Mile 10121: Now You See It

Above: Jack Narz was the host of the 1970s edition of the great game show "Now You See It."

SOMETIMES YOU JUST HAVE TO
SEE THINGS FOR YOURSELF.

As Dr. Psychobabble said, "Psychology is the bestest." Even though, yes, it is a biased opinion (she said so!), this week on the wards, I started seeing how it was the "bestest", exactly as I told you in my last entry. So far, my schedule on the wards has been pretty consistent. Each of my days are faced with an interesting juxtaposition: earlier in my day, I round with a Psychiatrist who is a consultant on the medicine floors, while later in my day I round with a Family Physician who is a consultant on the psychiatric floors. It provides two different perspectives on how to look at a psych patient.

However, to date five things have stood out about psychiatry that have made my first two weeks on the floors enjoyable:

1. Au contraire: psychiatry doesn't just deal with the extremes.
In my last entry, I described some of the more severe cases where my friends were physically "harmed" by a psych patient. However, although there's a chunk of patients that do present with danger, a majority of patients are not like that. Many of the medicine floor patients talk just like their non-psychiatric consult counterparts on the floor. The patients on the psychiatric floor have very cool personalities and backgrounds. Many of them are quite easy to talk to, which leads me to point two.

2. A psych patient is still a person.
During lecture last week, I heard in lecture that the best way to interact with a psychiatric patient is by starting a conversation just like any other in one's non-medical life. I totally enjoy getting away from the standard "conversation conformed to standard history taking" format, and being able to use the interview in another dimension to assess mental function is pretty cool. It was a concept I finally got a hang of this week and am trying to tweak.

3. Sometimes your imagination itself just has to fly.
A few days ago, I heard a patient down the hallway start to sing. Mind you, it wasn't emmy quality, but the few simple notes that the patient was singing were pretty catchy. I ended up looking out the room and saw the patient dancing a semi-two step to the same song. I was very tempted to go out there and dance with him, but I was still getting used to the psych ward. However, that moment really brought a smile to my face.

4. Psychiatry offers some really unique situations.
If I went to a cocktail party, I could actually ask the question, "How many med students does it take to cut a person's ring off?" and answer truthfully six. Our group spent 2 hours switching between each other with a manual ring cutter to cut this patient's ring off. It was grueling, but it was good to see our team pull together with each twist and grip of the ring cutter.

Although this situation could be seen in some other fields (ER for instance), I'll be honest, it was fun to hear our patient sing "Free at Last" when the ring finally came off.

5. A psych rotation offers skills to both future psychiatrists and non-psychiatrists combined.
Every doctor is going to run into psychiatric patients of different sorts throughout their career. Getting an opportunity to see how to interview these patients has been, so far, a great learning experience. To recognize different psychiatric conditions and how to handle them can help aid with not only treatments of the mental conditions but improved understanding of the patient and increased compliance with treatments for their own medical conditions.

I love having an open mind... it makes me enjoy more of what life has to offer. That's what has made me get through 10,000 miles... Here's to 10,000 more!

Mile 9714: Get Psyched!

Above: Meadowbrook Park in Urbana, IL gives visitors a glimpse of the original praries that covered Illinois.

NEVER EVER ASSOCIATE PSYCH WARDS
WITH STRAITJACKETS.

This week, I've started a new round and a new rotation at Jackson Park Hospital in Chicago for Psychiatry. My friends love to tell me stories about things that have happened on the wards when they did their psych rotations. Their stories weren't exactly the most amusing... one got coffee thrown in her face while another put up pictures on Facebook of arm bruises from of a friendly tap from a patient that was all but well... friendly.

Oddly enough, using psych terminology, I think I have a psych ward phobia to get over.

I'm personally determined to use systemic desensitization to getting over it. My first day on the rotation was on Monday, and I'll admit that the adventure was filled with just about every anxiety-producing moment I wanted to just avoid. I kept my eye on the doorway while interviewing patients, I made sure that the door was locked behind me to the nursing station, and I even watched my back to make sure that nobody tried to make a move on me. However, the only way I'll learn and the only way that I face what might happen head on.

