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Yesterday during Grand Rounds, the speaker was talking about growth mindset vs fixed mindset. At this point the concept of these mindset have been beaten to death in academic and professional development lectures and the like. Today though, I was thinking about how exposure during childhood can orient us toward one mindset over the other. Not to brag, but I feel like I’ve always had kinda a growth mindset, and I feel like watching shows like Pokémon growing up were big in fostering that. This idea of being being kinda shitty at something, but slowly getting better through hard work is a common theme throughout anime and sets up good example for kids in overcoming obstacle and pushing through adversity.

Then I thought about more western programming. Maybe I have selective memory now that I’m thinking about it in order to prove a point, but a lot of the American TV watched growing up was built more around fixed characters and archetypes. The stories were more situational than progressive. Characters personalities were fixed, and you knew what to expect out of them; how they would behave and how they would react to different situations which made for good TV for kids in its on way, but not in a way they sets up kids to be growth mindset oriented.

All I’m trying to say is anime is good for kids.

Fridays are dedicated education days so no surgery work today.

One of the tasks I assigned myself for this month was to affirm a stranger every day. It feels like a simple task, but one that has been hard to be consistent with. I’ve found that when you are trying to find something to affirm a stranger about it can be hard to come up with something, either that or I just feel too awkward about complimenting a random stranger to say anything. Uncalled for affirmations are weird, but they don’t have to be creepy. I guess my goal in assigning myself this task was to be a bit more out going and to try to look for the good in strangers. So far still needs some work.

I’ll state the obvious: life is full of choices. Knowing that isn’t all the helpful though, despite how often people say it. Knowing that I have to make a choice doesn’t relieve any of the pain or anxiety that comes with actually having to make it. That said, I am a firm believer that every person makes the best choices that they can with the information they have available to them at a given moment, otherwise they wouldn’t have made said choice. Event when that choice turns out to be detrimental or ends up causing the person pain, in that moment or at that time, the decision served some sort of function or seemed like the right thing to do under a specific set of circumstances. We can never say for certain whether the ultimate outcome is net good or bad. Sometimes people say there are no good and bad decisions and it always depends on what you make of it, but I’m not convinced that is 100% true. But also what do I know, and maybe it simply doesn’t help to think that way.

What I like about art is that even the most hyperrealistic art, even photographs, are all still just impressions. No matter how hard you try, an artist’s character will always bleed through the medium. You can never recreate the exact moment that a piece of art was being made, and so you can never recreate any one piece of art. Yet the art itself serves an as artifact of that moment, and with that creates its own, allowing those who experience to relive that moment within their own imagination and from the lens of their own worldview.

Penguins have always been one of my favorite animals. I don’t remember where it all started, but I remember when I was little always pulling out the “P” section of our World Encyclopedia to look up penguins and how the largest penguins are the emperor penguins. I think what I liked about penguins is that they seemed so out of place to me at the time. Like who who have thought these awkward birds would call icy tundras and rocky cliffs their homes. They waddle about on the land, having lost the ability to fly (without a doubt the best part of being a bird), until they trip and stumble into the water where they instant transform into these slick, graceful torpedoes with an agility that probably surpasses most birds in the air, swimming at speed that allow them to launch their whole as body out of the water back onto the ice/ land where they resume their unassuming terrestrial existence.

I feel like I can relate a lot to penguins. At least to the waddling and stumbling part.

Our culture is obsessed with heroes. From superheroes we read about in comic books or see in movies, to our adoration of military veterans and frontline workers during this pandemic, we can’t get enough heroes. At times it feels like our idolatry of heroes stems from a desire to be saved, from an attitude of either “I’m not strong enough to be the ‘hero'” or “I am unwilling to make the sacrifices of a ‘hero.'” Both are reasonable in their own right, but my response to these would be, Who says? and, Why not?

At the conference last month, someone said, “We don’t need more heroes, we need better system.” And that is 100% correct. If our systems were adequately taking care of people, especially the most vulnerable we wouldn’t need heroes. If our systems prioritized safety and wellbeing over revenue and profit we wouldn’t need heroes. But thank God we do have heroes to carry the burdens of society so I can continue to live my relatively carefree lifestyle.

