Here's my day...

In true Sesame Street form: today was brought to you by the letter "go f**k yourself" and by the number "kiss my a**". The theme for the day was: the delights of personality disorders.

The morning, started off as per usual with my morning tea and fruit salad, when it was rudely interrupted by a new admission. She seemed lovely at first, until she opened her mouth. I've never heard swearing like that before...and I grew up in a small town with what I guess you could call roughnecks! The woman had serious issues (most of which I can't go into because of confidentiality issues), but suffice it to say, she has had a very rough life. She claimed that she was being watched (as most crazy people do) and that she thought she was sold to a motorbike gang for cocaine. She didn't want to be in the hospital...and I didn't want to interview her either! Not my cup of tea.

My afternoon consisted of an assessment of a patient who was had borderline personality disorder but also fit the criteria for narcissistic personality disorder. Oh...and PTSD and bipolar disorder. What a joy to interview!!! It took me 2 and a half hours and she was still talking as we kicked her out the door. She wonders why everyone in her life is out to make her life a living hell and traumatize her? She doesn't realize that it's actually her!

On the flip side, a couple of my patients who are still in hospital are doing well and I think I am developing some rapport with them. One keeps asking for me at the nursing desk because he wants to talk with me and tell me more stuff. Nice to see from patients who don't trust others very well. My supervisor this afternoon was impressed with how I handled the patient above...he even said that I was "interviewing at a resident's level" and "is exceeding any expectations he has for students in 3rd year" (I'm grinning ear to ear)

So even though I am not necessairily enjoying Psych, I am feeling a bit better about the whole thing. Crazies and all.

Just a tad on the offside

So, turns out I suck at Psychiarty...at least that's how I'm feeling. This was my first week of being around psych patients after a very long and very boring week of seminars last week. How many times do we need to go over the diagnostic criteria of major depressive disorder (aka 'depression')? Not helpful to say the least since I learn better by seeing real patients as opposed to listening to some guy who likes to hear himself speak.

I spend most weekday mornings on an inpatient ward at a hospital. The ward is called "Early Psychosis Intervention (EPI)" but also has some beds for neurology patients who have psychiatric conditions secondary to their disease. The EPI program is mainly young adults or teens who have a first major episode or have relapsed. It's interesting, but the patients are very difficult to engage and mostly uncooperative. I feel sorry for them, because it's not their fault. Their 'world' is different from ours in that they inherently can't tell what's real and what's not. It must be very frightening...I'd be scared sh**less.

The afternons consist of outpatient clinics (psych checkups) and in child psych with families. I have Monday and Friday afternoons off!!! Ahhhhh...the benefits of psych!

As I was saying, I suck at Psych. I had patients refuse to answer questions from me (although they'd talk to the REAL doctor), I had patients insult me and tell me I can't read. I had one patient who decided that he wanted a diagnosis of "crazy" to get on disability benefits...but his answer to my questions was "that's none of your business". I'm learning pretty fast that it's very important to establish rapport and a sense of trust with thses patients to get them to talk to you...but I'm still trying to find ways to do that. Until then, I will keep banging my head on the door.

PS Good luck to my collegues who are doing their exams for "the big 3"!!!

End of an Era

Well, I've finished Obs/Gyne now. On looking back, I can't believe I've learned so much in 6 weeks!! I really enjoyed it; both the clinical and surgical experiences are something I could see myself doing. The thing that holds me back is the 5 years post-med-school that it'll take to train. Not so much into that!

We had our Obs/Gyne exams on Friday. The morning was spent doing what they called an OSCE (observed standardized clinical exam), but it was really an oral exam. A regular OSCE would have had patients (played by actors) as well as an observer (examiner) in a mock 'office visit'. You have 2 minutes to read the scenario that is posted on the door and you have 8 minutes to perform the task (usually to take a history or do some sort of physical exam on the 'patient'). The only time the observer talks is during your 1 minute feedback. There are usually 10-15 stations and the whole format is highly anxiety provoking! At my school, we do OSCEs from first year, but at others they only do them in the senior years, if at all.

The Obs/Gyne oral exam was similar because there were scenarios posted on the doors, but the examiners played the 'patients' where appropriate but they also asked questions to probe your knowledge and to prompt you if you got stuck. It's not as regimented as the OCSEs are, but for those who don't think well on their feet (me!) it's still a bit tough. Why is it that my brain falls out of my head sometimes?

The afternoon was spent doing a 2 and a half hour multiple choice exam. I'm not sure what to think of that one yet. I'll let you know when my grades come in.

I spent the weekend visiting with fellow classmates who were also in between rotations, watching the hockey game, at an awesome birthday dinner, and baking like mad. I managed to make a batch of peanut butter cookies, banana loaf, spaghetti sauce, butter tart squares, and a pumpkin pie all in one day. Must be the 'Type A' med student personality coming out!!!

Today, I started psychiatry. Should be interesting but I'm a bit nervous about the whole thing...the psychotic patients and all, but I'm sure it'll be fine (gulp).

Dr. McJerky

Here it is...my first run-in with an old school doctor. You've seen them as patients or even heard about them from other people. And you've thought they were arrogant, pompous jerks. Well, turns out that they treat med students the same, so don't think you're special!