After taking on weekend call today, I'm starting to see how Psychiatry, like Peds, takes the concept of medicine and adds its own interesting twist. There's an increased reliance on other people's histories (police, family, nurses), some treatments involve a huge amount of trust in psychology, and blood tests and lab values don't carry as much importance as they do in medicine in pulling a diagnosis (but still can be helpful). And it is for this, just like my previous adventures, I am looking forward to my adventure in psychiatry. There's a reason why psychiatrists enjoy what they do, and I've read about them. However, the only way I'll completely learn and understand is if I see these reasons for myself.

And, that's exactly why I'm keeping my eyes open.

Mile 9363: Countrified 4 - Growing Culture

Above: Nothing beats a tall set of golden arches to greet you on the road. Gilman McDonald's, Exit 283, on Interstate 57 in Illinois.

"I ROAMED THE COUNTRY
SEARCHING FOR ANSWERS TO THINGS
I DID NOT UNDERSTAND."
- Leonardo da Vinci

4:40 PM, Sunday - My friend Don and I were driving back on good old Illinois Interstate 72, after visiting an elective site I'll be attending this upcoming January. I-72 is a four-lane corridor originally designed to connect the mid-sized cities of Springfield, Decatur, and Champaign, Illinois. We got to talking about places that seemed so "perfect," that they were "too good to be true." And for some odd reason, that got me on a mantra to talk about what I liked about Champaign, a city I spent a good 4 years of my life in. To me, it was an example of perfection, but there seemed to be no strings attached to that experience.

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The debate is still hot. Even though it has been just over a year since I've written anything on this topic, it's still something I do think about. I'm still attracted to the sense of urban sophistication that's given in the larger cities like Chicago, but something also pulls me towards the growth and potential in smaller cities found away from metropolitan areas.

I drove down to Champaign this past weekend to spend some time with my good friends Neal & Christine, who I've always wanted to spend time with (more than the 13 hour stop I made last time I was in town in May). On a cold Saturday morning, I whipped down I-57 and made it from the Chicago Area in a very efficient 2.5 hours (without speeding, and with a McDonald's stop for coffee placed in there). When I got into town, seeing a good chunk of people outside at 8:30 AM doing their morning jog on streets made me smile. It was good to see at a metropolitan area of about 100,000+ people (without the students at the University of Illinois) still had that sense of freedom that comes with safety. I soon found myself in the outer rim of the city, entering the "suburb" of Savoy where Neal & Christine live. I smiled when I noticed that when I looked to my left, I saw houses, but on my right, I saw the beauty of endless fields of corn blowing in the wind.

With a lot of smaller cities, especially those home to colleges, there is an investment into downtown areas, to infuse culture, improve the quality of life and to show that these cities have identity. The Champaign-Urbana area has exactly been doing that, and every time I come back, there's something new or something improved about the area. When I first visited the U of I in 2002, I saw the potential in the area, as this was when the improvements were beginning in the cities. And 8 years later, I can see there's something for everyone, with everything from a Weekend Farmer's Market in Urbana to fancy eating in the downtown area of Champaign to summer festivals that complement any social outing quite well.

No, this isn't a post to simply limit my future to be here in Illinois (although I would love to be), but an example of a place I would love to live. I look at other large college towns, like those in Bloomington, IN, Madison, WI, and somehow that "oasis" of urban-ness within miles of rural terrain pulls me to places like those too. From a professional standpoint, the mix of people coming from a city-life and from the rural areas to receive health services makes this an attractive patient base to work with in my future. For me, there's always something about a city that is with vibrant growth that will entice me to live there.

So, although I got some R&R by hanging out with my friends in Champaign, I also got to learn a little more about what I wanted too. And that's what made this past weekend quite awesome.

