Tell me more

My favorite patient right now is this 25 year old guy who looks just like a cartoon character. Seriously, he looks just like the anime character pictured. Minus the giant muscles. And plus a hospital gown that he insists on wearing like a cape. He's super animated and has these giant puppy eyes that make you want to believe everything he's saying to you. Except the things he says make no sense whatsoever. I can't quite figure him out. I can't figure out what he's trying to tell me. And I can't figure out how to fix him. So, I'll just keep on waiting until the antipsychotics reach max dosing and hopefully he clears up soon and can tell me something coherent so that I can help him with discharge planning. But for now, I'll just continue to have my nonsensical conversations with him, and keep on biting my cheek to prevent myself from laughing at some of his remarks. A T-rex! Seriously.

ME

Hey M--, how are you doing today?

PATIENT

Squeak, squeak.

ME

M--, I don't know what that means. Can you translate that into English for me?

PATIENT

They tell me I am a mouse. Squeak.

ME

Hm. Are you still hearing voices?

PATIENT

[nods] 

They tell me to eat pizza.

ME

Oh. And does anything happen if you don't eat pizza?

PATIENT

Me? They tell me tropical. Smokie in face.

ME

Hm, what do you mean?

PATIENT

Me? I was born a tadpole.

ME

Okay. And where were you born?

PATIENT

Outer space.

ME

Hm, okay, and how did you get here?

PATIENT

Me? I came here on a turtle.

ME

Hm. A turtle.

PATIENT

I was born for the special cartoon marathon.

ME

Oh?

PATIENT

Yeah. I'm scapularis. So's my mom.

[pauses for 2 seconds] 

I'm a T-REX!!

ME

I see. And M--, if you were to leave today, where would you go?

PATIENT

I would eat a cookie.

[nods solemnly]

ME

And where would you eat this cookie?

PATIENT

Desk.

ME
The desk?

PATIENT
Yeah. Inside drawer! Duh.
---

Man, I love my job. And the whole not-having-to-work-weekends bit isn't bad either.

You drive me crazy

ME

Oh man. I admitted this crazy patient today...

MARTIN

Michelle, you do realize that all of your patients are crazy, right? So you can drop the 'crazy' adjective and save yourself some saliva.

Brighter than the sun

I swear

My senior resident only went to court once last year as an intern.

In just two weeks, I've gone three times.

Three times. Three!

Now, there is a reason why I didn't even consider going into law. There is a reason why I never participated in Mock Trial. There is a reason why I was never a part of student government.

I hate speaking in public.

In fact, I'm deathly afraid of it. I get full on diaphoresis, tachycardia, dyspnea, chest pain, you know -- the works.

And court? It's the real deal. It's just like on TV - with a judge and a bailiff and a secretary recording your every word in some strange shorthand. But for those who are wondering, no, the judge does not wear a powdered wig, George Washington style.

I do have to do the whole state your name for the record, raise your right hand and swear to tell the whole truth, and please be seated. And I give my testimony, answer questions for my attorney, the D-freaking-A (who coincidentally looks just like Alex Cabot for you Law and Order:SVU enthusiasts), and then I get cross examined by my patient's advocate.

So I sat through four other trials before I got called up to the stand. And as I watched the other psychiatry residents go through the process, I started squirming in my seat, sweating galore out of my armpits, kneepits, elbowpits, you-name-it-pits.

PATIENT ADVOCATE

Sir, you diagnosed my client with schizophrenia. And you believe, based on your clinical judgment, that he should be forced to stay at the hospital involuntarily for another fourteen days.

RESIDENT

Yes.

PATIENT ADVOCATE

Hm, well sir - I just looked at your title. And correct me if I'm wrong, but it says you're a D.O.?

RESIDENT

Yes, but --

PATIENT ADVOCATE

So you're not an M.D.

RESIDENT

No, but--

PATIENT ADVOCATE

So, are you allowed to practice medicine in the US?

RESIDENT

[exasperated]

Yes!

That was the first case.

Second case, different resident, different patient, different patient advocate. Same craziness with the cross-examining.

PATIENT ADVOCATE

Doctor, what year are you in residency?

RESIDENT

I'm in my second year.

PATIENT ADVOCATE

Are you fully licensed to practice psychiatry?

RESIDENT

I've taken and passed Step 3 and am currently applying for my license.

PATIENT ADVOCATE

Oh, so you're not licensed. Should you be seeing patients if you're not licensed??

RESIDENT

I am supervised by an attending - who is fully licensed - on all of my cases.

PATIENT ADVOCATE

So you're nothing better than a medical student.

I think this is when I started quaking in my boots. And before I knew it, I was up. Up on the stand, wanting to throw up.

But I kept it together. And somehow, started going through the motions. Stating my name. Naming my medical school. Naming my residency program. How many patients have I seen with psychiatric illnesses? Over 100. How many with schizophrenia? Over 30. Have you been taking care of this patient since she was admitted? No. Why not? The residents just changed rotations.

The whole time, I kept my fingers crossed that they wouldn't ask me how long I'd been a psych resident (four days), how many patients I had been the primary treating doctor for (only six, as opposed to the large numbers I threw up to include patients seen during my medical schooling), how I arrived at the diagnosis (that's what my attending told me), or anything about my licensing (esp since I haven't even looked at a board review book for about a year).

