doc w/ pen

a journalist becomes a doctor before your eyes

Month: October, 2017

Only in medical school … (#1)

Medical school is a unique environment. It’s also an immersion experience. As such, over the last 2 years I’ve had all these moments where I’ve said/thought/done something that seemed natural, but upon reflecting I’ve realized that my words/thoughts/actions were a bizarre product of medical school. I had one of these moments yesterday, and decided I should start recording these experiences here, going forward. I think they speak to how much medicine seeps into you when you’re steeped in it all day, every day. I also think they’re rather humorous, but I’ll let my readers be the ultimate judge of that. Here’s what happened.

Medical school affects how I think about everyday, nonmedical things — including how to describe the direction I cut my sandwich.

I was making my lunch, a ham-and-cheese sandwich on sourdough bread. I’d had the same thing the day before. And the day before, I’d cut the sandwich in half diagonally, a little offset from the corners, the way we’d done it at the sandwich shop where I worked one summer in high school. Yesterday though, as I stared at my sandwich, I decided to shake things up. Since I live alone, I have a habit of talking to myself out loud sometimes, and said this to no one in particular other than me, quite definitively:

I think I’ll cut it midline today.

I started sawing at the sandwich, then stopped halfway through, realizing what I’d said. Three years ago, I would have said something quite different, probably that I’d cut it “in half in the center,” or “down the middle.” But now I clearly think anatomically, like an attending surgeon discussing with his resident where to make an abdominal surgical incision. That’s what 8 weeks of rotating through surgery will do to you, apparently.

I chuckled as I finished cutting the sandwich and wrapped in foil.

I hope this brings a smile to your face as well.

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Working in the psych ED

As many of you know, I write a monthly column for the online magazine The American. Here is my latest piece, describing my reactions to working in the psychiatric emergency department. You can see the original piece here.

 

“Repairing the mind”

Bless you,” one of our lecturers told me when she heard I’d asked to spend part of my six-week psychiatry rotation in the psychiatric emergency department (ED). I understand all too well why the psych ED is a place many people might want to avoid. Many patients in this locked unit are acutely and severely ill. One patient might come in talking about hanging himself, another of how how voices are commanding her to kill people. An ambulance might bring in someone found found running down the street in undergarments. A handful of these patients can turn aggressive or violent, yelling and threatening to harm the physicians and other staff.

Most can usually be talked down but some require sedation via an intramuscular injection — and in a few cases physical restraints. Safe to say there are few dull moments.

Before I discuss my own response to the psych ED, I want to talk about a tension that generally speaking exists in medicine. I’ll use hypotheticals to illustrate my point. Imagine a doctor sees a hospitalized patient afflicted with a rare, potentially fatal disease.

“Wow, what an interesting case,” the doctor tells a colleague when the patient is out of earshot. The colleague replies, “No kidding, I’ve never seen a case of that before. Let me know what the outcome is.”

This fascination with a rare, possibly incurable disease might seem cold-blooded to a non-medical observer. What kind of person would say something like that? But medicine is all about compartments. Doctors have compassion for their patients. They care for them to the best of their ability — applying empathy and professionalism. At the same time, they’re possessed with intellectual curiosity about the underlying processes of diseases. Probing pathophysiologic principles is part of the scientific method they’re trained in.

Though compassion and curiosity coexist quite peacefully, all this might sound callous to a casual observer uninterested in these medical compartments.

My years as a medical student have taught me that patients and their families are sensitive to remarks made in passing. Medical curiosity can seem unfeeling. As a result, I’m careful as to when and how I express it.

That preface in mind, let me move on to the psych ED, an assignment I found both medically and professionally exciting. The unvarnished truth is that patients need the service and the service needs a staff. The psych ED is a high-impact place with plenty of patients ill enough to pose an immediate threat either to themselves or others, or both. For a doctor, it’s a high wire act whose reward comes in the form of helping prevent a suicide or bringing someone down from a dangerous manic episode. Plenty of patients admittedly don’t want to be in the unit. Some refuse medication and protest their hospitalization. But even in such precarious situations, you’re still providing patients with short-term safety.