Mile 8895: Keep on Moving

Above: I do miss the 6 AM rush hour.

ALTHOUGH I MISS INTERNAL MEDICINE,
THE ADVENTURE MUST CONTINUE.

And just like that... it's over. One of the odd ways I've thought about the last 16 weeks is, I've been at the hospital 4 weeks longer than the current interns.

My last 16 weeks at Westlake Hospital were absolutely amazing.

Some of the biggest lessons that I learned during my time in Infectious Disease weren't even in infection (although, with the amount of cellulitis cases that we got called for, I would almost consider myself an expert in cellulitis now). When comparing my 12 weeks on the floors, where we took care of just about every single aspect of our patients, my 4 weeks on infectious disease were simply focused on that. I still remember the first day when I was on "floor mode" - as I liked to term it - and wrote just about every single assessment and plan on the patient I could in my note. I quickly learned that was quite inefficient considering I was on a consulting service. But this is one reason that I couldn't see myself - at this moment - going into a subspecialty; I feel odd treating only one aspect of a patient.

One thing that I really enjoyed was that my Infectious Disease rotation came right after my Internal Medicine rotation and at exactly the same hospital. I knew how the teams worked along with who worked the teams, which not only made the transition easy, but I appreciated how the tables turned. On the floors, my intern would let me know what consults I need to pull, but now the interns were coming to my doctor and me with new consults. I'm going to miss the rhythm I started putting together with the interns, seniors, and students, but I must keep moving...

It was with this program that I appreciated some of the aspects of smaller community programs, getting to know everyone's face, seeing common cases repetitively (i.e. like the cellulitis above), working with tight knit teams, and sometimes seeing patients over and over again. I've been a big fan of the "make a big world a small one" concept, and community-type residency programs attract me in that manner.

For the next 3 weeks, I have them off, but starting in late September begins my Psychiatry rotation at Jackson Park Hospital. But I tell you, I surely am going to miss running up and down those floors.

A huge thank you goes out to the attendings, residents, and students at Westlake.

Mile 8652: (Cue Marching Band)

Above: Rush University Medical Center's new Advanced Center for Emergency Response. From Rush News.

I FELT LIKE I WAS IN AN
AIRPORT TERMINAL...

I learned this week a situation where clear, accurate documentation is critical for monitoring a situation. Let's just say this, figuring out whether or not someone has a "critically morbid chronic condition" from hearsay isn't the best way to handle it. With medicine, a certain line of things need to be done to confirm or rule-out whether someone has a condition. If those tests aren't done in order, it breaks the chain, and a degree of uncertainty (which is never good) hinders the line of treatment for the patient. Nobody wins if things are not documented and tracked appropriately.

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A few weeks ago, the Infectious Disease team that I am a part of goes to the Infectious Disease grand rounds that go on at Rush University near the heart of Chicago. My attending picked me up from the hospital and we soon walked into a series of tall buildings, a facade of steel and glass. We soon were walking down a hallway with large directional signs and a walkway that could support a flow of a huge crowd (making me feel like I was about to catch my 9 AM flight). After going up to the fourth floor of the building we were in in the middle of a slightly crowded conference room that holds about 50-75 people, I watched several presentations from residents of some fairly interesting cases that they ran into. As the attendings, fellows, residents, and students chatted amongst themselves (and myself with my attending) to discuss each case, I felt that the openness to discusssion I observed to encourage each other's understanding of the concept was amazing. When I look back to my several hours there, I honestly saw myself as a kid in awe at a candy store.

And that's what is really attracting me about university programs when I'll match (next year). The variety of cases that you get to see there, their reputation for being at the forefront of medicine and research, the resources that are available, and not to mention the aura of academia (which I enjoyed after my 1.5 years in a Masters program at the University of Illinois) are just astounding. I really feel that a university program would easily satisfy me academically and open me up to even more new opportunities in medicine. However, aspects of community programs also reach out to me, and I'll tell you more about what attracts me to them in the next post.

