, and ye gave me meat: I was thirsty, and ye gave me drink: I was a stranger, and ye took me in:
36 Naked, and ye clothed me: I was sick, and ye visited me: I was in prison, and ye came unto me.
37 Then shall the righteous answer him, saying, Lord, when saw we thee an hungred, and fed thee? or thirsty, and gave thee drink?
38 When saw we thee a stranger, and took thee in? or naked, and clothed thee?
39 Or when saw we thee sick, or in prison, and came unto thee?
40 And the King shall answer and say unto them, Verily I say unto you, Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me.
And then, echoed to the Hebrews (Heb 12:12-13)
12 Wherefore lift up the hands which hang down, and the feeble knees;
13 And make straight paths for your feet, lest that which is lame be turned out of the way; but let it rather be healed.
(emphasis mine)
I wonder how Christ would respond if He was told “Healthcare is a luxury, not a right”.
Maybe it is a luxury, but it’s a luxury that our philosophy as a nation, and our responsibility as Christians (those of us who are), demands we provide for those in need of it. It’s a luxury everyone should have access to, regardless of his means, and I’m beyond disappointed that people I love and care about would be so uncaring.
But, then, if so many people in this nation truly feel this way, perhaps it’s appropriate that the Statue of Liberty has closed her doors.