So let’s toast to them and make them banners and give them a day where we celebrate them and tell our kids to aspire to be like them. Anything but create better systems to support them and to make them not have to be the safety nets for all of society, especially when things go to shit, because to do so means placing some of that burden on me, which simply will not do.

Yesterday I started a challenge for the month of November to complete 10 tasks every day for the whole month. Part of this was a revisiting of the monthly challenges Alfred and I used to do for the In-Progress Report (yes we will start it up again eventually). The original intention was to help us develop better habits to work towards our various goals that would bring us closer to who we wanted to be. It was helpful as a way to remain cognizant of my daily activities and be more intentional with how I spent my time.

This time around, I want to open it up to whoever wants to join and also put some more skin in the game by adding a cash prize from a collective pool. I think utilizing community is a historically untapped (by me) resource that can be really helpful for accountability and motivation.

If you are feeling like you are in a rut or want to change things up or have been trying to develop/ change some habits you are welcome to me and the others who are challenging ourselves and each other this month. Instructions for how to join are here, sign-up by next Tuesday if you want a chance to win, but you are also welcome to join or follow along without competing.

Even though I’ve learned a lot on this rotation, it still feels like there’s so much I haven’t learned/ haven’t studied enough. Every day something comes up that feels so basic, but I’ve never encountered before. I’ve been studying more these past couple weeks, but it doesn’t feel like I’ve become that much more well-equipped to handle certain situations. As we approach the last couple days of this rotation I’m hoping to close that gap as much as I can.

This week I’m back on the emergency department holding unit (EDHU) and consults service. I don’t think I commented on it before, but it was especially apparent today — the difference between the kinds of patients we see in the EDHU compared to those are in the voluntary unit I was in last week. The patients in the EDHU are just more acutely sick and I get to see a lot more active psychosis which is more interesting to me from a pathology standpoint, but somewhat less interesting to me from a patient care standpoint.

Today we had someone who thought her neighbors implanted a device in her tooth and were talking through it, another person who thought he was constantly stopping nukes from falling everywhere, and another who took off all her clothes and was hiding herself in the cubby closet.

Because of that though I don’t get the same opportunity to connect with patients that I do in the voluntary unit. But for now I look forward to seeing more of the acute stuff.

This post includes discussion about suicide. If you or anyone you know is struggling with thoughts of suicide the National Suicide Prevention Hotline is 1-800-273-TALK (8255).

New week and with it an attending change. Of course the day I run out of scrubs and come in business casual is the day with the one psych attending that wears scrubs. If the attire and long flowing hairs wasn’t enough of a tip-off, his practice style was very chill. The way he talks with patient’s is very familiar (in the sense that the way he present himself is very down to Earth and comforting).

At this point I’ve gotten a couple opportunities to talk to patient’s struggling with suicidal thoughts. Today was my first time talking to a patient who was feelings actively suicidal. From my perspective, what was difficult about the conversation was it felt like talking to a wall. This person had been struggling with depression and suicidal thoughts for several years. They had tried various treatment options without any respite and they just want it all to end and they resent the world/ society for not allowing them to follow through with. As heartbreaking as it was to hear them speaking, I also thought what they were saying is reasonable. I can’t feel what they are feeling, but I can only imagine if I were going through years and year of torment and people saying they can help me or that they want to help and nothing changing that could drive me to contemplate suicide. So often we invalidate patients experiences, even when we don’t mean to. We’ll get you better. Just keep an open mind. Trust us. Why? Why should they trust a system that has historically failed them and only led to disappointment? Why are we acting like they are the one that is broken and they are only one more trial of SSRIs, one more session of group therapy away from being whole again? Yes these are proven therapies and in many case do work to help people manage their depression, but pills and therapy can’t fix the life circumstances that may have brought them there in the first place. This is just a half-baked thought and I’m not sure how to reconcile this. The way I approached it for myself today was essentially selfish and also in acknowledgement of the reality: I don’t want this person to die and we as a medical facility for better or worse have an obligation to keep this person from dying by whatever the means, i.e. we aren’t going to help them end their own life nor are we going to send them home in the state where they are likely going to end of their own life, even if it means holding them in the hospital against their will. So in the face of those realities, we might as well try something to see if it helps, and maybe keep expectations low.