Maybe they were tired. Maybe they knew I was brand new. Maybe he couldn't breathe, sitting next to my patient who hadn't showered in over three months.

Whatever it was, for some odd reason, my patient's attorney went easy on me. And the judge agreed with me and the hospital, denying the writ, and I was able to keep my patient in the hospital for the remainder of her fourteen day hold.

Granted, we then had to petition to give her meds involuntarily. And then when her fourteen day hold expired, I had to go back to court to ask for a 30 day stay. And in about two weeks, I'll have to go back to the same exact courthouse to testify in her conservatorship hearing. But the people are starting to recognize me. The security guards no longer look at my badge. The DA knows my first name. The judge smiles at me. And I'm starting to sweat a little bit less on the stand. So I'm keeping my fingers crossed that I'll start to feel more comfortable up there soon, and less like I'm about to have a heart attack.

E.T.

NURSE

Doctor, your patient just hit his roommate. Unprovoked.

ME

What! [Name redacted], why did you hit your roommate? I thought you guys were friends.

PATIENT

It's not my fault! I have a homunculus in my brain! 

ME

Er, what?

PATIENT

No seriously! A tiny gray man jumped in my eye and now he lives in my brain. But he looks funny, 'cause he has a giant head with great big lips and small tiny arms but a humongous big toe.

ME

Well...that's kinda true.

PATIENT

And he controls my movements.

ME

Hmm. Kinda.

PATIENT

See -- it's not my fault. The homunculus wanted to hit him. Not me.

ME

Ehhhh, that's where your reasoning goes wrong. But you're partly correct about the whole homunculus thing. 

PATIENT

I KNEW IT! I HAVE A MAN IN MY BRAIN!

ME

Oh crap. I didn't mean to say it like that.

Highway to hell

Carmageddon turned out to be more like Car-heaven.

Thanks to a ton of patients acting out, I didn't get out of work until 7pm on Friday. Exactly when the 405 freeway was scheduled to close, and the dreaded Carmageddon was supposed to hit.

This is what I expected my commute to look like.

This was what my commute home actually looked like.

Blue skies and smooth sailing down the 110.

Needless to say, it was pretty freaking fabulous. Normally there's incident traffic so it takes me at least 40 minutes to get home. On Friday, my door-to-door transit time was only fifteen. So glorious. This must be what it's like to live in a non-traffic-infested area.

Here are some nicer media pictures:

You remind me of a girl

[During our team lunch]

MED STUD #1

Michelle, this is going to sound strange, but I've always thought you looked like someone, and I just figured it out. You really look like the daughter from The Incredibles.

SENIOR RESIDENT

Oh, I can see it! 

MED STUD #1

Yeah - I think it's the big eyes and the hair.

ME

Haha, thanks guys! I look like a cartoon! Whose secret power is invisibility! Hopefully you're not commenting on my ability to disappear during rounds....

MED STUD #2

You know, I've always thought Michelle looked like Jack Nicholson's wife from The Shining.

SENIOR RESIDENT

What?!!

ME

I look like a crazy woman? I've never seen The Shining, so I don't know who that is.

SENIOR RESIDENT

I'll Google image it right now.

ME

This might determine whether or not you pass Psychiatry.....

MED STUD #2

...Um, I mean you look like Angelina Jolie! Jennifer Love Hewitt! The most beautiful woman alive!

[Thirty seconds later, this is our image result]

ALL

Hahahahahahaha!!

MED STUD #2

No you just look like her, not necessarily her character!!

ME

Hahaha! I don't know if that makes it better!!

MED STUD #1

Also, I don't think that picture is from the movie! That's just her in real life! Haha!

SENIOR RESIDENT

Hmmmm, so should we scut him out, Michelle?

MED STUD #2

Fine fine. I'll go see the two new admissions now.

For good

I am a good person.

I mean. I will see consults that others don't want. I'll call difficult patients two weeks after their discharge and make sure they went to their follow-up appointments. I'll spend a couple more hours at the hospital playing rugby with kids. I'll send some of my Stenn Award money to a kid in Africa. I am a good person.

And when I started at my residency program, I could see that the program director had kinda placed us in certain roles. One girl is the Outspoken Girl who will most likely become our class rep to get us better benefits and paychecks. Another is the Funny Guy who cracks jokes during lectures to make us all loosen up. An older girl is the Schmoozer, able to carry on conversations with the most dodgy and stuffy of professors. 

So I figured. I am the Good person. Moral compass. Jiminy Cricket.

Until this happened.

After lecture last week, a few classmates and I were picking over the leftover food, deciding who would take what home. Armed with some sodas and a nice bowl of pasta, I started walking out the door when I saw Max. 

MAX

Oh hey! You guys are taking food home?

ME

Yup! You sure you don't want any?

MAX

No it's okay. I biked. Wait, who took the sandwiches??

ME

Oh, no one.

MAX

Dude, those sandwiches are good!

And with that, he went running back to our classroom, presumably to claim the sandwiches for his dinner.

