Sunday, April 27, 2008


I did not fail the neurology shelf exam!! HURRAH!!

It was my lowest raw shelf score ever, but I still beat the mean by a decent margin. I'm not sure how I pulled that one off, but DAMN.

Psych ward continues to be amusing/scary/sad. At least the hours on psych are nice and cushy, although I do have call this week. In any case, the shelf is on Friday and other than continuing to get all of the stupid drugs mixed up in my head (the names, actions, and side effects of the drugs, not the actual drugs, unfortunately) I am feeling pretty okay about it. Also, this is my second to last shelf test EVER!! Wow.


Okay, back to studying. There's nothing like studying crazy people on a Sunday night...

Wednesday, April 16, 2008

The interesting thing about delusions...

No matter how crazy they are, most patients just sort of assume that you believe them.

I was worried about how I would respond if someone busted out with something really nuts and one of those "You gotta believe me, doc!" sort of rants you see in the movies. But really, it's been more like "It's that cat. The one that can smell you and hunt you down and suck out your soul. It's comin' for me."

It is WEIRD.

It is also kind of disturbing how profoundly your mind can betray you. One dude can't even draw a clock anymore; he was totally fine three days ago. It's amazing what a little acute renal failure and oxycodone can do to your brain.

Okay, I have to get back to memorizing the psych dictionary. That's mostly what you are tested on for the psych shelf; it's the DSM criteria, which are basically just long, complicated definitions. You know, stuff like the patient has X if they have 2 from column A and 3 from column B. Which makes for a lot of memorization, since column A and column B are usually not too short and fairly complex. There are also a lot of sister diagnoses, meaning that A is just like B except with (or without) symptom whatever. It is interesting, at least.

So far I only have one diagnosis: generalized anxiety disorder. I keep reminding myself that I am just a little too high functioning to truly have a disorder, but I definitely have most of the symptoms:
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). CHECK!
B. The person finds it difficult to control the worry. CHECK!
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months).
-restlessness or feeling keyed up or on edge CHECK!
-being easily fatigued CHECK!
-difficulty concentrating or mind going blank MEGACHECK!!
-irritability Ask my husband!
-muscle tension OH LORD YES!
-sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) Okay, not this one... KIDDING! ABSOLUTELY!
D. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in a Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder. Okay, I may be a little afraid of being embarrassed on rounds, does that count?
E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder. Not as far as I know...
F. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. THIS is the one that saves me. I don't think I can say that this one is true.

So there you are. I'm one step away from a psychiatric diagnosis. How come I can't get my hands on any of the good meds?!?

Friday, April 11, 2008

Bi-Polar Bear

("This looks like a job for Bi-Polar Bear!!! But I just can't get out of bed this month..." For those of you who are not familiar with The Tick, I suggest you clickity click and find out what you are missing).

Anyway, friends and neighbors, I have come to realize that some of you are angels straight from heaven, and some of you hate me and wish I would just go ahead and knock myself off so you wouldn't have to deal with me anymore. Of course I haven't had thoughts of killing myself, but if someone doesn't stop this pain, what choice do I have? Would you want to live with pain like this? No, that would be it. You can't put me on the Crisis unit for saying that, can you? I'm not saying I am going to kill myself. It's just that if I wanted to, you couldn't stop me. Why should I stick around here? Even my father wouldn't care; he 's always said I'm a loser. Now how am I supposed to feel about that? You know, if I could just get a little something to take the edge off... no, not that, only lorazepam really works... no, 2mg isn't enough, I'll need more like 10 or 15mg to really help... seriously, they haven't been giving me my home medicines and now I haven't slept for four days! Just don't give up on me. You understand me. That other doc who was in here, I don't know what his problem was, but it was like he wouldn't listen. Or he thought I was crazy, or something--just made me feel terrible. But not you, I'm so blessed to have you, you are the one who is really going to be able to help me. You are so wonderful, God sent you, and... what? What do you mean you won't give me 15mg of lorazepam? You're just like all of those other doctors, aren't you? Where is that other doctor, the nice one, the one who actually listened? Send him back in here, and don't bother coming back, okay?

