Camp Hess Kramer
Malibu Ropes Course
USC Psychiatry Residency Retreat 2012
3 years ago
Monday, September 24, 2012
Wednesday, September 19, 2012
The vicious cycle
Somewhere along the way, I became Dr. Meanie Bikini.
No, I take that back.
I'm Dr. Meanie No Bikini. (I did gain the intern twenty after all.)
I don't know how it happened. It feels like it happened overnight. I didn't feel myself becoming meaner, more bitter, more burnt out.
I didn't see it happening. But it happened.
The abused has become the abuser.
I'm not proud of it. But I'm realizing that I'm getting frustrated at the lack of professionalism that my med students exhibit, the lack of respect they have for psychiatry, the lack of initiative that I thought every med student had ingrained into them on day one of clerkships.
I had a patient who was in florid myxedema coma, and I had to emergently transfer her somewhere - anywhere! - that could get some thyroid meds into her veins. I asked my medical student to help me get her most recent vitals for the transfer paperwork. He sighed loudly, unhappily, and then said, "Can it wait? I just need five more minutes and then I'll be done with this note." I looked at him pointedly and said, "Patient emergencies are not things that you can wait on. You came to medical school to help patients, not to write notes. And right now, the best thing you can do to help this patient is to go get her most recent vitals. The note can wait."
In case you were wondering, yes, the medical student was following this patient. And that note he was writing, was for an extremely stable, just waiting for placement, patient.
But the cherry on top? I can willingly admit that I was a bit harsh. But then he snapped right back at me. "Well, why do I have to do it? If you're transferring her, I'm not going to follow her any more, so how is this educational?"
I mean, seriously? Seriously??
To this day, he still has no idea what myxedema coma is. It might be my fault, but he had no interest in learning, no interest in knowing what qualified as a patient emergency, no interest in finding out how to triage in those kind of situations, no interest in anything but going home before 3pm.
I like teaching. I really do. But I don't know how to teach this student.
No, I take that back.
I'm Dr. Meanie No Bikini. (I did gain the intern twenty after all.)
I don't know how it happened. It feels like it happened overnight. I didn't feel myself becoming meaner, more bitter, more burnt out.
I didn't see it happening. But it happened.
The abused has become the abuser.
I'm not proud of it. But I'm realizing that I'm getting frustrated at the lack of professionalism that my med students exhibit, the lack of respect they have for psychiatry, the lack of initiative that I thought every med student had ingrained into them on day one of clerkships.
I had a patient who was in florid myxedema coma, and I had to emergently transfer her somewhere - anywhere! - that could get some thyroid meds into her veins. I asked my medical student to help me get her most recent vitals for the transfer paperwork. He sighed loudly, unhappily, and then said, "Can it wait? I just need five more minutes and then I'll be done with this note." I looked at him pointedly and said, "Patient emergencies are not things that you can wait on. You came to medical school to help patients, not to write notes. And right now, the best thing you can do to help this patient is to go get her most recent vitals. The note can wait."
In case you were wondering, yes, the medical student was following this patient. And that note he was writing, was for an extremely stable, just waiting for placement, patient.
But the cherry on top? I can willingly admit that I was a bit harsh. But then he snapped right back at me. "Well, why do I have to do it? If you're transferring her, I'm not going to follow her any more, so how is this educational?"
I mean, seriously? Seriously??
To this day, he still has no idea what myxedema coma is. It might be my fault, but he had no interest in learning, no interest in knowing what qualified as a patient emergency, no interest in finding out how to triage in those kind of situations, no interest in anything but going home before 3pm.
I like teaching. I really do. But I don't know how to teach this student.
Tuesday, September 11, 2012
Monday, September 10, 2012
Guess the bleeps
[in response to "Why are you in the hospital?]
"Are you **** asking me why I'm in the **** hospital? What the ****! How would you feel if you got ***** butt ***** every ***** fifth **** night in the ******, you *******. *****! Go ****** experience the ******* world of ******** gang ******* and then you can ******* come back in here and ******* ask me why the ****** I'm in the ***** hospital. Until ***** then, you can ****** shut your ***** mouth, ******."
Oh, lovely.
I'm so glad I'm not primary.
"Are you **** asking me why I'm in the **** hospital? What the ****! How would you feel if you got ***** butt ***** every ***** fifth **** night in the ******, you *******. *****! Go ****** experience the ******* world of ******** gang ******* and then you can ******* come back in here and ******* ask me why the ****** I'm in the ***** hospital. Until ***** then, you can ****** shut your ***** mouth, ******."
Oh, lovely.
I'm so glad I'm not primary.
Sunday, September 09, 2012
I love psych C&L
ME
Hi, this is psychiatry!
ORTHO INTERN
Hi, I wanted to place a consult.
ME
Sure, what's the consult for?
ORTHO INTERN
Well, we have a guy who broke both his legs and we were hoping you could come assess him for depression.
ME
Oh no. How did he break his legs? Suicide attempt?
ORTHO INTERN
No no, he got into a bad car accident. We're actually going to operate and he should be fine.
ME
Is he refusing the surgery?
ORTHO INTERN
No, not at all. But he's depressed.