I went to my car, and took a while setting up my radio, fixing my seat and mirrors, and waiting to see if Martin would text me back that he was done with work at 5pm (unlikely) - so fifteen minutes later, I finally peeled out of the parking lot.

As I drove by the front of the hospital, I saw Max. Handing out sandwiches and bagels to the homeless.

And that's when I realized. Max is a Good Person. Because he is undercover Good.

So where does that leave me? I had half a mind to pull over and start handing out pasta right alongside him. But then I realized that there was traffic, and man, that pasta was really good.

For the first time

$4 glasses of wine + $2 steakhouse sliders = a lot of very happy interns

This was, after all, our very first day of wearing a long white coat, and being expected to manage three different inpatient psych wards. 

Never mind the wrong prescriptions, the incorrect diet orders, and all the crappy holds we wrote -- never mind all that, because hey, no one died.  

And that's a start.

America the beautiful

Ignite the light

And let it shine

Just own the night

Like the fourth of July!

I love that I was able to watch six different firework displays from my balcony, as I crammed as much psychopharm knowledge into my head. Fireworks before my first real day of work - that's auspicious, right?

Borderline

Back on the interview trail, I ran into quite a few interesting applicants. Even blogged about a few of them. But while those people were quirky, none of them were flat-out mean or distasteful. None of whom I had complete misgivings about possibly working with.

Except one.

There was one girl, who was so hung up on her awesome prestigious school, that she would work it into all of her introductions. "Hi, I'm Casie from Hopkins." "Oh your name is Mary? I go to school in Maryland. You know...Hopkins." One time, she didn't even bother with her name, but rather just shook the fellow applicant's hand and replied with "Hopkins."

I swear, to this day, that applicant probably thinks that's her name. Hopkins.

She was at three of my interviews.

But she was insufferable starting with the first. At that one, the program director had memorized our names, and greeted us warmly when we walked in the door as he poured us cups of coffee into real mugs. I was impressed, to say the least. Casie was less so, far less so. "It's pronounced KAY-see," when he called her "kass-see."  He quickly apologized, as normal people are apt to do, but she wouldn't let it go. "I don't know why everyone pronounces it wrong! It's not that hard," she responded, ending her sentence with laugh, as we all stood there in stunned silence, seeing as she had just reprimanded a rather distinctive figure in our field.

The All-About-Casie show continued. Halfway through the hospital tour, she held up her hand and asked the chief resident - in falsetto - if she could use the little girls' room. Of course, he replied, expecting her (as we all did) to just excuse herself and go, and continued on with his discussion of the psych ER. She held up her hand again, "Haha, but wait! I don't want to miss out on the tour! I mean, I need to know about the psych ER too if I'm to rank this program highly, right? So do you mind just waiting? I won't be more than ten minutes!"

You'd think it couldn't possibly get any worse, but it does.

We then got in a van to continue our tour at the other training site. The car was filled to the max, and the road was bumpy. The girl sitting between me and Casie started to feel ill, and she started dry-heaving, as discreetly as humanly possible. Feeling her pain, I asked if she was okay and started to turn AC vents towards her. That's when Casie noticed. "Oh hell, are you feeling sick?!" The girl in the middle nodded imperceptibly, as she turned a darker shade of green. "God, are you gonna puke? Because this suit costs a motherload, and believe me, I will make you pay for the cleaning costs if you get it dirty." I was staring at Casie in shock when she finally addressed me, "And hun? Do you mind not turning those vents towards me? You're drying out my contacts."

I never blogged about her, because well, she wasn't entertaining. She was just flat out horrific. The only redeeming factor about her was how vocal she was about wanting to stay in Maryland, at her home program. Because her husband had a very lucrative job with the government. And all of these other programs were safety programs for her, because hey, given her resume - her perfect resume, mind you - she could go wherever she wanted. I mean, do you know who she is? Do you know who she's worked with? Who she's done research with?? It also helped that she was half Alaskan Eskimo, and therefore, programs would be begging her to rank them first. Of course, and that's not even mentioning her sparkling personality.

So imagine my face when I walked into LPS training with all the psychiatry interns from programs in the area, and sitting there was my dear friend Casie. Cue disbelief and horror. But you know what? People act strangely during interviews. Interviews are a strange trip. I know that I said and did things that were questionable. So I figured, let bygones be bygones, and let's make new first impressions, right?

With that in mind, I introduced her to another psych intern, whom I had just met in the elevator. "Casie, meet Mandy!" Mandy smiled warmly and extended her hand, "you're from Hopkins!" having seen the info sheet with all our names and medical schools. Casie smiled indulgently, "Oh my goodness, why does everyone keep bringing that up? We're all equals here. No need to go on and on about my pedigree."

And with that, I became quite ecstatic that even though we're in the same neighborhood, I'll most likely never need to see or interact with Casie ever again. Thank the heavens. Seriously.

I mean, seriously!

The coolest

Two things I recently discovered about my apartment that are absolutely amazing and truly very awesome:

• Air conditioning is FREE. As is the rest of my electricity. 
• I can see fireworks from my apartment! From three different launch areas! God bless the USA, indeed.