I was paired up with another doctor in the operating room when Dr. McJerky came in to assist. He seemed nice at first until he started quizzing me (which is a normal part of our training...what us med students call "pimping"). He asked me what the blood supply of the ovaries were and I answered quite confidently that it was the ovarian arteries (duh) and they arise from the abdominal aorta (largest vessel in the body). "Wrong" he said, "You better go look it up later". I spent the rest of the surgery pretending to watch, but secretly wondering if I had missed something HUGE in anatomy in the last 2 years. I was doubting myself (because I do that sometimes), but was quite sure that ovaries were similar to testes in males and that they were supplied by ovarian/testicular arteries that come off the aorta. After my shift, I looked it up. Sure enough, I was right...for the most part (there is also a portion that comes from the uterine artery). "That f***er! What an a*****e" ,I thought to myself. Not only was Dr. McJerky wrong, he made me doubt myself. Lesson learned. The immature part of myself wants soooo badly want to rub it in his face, but he has to evaluate me, so I think I better not!

Same doctor, different day. He 'pimps' me again: "Tell me what you know about HPV". I start off by saying that HPV is a DNA virus and there are many types of HVP. Some are passed by contact and cause simple warts or plantar's warts and some are passed sexually and cause genital warts or cervical cancer. I keep blabbing on until he stops me and says "Wrong. HPV is always passed sexually and does not cause regular warts. You should do more reading." This time, I am quite confident in my response because I had read about HPV the night before, so I say to him "I am quite certain that HPV is the virus that causes warts, but certainly in the context of gynecology, HPV is only sexually transmitted." His reply: "Nope, HPV is ALWAYS sexually transmitted...period."

Dr. McJerky has changed the results of the last few decades of biological research. It's a miracle! It's not so much that he is wrong about things (hey- I am every day), but it's the WAY he approaches it. He should maybe go back and do some reading...and get some social skills.

Oh- and make sure you women are up to date on your PAP tests. I know they're uncomfortable, but it may catch a cervical cancer.

An open mind

I think of myself as an open-minded person and have always had the philosophy of "to each their own", but recent experiences have made me realize that there are limits to my acceptance.

As past of our training in obstetrics, the department has paired us up with midwives so we can have a 'less medicalized' experience of how different women approach childbirth. I like the way that midwives for the most part approach the birthing process (i.e. keep a normal biological process normal and not medicalize the experience). I feel confident that for a normal uncomplicated pregnancy, a midwife is a great alternative to the traditional physician for pregnancy care...in some ways better!

I did learn that midwives tend to attract a certain sort of client. One of these clients taught me something I didn't know that existed until yesterday! It is called a "Lotus Birth". In this, when the baby is born, the umbilical cord is not cut and if left attached to the baby. It is allowed to stop pulsating (i.e. blood flow to the placents has stopped) and the placenta is then birthed. Afterwards, the placenta and umbilical cord are left attached to the baby until they detatch naturally! This process can take days to weeks! EEEEEEEWWWWWWWWW! So this baby is carried around with this rotting, smelly, decomposing placenta wrapped up in a towel. That is f***ing disgusting. I have no idea why people do this, but I can't think of a single reason.

A classmate told me about his experience with a client. She absolutely refused any sort of perceived intervention with her pregnancy. She refused bloodwork of any sort (which screens for any infectious diseases that can be transmitted to or affect the baby), ultrasound, vaginal swabs (again which screen for dangerous infections) and even the dopplertone (what they use to hear the baby's heart in the office). She thought that "her body would know when something was wrong". That's just plain stupid. She wanted to labor alone, but she found out it is illegal to purposefully have an unassisted birth (i.e. no doctor or midwife present). I shake my head. Hope everything goes well for her. Like I said, there are limits to my open-mindedness.

My 'non-med' friends

I do have somewhat of a life outside medicine. Really, I do.

This past weekend, I got together with some of my 'non-med' girlfriends. There is a group of 8 of us that gets together about 4-5 times a year...sometimes for a whole weekend, sometimes just for a night. Considering there is so many of us, there is usually at least one of that misses out, but we try our best!

Out of the 8 of us, 5 are married and 3 of us single..although it sounds as if that's soon to be down to 2! Out of the 'smug married girls' 4 of them have kids. One of the single girls is a single mom and a foster mom and a full-time student to boot! When we first started out, none of us had any kids, so it's been fun to see everyone go through their pregnancies and bring thier little ones to our get-togethers. But we have one rule...breastfeeding kids are OK to bring, otherwise they have to leave them at home! It's supposed to be mommy-time for those who have kids.

I'd like to tell you what we do at our get-togethers...but then I'd have to kill you. It's top secret, but it involves yummy food and drinks...and solving the worlds problems. Other than that, my lips are sealed! We also try to have one big trip every year. One year it was cross-border shopping, one year it was a weekend at a luxurious spa (my fave so far). Not sure what it'll be this year, but hopefully I'll be able to go.

This weekend, I'm off to my hometown to attend one of my oldest friends' wedding! She asked me to be in her wedding party, so I'm very excited (for her as well!) I grew up with her, in fact our parents went to highschool together, so we've always been close friends. I haven't seen her since she shopped for her wedding dress, so I can't wait!!!!!!

I've caught many babies now. My fear of dropping them has slowly faded but remains a real possibility! Well, that's all for now. I have been on call too many days in a row and I'm sleepy.