ME
Oh, what did he say?
ORTHO INTERN
Oh, I didn't talk to him. But he looks sad.
Saturday, September 08, 2012
Inner monologue
I got a psych consult the other day for "patient refusing insulin." Now, our consult service is simply too large, too overworked, too busy that we don't have the time to see routine capacity issues. Every physician can do it, so we usually defer those things to the primary team. But, before I call up the primary team to refuse a consult, I always go see the patient to see if there's something else going on.
So I walk into the room, and meet this very sweet and pleasant 63 year old lady, and ask her why she's in the hospital.
"Well, I have an umbilical hernia, and I started to have a lot of pain..."
Hm, this all seems rather non-crazy and straightforward.
"...and so I went to the bathroom, and there was a lot of blood!"
Oh crap, did they mean to call surgery? Why was psychiatry called?
"...and then my head started to hurt..."
Still plausible.
"...and then a baby was born from my head!"
Ah. That's why I'm here.
P.S. I kept the consult.
So I walk into the room, and meet this very sweet and pleasant 63 year old lady, and ask her why she's in the hospital.
"Well, I have an umbilical hernia, and I started to have a lot of pain..."
Hm, this all seems rather non-crazy and straightforward.
"...and so I went to the bathroom, and there was a lot of blood!"
Oh crap, did they mean to call surgery? Why was psychiatry called?
"...and then my head started to hurt..."
Still plausible.
"...and then a baby was born from my head!"
Ah. That's why I'm here.
P.S. I kept the consult.
Tuesday, September 04, 2012
Learned helplessness
ME
Hi, this is Michelle from psychiatry. You placed a consult on this patient?
INTERN
Oh hi! Yes. Are you going to see the patient soon?
ME
Um, it depends. Can you tell me what the specific question is?
INTERN
Oh, our patient has dementia, and we were hoping you could help us figure out the etiology?
ME
Hm, so dementia is usually worked up by neurology.
INTERN
Oh okay.
ME
All right then, I'm going to cancel this consult okay? But if he starts to--
INTERN
Wait, what! Why??
ME
Because dementia is a neurology issue. So you should consult neurology.
INTERN
Oh.
[3 second pause]
Um, do you know the number for neuro consult?
[3 second pause]
Um, do you know the number for neuro consult?
Sunday, September 02, 2012
Crash and (almost) burn
So I thought I was having a bad week.
I was wrong.
I was having the worst week of my life.
Because this happened.
Don't worry. Me and Martin are completely fine. We dashed out of the car with nothing more than a couple of scratches and a nasty seat belt burn across my neck. But my beautiful 2005 Toyota Corolla, with no more than 41,000 miles on it, is basically dead, thanks to that fire hydrant.
I want to cry. But I am thankful that the fire hydrant wasn't a pedestrian, that me and Martin were totally okay and fine, and that no one else was hurt in this terrible car accident process. And many thanks to everyone for telling me how much worse it could have been. That the speeding red-light running car could have T-boned my car and broken both my legs in half. That my car could have gone up in flames. That I could have hit that light pole instead of the fire hydrant. That I could have this and I could have that, but thankfully, in the end, everyone is okay.
And a big sentimental thank you to my beautiful Corolla, for the many road trips to Wisconsin, Michigan, and those drives up and down PCH and Lakeshore Drive. Thank you for being the car I learned how to drive in, the getaway car we used during med school, the car that made the cross-continent trek from Illinois back to Southern California with me, the car that got me through intern year, and the car that saw me break down and cry many many times. Like Martin says, she's off to the Corolla farm, where she'll get to drive 80+mph to her heart's content and go off-roading as much as she wants to. She was a good car, and the best first car a girl could have possibly asked for.
I'm okay. And everyone else is okay. And that's most important.
I was wrong.
I was having the worst week of my life.
Because this happened.
Don't worry. Me and Martin are completely fine. We dashed out of the car with nothing more than a couple of scratches and a nasty seat belt burn across my neck. But my beautiful 2005 Toyota Corolla, with no more than 41,000 miles on it, is basically dead, thanks to that fire hydrant.
I want to cry. But I am thankful that the fire hydrant wasn't a pedestrian, that me and Martin were totally okay and fine, and that no one else was hurt in this terrible car accident process. And many thanks to everyone for telling me how much worse it could have been. That the speeding red-light running car could have T-boned my car and broken both my legs in half. That my car could have gone up in flames. That I could have hit that light pole instead of the fire hydrant. That I could have this and I could have that, but thankfully, in the end, everyone is okay.
And a big sentimental thank you to my beautiful Corolla, for the many road trips to Wisconsin, Michigan, and those drives up and down PCH and Lakeshore Drive. Thank you for being the car I learned how to drive in, the getaway car we used during med school, the car that made the cross-continent trek from Illinois back to Southern California with me, the car that got me through intern year, and the car that saw me break down and cry many many times. Like Martin says, she's off to the Corolla farm, where she'll get to drive 80+mph to her heart's content and go off-roading as much as she wants to. She was a good car, and the best first car a girl could have possibly asked for.
I'm okay. And everyone else is okay. And that's most important.
