Dream Office #2

It would be nice if the first time you saw your doctor, the doctor took your vitals themselves. Traditionally nurses or other office workers take down your measurements, and while this is incredibly efficient, it probably makes people feel as if they are being processed.

Planning the Rest of Your Life

It happened when I was being active in the milieu, playing bananagrams with a handful of occupants admitted to the in-patient psych ward: two suicide attempts, one recurring major depressive disorder not responding to recent medication changes, and a non-psychotic manic depressive who in conversation appeared to be slightly more psychotic than the notes suggested. I was rather enjoying myself, realizing that I could spend hours talking to any one of these people. The etiology of mood disorders had always fascinated me, and now I was able to explore them by myself, at my leisure. 

And although these patients were very kind and open, they were growing frustrated with another patient--a schizoaffective--roaming the common area: she would not stop talking. It wasn't pressured speech--it was continuous speech. It was rambling, non-directed speech, spoken to the hospital at large, and it was spoken with an annoying twangy accent that could be described as an inner city uptown chicago accent--very short A's. 

The bananagram players began to mock her, not to her face, but they began to mimic her monologues as they spelled out intersecting words. Halfway through the game, one of my patients, a very irritable and consistently antagonizing schizophrenic, sat down at our table and tried to get on my nerves, insulting just about everything he could get his mind to focus on. The guise of bananagrams saved me because I appeared and actually was busy, trying to win a game. He left shortly and I felt relieved to once again be surrounded only by the moods. And I realized, painfully, that I could not go into psychiatry. I loved my mood disorder patients, but I couldn't tolerate the psychotic ones for more than a few minutes. And while I could eventually work solely outpatient and see only patients with predominantly mood disorders, psychiatry residency programs are four years long, so I'd be spending four years doing something I could kind of tolerate to do something I'd probably love for the rest of my life.

As a third year nearing the end of her clerkship rotations, I've been spending a disturbing amount of time freaking out--I suppose the correct term would be "having panic attacks"--about my future. But my debate between family medicine and psychiatry is far simpler than some of my friends considering even longer residency programs.

Take my good friend Annette. Everything about her screams surgeon: her steady, unshakable confidence, her ability to immediately befriend and then joke-around with just about anyone, her oversized-for-her-stature-hands. Surgeon! But if she was to become a surgeon, she would most likely want to go into something very specific: pediatric GI. Her internal debates, one would imagine, would go something like this: waste another five years of my life learning other types of surgeries to eventually get to begin doing fellowships in something I love. Five years. Five years of surgeries on adults. Five years where, yes, she would learn some very important things that would make her a better doctor, but also a lot of things that have no bearing on her future dreams.

I would consider anyone entering the medical field to be an expert at appreciating delayed gratification. But as my friends and I begin to plan out the rest of our lives, it sometimes seems like medicine is asking almost too much from us. 

Blasphemy, I know. I've already spent hundreds of hours preparing for tests that I promptly forgot all the answers to. I've delayed seeing my own physicians--sometimes for months--in order to never miss a day of clerkship. I've stopped exercising and my diet consists of, and I am not kidding, microwavable popcorn, cheese sticks, and diet coke. Medicine has already asked a lot of us.

For me, my choice is easy: I've always felt strongly about family medicine, and as it turns out, you see a lot of psych patients in primary care settings. Family medicine: where you see everything and the residency program is only three years. 

But for my friend Annette, her decision between surgery, pediatrics, and pediatric GI surgery has to take into account how much of her life she wants to live inside of a hospital. 

Stereotypes in Medicine

It’s unfortunate that I want to go into family medicine, because I think the stereotypes about family practitioners are often times nonsensical. But I suppose it’s also good that both of my parents are kind, friendly surgeons, so stereotypes about medicine’s specialties don’t really hold true for me and my family. 

So surgery often gets stereotyped as being full of jerks. And while I think there are a lot of surgeons who seem to have an unnecessary and occasionally dangerously elevated sense of self-worth, you find that in other specialties, too, so I don’t think it’s terribly accurate.

Internal medicine people are obnoxious. It’s like they’ve convinced themselves that what they are doing is interesting, even though they’re stuck in a hospital all day dealing with dying people.

I want to say people going into radiology, ophthalmology, and dermatology are all terrible people who are in it for the money instead of really helping people. But that’s not true. And everybody’s idea of help is different. I don’t know why they’re interested in their fields, but technically, someone’s got to do it.

Emergency Medicine is full of hipsters. I don’t know how this happened, but it’s pretty accurate. People who are hipsters, people with ADHD, and people who get bored easily. As for their personalities, they’ve got their jerks and their saints, too.

Psychiatrists are indeed crazy. But I think that’s because if you have a mental illness yourself, dealing with medical students and physicians in other fields gets incredibly taxing. If I hear one more person reduce major depression to a simple affair that people should be able to handle without medicine, I may start applying to psychiatry residencies right then and there.

Neurology is full of people who are more emotionally stable than psychiatrists, but are still very, very weird. But understandably so. Like more professional psychiatrists. Or just more stuffy.