The psych ED encouraged me to use both my journalistic and my medical training. Skepticism is essential in any kind of psychiatric work. Some patients will lie and behave manipulatively. They’ll do whatever they can to get out of the hospital, or remain inside. Others will try to lie their way out of medication, or into it. Part of the history-taking process includes gathering what’s called “collateral information,” which involves calling around — psychiatrists, therapists, social workers, and internists — to verify a patient’s details. With permission, we’re also allowed to get in touch with family and friends to get the fullest possible portrait of the person, assess his condition and safety, and create the best treatment plan. The number of phone calls and the tracking process can revive old investigative journalist training. You doggedly hunt down clues, refusing to back down when one lead dries up. Persistence comes in handy.

As a medical student, I’ve spent a significant amount of time with patients themselves. Once a patient is safe and secure, students are often tasked with conducting the initial psychiatric evaluation. They then present their findings, assessment, and a proposed plan to the resident and attending, afterwards writing up a note about the encounter.

This sense of teamwork, of contributing to hourly and daily goals, is uplifting. In other clinical environments, my work was duplicated — often in front of me. I’m a student. Obviously, some of my moves require double-checking for safety reasons. That’s normal. But the duplication often left me feeling redundant.

In the psych ED, when I called the patient’s psychiatrist, I wrote a note about the conversation and then presented my findings. If I missed key information, I called the doctor back. My work wasn’t repeated. I felt more trusted, more competent. Having spent a decade working in publishing, I’ve missed both the trust and the sense of competence.

There have been many challenges. The psychiatric patient interview differs from a standard medical evaluation. In the case of suicidal patients, for example, it’s essential to ask whether they have access to a gun at home. That’s not a typical question in other disciplines.

It’s a delightful combination — to feel both challenged and effective on a daily basis. Most important, I feel like I’m making a difference in someone’s life.

It’s the muppets! (and more)

I never thought I’d get a hug from Big Bird. Here I get hugged by Big Bird AND my sister at the same time. So amazing.

My youngest sister, Joy, is in town for the weekend. It’s her first time in New York City, and her main tourism priority was a little off the beaten path. Her #1 activity choice in the city was seeing The Jim Henson Exhibition at the Museum of the Moving Image. It’s something I’d wanted to see too, though not with quite so much fervor.

I’m so glad we went. The museum, which highlights and celebrates the evolution of cinema and television, was incredible. As was learning (and seeing!) all the muppets I’d grown up with. This was one of the most interactive museums I’ve been to, with stations that allow you to create your own frame-by-frame animations, add strange sound effects or music to well-known films like “Jurassic Park” and “The Terminator,” and dress up your own muppet.

To the latter, I added an additional educational layer. I’m on my neurology clerkship now. One of the issues neurologists frequently get called for is eye deviation. This can be due to a number of things, including failure of one or more cranial nerves to fire and signal the eye muscles to move. I created two different muppets, as you’ll see from the photos below. The one with the red hair has a cranial nerve VI palsy, because he’s trying to look right, and his right eye cannot move laterally (lateral gaze is mediated by cranial nerve VI, while medial gaze is mediated by cranial nerve III). In the picture where I’m smiling with my lovely platinum blond-haired muppet, she’s doing fine, looking down and in toward her nose. In the image where I’m frowning, she’s undergone some sort of trauma, and cranial nerve IV isn’t working, because her left eye can’t make this down and in movement, which is called “intorsion” (cranial nerve IV is the one most likely to be damaged in trauma because of its long course). I know, I’m a nerd.

But it’s not just the muppets. There’s so much more. Of course, you can’t have a museum dedicated to TV and movies without a section on sci-fi. I enjoyed seeing the paraphernalia from Star Trek (I grew up watching The Next Generation series) as well as Star Wars. Some of the Star Wars stuff was bizarre, including mugs featuring the mugs of Princess Leia and Luke Skywalker, a teapot with Luke riding a tauntaun, and a scotch tape dispenser with C-3PO.

As a writer, I also couldn’t help but take a picture next to the sign emphasizing the essential contribution of screenwriters. I especially like the quotation it includes from “Sunset Boulevard.”

Audiences don’t know somebody sits down and writes a picture. They think the actors make it up as they go along.

While that may not exactly be true, I do think the writing is often taken for granted because it takes place behind the scenes, rather than directly on the screen, like acting or special effects.

If you’re in the city and haven’t been to this museum, I highly recommend it. It’s a good time, a perfect mix of learning about the moving images that are such an integral part of our culture, of making and doing things, and of laughing. For me, it was especially wonderful to share this experience with my favorite youngest sister. Thanks, Joy.