Mile 8246: To Tell the Truth

Above: A depiction of the electronic medical records system from Upstream.

WHO CAN I TRUST MORE:
THE PATIENT OR THE CHART?

Infectious Diseases has been a great rotation thus far. Although I'm still at the same hospital as my previous rotation, the days feel a lot different as a consultant than as someone who's working the floors. Maybe its that the subject matter is much more specialized, or its probably also not having to deal with as many folks left and right when managing patients (on the floors for the last twelve weeks, everything from nurses to consultants and even writing notes would slow down a day's efficiency dramatically). However, I'll be honest that after 12 weeks of intensely working the floors, 4 weeks of consulting is a breath of fresh air.

Don't get me wrong, I've learned a lot about management of infectious disease simply from my first week on the post. I've at least had some slight refining with my knowledge of antibiotic spectra, common sense on when to appropriately check for blood cultures, and even evaluating if a "fever" is truly a fever. For some odd reason the "card-playing" game with empiric and more targeted antibiotics is something that intrigued me. I'm looking forward to learning more about that in the near future.

1:30 PM Friday. My attending and I are in the room of a patient along with their family. However, when my attending was further questioning a part of the patient's family history, we basically got a irate response of, "Go look in the chart!" from the family (I'm guessing that getting asked the same questions multiple times by multiple people finally go to them). My attending handled the situation calmly and well and explained to them that it is better to get the information from the patient rather than from the chart, because the chart has the higher chance for errors. Only when the patient couldn't recall the information would my attending refer to the chart. My attending further mentioned that the patient was someone that could be trusted more. With that, the patient, along with the family, had smiles of confidence and breaths of relief.

The point makes much sense though. If you've ever seen people try to spread news from one person to another, it never comes out straight after being handed down several people. The chart is like that, especially exaggerated when trying to interpret someone else's words when someone is not there to clarify or answer any of the doctor's questions. The bottom line from this lesson is that the purpose of the chart is to document what was done, but not to be used to substitute for a proper history taking or physical examination.

A simple, but very useful lesson.

Mile 8052: Teaching an old dog new tricks

Above: Jon, John, and Khoi and myself enjoying a night out at an Ethiopian restaurant after our final day.

ON MY LAST DAY
I BROKE A SWEAT.

7:40 PM Friday. I never really had Ethiopian food before. I'm very glad that one of our colleagues Jonathan had brought up the idea. You basically go in, and all the stuff that's ordered comes out on this huge platter. If you've been to Maggiano's or some other "family style" Italian eatery, you know how family style works. But I learned that Ethiopian family style is much more adventurous... it involves eating with your hands. I never imagined that eating with my hands could be so enjoyable... and so tasty!

Who knew that at the end of a medical rotation, I'd still have the brain capacity to learn something new.

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It's the end of my twelve weeks here for Internal Medicine. Before I keep going, I apologize for not writing more during those twelve: it was that intensive. I admit that its tough for me to study at home even more now, because I guess I've conditioned myself to take home as a place of rest. Even with coffee, I sometimes struggle with trying to make it through the latest literature or even just high yield Step 2 studying.

Am I glad its over? In ways yes, and in other ways, no. Yes, I'm tired. Yes, I need a vacation (even though I had an awesome one a few months ago). But I loved my group (we all had a rhythm and enjoyed each other's contributions to the team), and also what I had learned in the last few weeks. One of the attendings had said to us that learning medicine was the essence of repetition, and I'll admit that seeing dozens of many cases made me get into a rhythm of what to look for while taking a history and the direction to take when managing a patient. I loved running the floors, writing notes, and working with nurses, attendings, and case managers. I really had the feeling of what residency would be like in internal medicine.

What's next for me? Well, same place, but second verse. It's time for a little adventure into the world of Infectious Disease (ID) for four weeks. Think of it as an extension of Internal Medicine. So during the next few weeks, I'll try to replay some of my experiences during IM, and also try to expand on what exactly ID brings for me.