OK! Now, those of you who have not had psych or the delightful experience of interacting with numerous patients probably feel confused and blindsided. Everyone else got to the second or third line and a neon sign in their head lit up, and that sign flashed BORDERLINE! BORDERLINE! BORDERLINE!

Believe me, it is just as fun as it sounds to interact with Borderline patients. By which I mean, it is no fun at all. It is one of the most frustrating things that exists in medicine, although what makes it so hard sometimes varies from person to person. For me, it's hard because most of these patients have had lots of bad things happen to them--some just because, some self-inflicted in some respect--and they are in a lot of pain but have no idea how to get themselves out of it. Also, Borderline patients tend to be master manipulators, they push your buttons, good or bad, they make it REALLY hard to take care of them, either because they are not telling the truth, alienating the team, disobeying orders, etc etc.

Also, a tip for those of you just starting into the clinical world: At least half of the patients who tell you they are "bipolar" actually have Borderline Personality Disorder. Probably more like 80%. Unless you are on psych, and then you probably will be lucky enough to see truly bipolar patients in a manic phase ("No weapon forged will prevail against me!!"--not a Tick quote, an actual patient quote). You'll secretly wish you could feel like them for just a little while.

Quick side note: I've learned that just because someone thinks that a white van full of Navy SEALS is following them around and then jumping out of the van to chase them with bicycles doesn't mean they have paranoid schizophrenia. Apparently it can also mean that they have been taking 16-30 pills of dextromethorphan at a time for the past five years or so (along with several other street drugs, of course).

Anyway, I'm off to learn about more psych, so I can find a few more frightening diagnoses which almost apply to me. Also, I think I see a white van outside.

Friday, April 4, 2008

Holy Mother of God

Today, for the first time, I left a shelf exam thinking, "Wow, it is entirely possible that I failed that exam."

The neuro shelf exam was horrible. HORRIBLE. Maybe it is partially due to how little I enjoy the subject, but it was brutal.

It's going to be a tense few weeks waiting to hear about THAT sucker.

And now to totally cleanse the palate of the mind and prepare myself for a weekend of working to catch up on life requirements and starting a whole new rotation! Hurrah!

But first, excuse me while I curl up into a ball in the corner, rocking and mumbling to myself.... there's no place like home... there's no place like home...

Thursday, April 3, 2008

Hoping for that magic spark of panic

Otherwise, how will I ever find the motivation to study more neurology today?

I already blew hours of time yesterday which I could have used to study, but no. What has happened to me? I used to whine and complain but I would eventually study, and study big time. Now it seems the thrill is gone.

Maybe it's burnout. Maybe it's just neurology. Or maybe its... shudder... neuroanatomy.

In any case it will be all over tomorrow, when I take my third-to-last shelf exam, leaving only psych and medicine to conquer before I reach the promised land of 4th year.

So, what did I think of neurology? Well, the people (residents/attendings) were almost unanimously extremely nice. Okay, but how did I like neurology?

They were very, very nice.

You know, like the classic example from When Harry Met Sally, when Harry points out that saying a woman has a good personality only means she's unattractive if "she has a good personality" is the answer to the question, "What does she look like?"

Neurology is interesting in theory, but it goes against one of my core traits, something my dad calls "a strong bias towards action". I want to DO stuff to patients that makes them better. In neurology, it just seems like you do stuff to patients just to better define all of the stuff you can't really fix. Plus, there is something deeply and spiritually disturbing about seeing patients who are now different people because of a 1cm-wide change in their brain.

Plus--and please believe me of understatement when I say this--neurology easily ties rheumatology for the coveted Specialty With the Most Crazy Patients award.

And no, I'm not forgetting psychiatry.

In any case, like it or no, it's time for me to do the age-old medical student ritual of cramming what feels like millions of anti-convulsant drugs and their various uses into my brain for the exam so that I can immediately forget them for the tenth time.

Next post: the never-ending cycle of Relearning and Reforgetting: the Cornerstone of Medical Education.