I like pediatricians. But I wouldn’t say they’re the nicest people in the world. Kids are just more tolerable than most other patient populations, so it’s easier for them to look happier while they work. Whether they are or not, nobody knows.

Obstetricians and Gynecologists are exactly like surgeons. Who will occasionally smile at patients because their patients are neonates.

And that pretty much covers it. Does this effect what I want to go into? Not really. It just makes me louder about defending my choice to go into family medicine, which most people seem to think is incredibly boring, despite the fact that, to me at least, it seems almost as exciting as emergency medicine (when you remove trauma cases) while also including continuity of care.

And to me at least, being a doctor means being a family physician. All other fields just add complexity—necessary or not—to the medical field.

Diagnosing One's Identity

I have started my psychiatry clerkship and I think I'm in love.

The staff is nice, funny, accommodating, kind. The physicians are crazy in their own way. The patients, well, the patients are all fascinating--there's something so complex about mental illnesses that makes it hard to reduce any one person to simply medicine alone.

And yet, with my patients, I feel like I keep reducing them to their diagnoses.

We are always told that patients are people--that we are treating them, not their illness. But with mental problems, the person is their illness because, well.... hmmm....

What is identity? It is the way we interact with our environment. It is our behavior. It is our thoughts, are consciousness. It is who we see ourselves as. It's what comes to your mind when you're asked to define yourself. Throughout college I told people I was "biracial, bisexual, and bipolar," because 1) I liked the way it sounded and 2) it seemed to partially capture the fact that my entire life I've seen myself as someone stuck in a huge gray area between the black and white poles of the various identities constructed by society. Definitively nothing, unquestionably everything: Elora Kathryn Apantaku.

But back to psychiatry and patients and their identities. I didn't realize how chronic most psychiatric disorders were. A lot of the older patients--in their fifties and sixties--a lot of them have been suffering from these illnesses--manic depression, major depression, schizophrenia--for decades. Their lives are so strongly influenced by their diseases... and although medication and therapy can help them stay out of the psych ward, their presence on the floor argues that they are doomed to continually function in a way that is maladaptive--either to their family, their friends, or to society.

The Barometric Mind

I woke up this morning around 5:30, very briefly--thirty seconds maybe--because it was raining, and although the sound of rain beating on my apartment's giant windows overlooking the South Loop is usually really calming, the water dripping through my roof, through my ceiling, and onto my already stained carpet is quite distressing. But I didn't stay awake because at this point, a stained carpet is very low on my list of worries.

I'm thinking about away rotations and my grades and how to make myself look good for residencies. Am I forgetting paperwork? Probably. Where should I go next year? Do I want to go to Maine? Stay with my sister? Or should I go somewhere I've never been before, working in a hospital in Mississippi all by myself. Do I want to do family medicine rotations or psychiatric ones? These are the things I've been worrying about, but I recognize that my worries are not really important, just bothersome.

The patients in the psych ward, now their worries are real. Your family can't tolerate your manic outbursts anymore so they have you admitted--you promise to adhere to your medications from now on, but your family doesn't trust you any longer so now you don't have a home. Where do you go? In this already stressed out health care system, you run a real risk of becoming homeless--or as the hospital I'm working at calls it: undomiciled. That's a worry. Or let's say you're psychotic. Then the voices can give you a whole new set of things to worry about: "you're going to die as soon as you leave here" they might tell you, or "you need to be back on heroin again--that's the only thing that can help you, this anti-psychotic sh*t isn't helping and you and I both know it."

I arrive to the inpatient psych floor at 9:30. One of my patients, on the spectrum of schizophrenic to bipolar, is standing in the hallway, leaning against a wall. She looks terrible. "Good morning Miss [HIPPA compliant], you look tired, did you sleep well?" She says no. I stand next to her for a good fifteen seconds, waiting for her to elaborate, but she does not, so I slowly walk away, looking back at her as if she'll suddenly want to tell me more. Later, when I follow the doctor around like her own personal shadow, we stop by to see my patient. "This morning the nurses said you were banging against the wall and screaming, why was that?" My patient answers back something about "the voices" which I was almost positive had been alleviated by her sudden acceptance of her anti-psychotic meds.

Another patient, depressive with psychotic features, also has a similar complaint. The medications had helped reduce the voices to whispers, muttering always, no longer commanding. But this morning, they woke her up again, yelling at her. She looks tired today--much more so than yesterday.

I am a scientist--but I am a bad one. For me, personal anecdotal evidence is much more powerful than studies that have thousands of patients arranged into double blind groups and blah blah blah.... This is why when I think of sickle cell disease--how my dad's a carrier, my mom's not, but yet all three of their daughters have the trait--I think that there's more than coincidence going on with how it's inherited--either magic or some genetic translocation oddities.

Which is why I know believe that weather can make you psychotic. Two patients woke up in the middle of the night, around the time I woke up freaking out about the rain, and were brought back to their presenting level of psychosis. Maybe the pressure drop affected the neurotransmitters as much as it affected the forecast.

Just a silly, crazy, insane thought.