Category: Uncategorized

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.

Why is it so annoying when people zoom past us on the road? In general I wouldn’t call myself a road rage kinda person. I feel like I have a high tolerance for getting genuinely upset on when I’m driving. That doesn’t mean of course I don’t given in to the occasional cathartic expletive when drivers around me are being stupid, but usually I’m not actually angry. That said there is something about someone behind you switching lanes to drive past you even though it’s the person ahead of you holding you back that inspires so much annoyance. And then when they get caught behind a slower car you can’t help feel immense satisfaction at their misfortune, like a fat “I told you so.” (Even if I agree that the left lane should be reserved for active acceleration past cars and not for cruising and that the person up ahead is also a dumby).

But again why is it so annoying. Getting upset for people driving too fast or too slow is so dumb. Tailgating someone to make them go faster or get out of the way is so dumb. Driving 80 on the freeway with no one in your way will probably get you to your destination only a few minutes faster than if you drove the speed limit. Are you that pressed (I tell myself) that you want to endanger yourself and others by swerving past other cars and get yourself worked up how others are driving? As if those three minutes are going to significantly changing your experience after arrival (of course there are exceptions).

Don’t fuss over it. It’s not worth it.

TTITF
Light, but soft and warm throw blankies, ducks, fishing ponds

Expectations are a huge part of medicine. Whether you’re are a provider, a patient, a student, a family member, or in any other role your expectations and whether or not they are met is a major deciding factor in whether or not your healthcare experience is a good one. In many cases, it seems like it’s the physician’s role to help manage expectations for the care team and for the patient. As a student, I’ve noticed it can be easy to get caught up in chasing lab values as an objective marker of a patient’s health improving. So much conversation and decision making occurs in the workrooms, unbeknownst to patients. Orders get signed, patients get sent of for diagnostics, or get their blood drawn without much shared decision making or conversation. I’m not necessarily saying that the patients need should be consulted before making every single decision, that would be impractical, but they deserve at the very least to know the plan before it happens or as it happens if possible. We need to set expectation so they don’t think we are poking them just for nothing, and when we think about it this way I think we become more mindful as to whether or not certain things are necessary. On multiple occasions, patient’s were getting their blood sugars checked unnecessarily, just because the order was placed in the ED and never canceled as they are transferred, until I point it out to my seniors or attending. Often times the patients have not expectations, so they just go along with it because they assume we are doing what’s best. Having conversations with patient about their care should be the standard. Managing patient expectations should be a part of their care, not an afterthought.

TTITF
Costco pizza, good public radio programming, innovative alarm clocks

It’s been hard to keep up with these, but to be honest, in terms of experience, a lot of these days are more or less the same. I go in, rush to not be late even though I’m already waking up at 4:30 AM, starting looking at what happened to my patients overnight, start reviewing the charts of the new patients so I can decide which one I want to take, go get sign-out from the overnight docs, come back, do more chart review, go see my patients, start some charting, go on rounds, do more charting… wait I am just now realizing I went through all of this in the last post I think. It is interesting to see the different pathologies though, and to think about some of the more difficult etiologies of refractory problems. Also so far I feel like I’ve gotten pretty lucky with patients being pretty open to talking to me. I also feel like my Spanish is improving… slowly. Definitely been helpful to be hearing a lot of medical Spanish on a daily basis. I’m also learning a lot of other stuffy too.

We also got a new attending today. She’s little more formal, but also seems like we are going to have very clear expectations of us for this coming week. Wish me luck.

TTITF:
(1) Friends who talk to you about new things and make me think about things in different ways, (2) lasagna, (3) finding something you thought you lost forever.

We had a substitute attending. Both the attendings I’ve worked with so far have been pretty young. Like late 20’s early 30’s looking. He was a super friendly guy with a very amicable and loose way of talking, as if we were his buddies and we were hanging at the bar. Except instead of beers we all had black coffee. And instead of sports, we were talking about anion gaps and how to spot right bundle branch block on an EKG. He put a lot of pressure on me when I was up to present my patient. He wanted me to read an x-ray and give a full assessment and plan for a patient, who I honestly had no idea what was going on. As we went through the presentation I maybe started to piece somethings together as processes were running in the background while I was speaking, trying not to repeat myself too much. When he actually asked for my assessment, I paused for a while, and stammered a bit, but eventually pulled a diagnosis out my ass, and he actually agreed. At first I thought he was doing one of those things where they just humor you at first as a teaching point and make you defend your case and describe your thought process even if you’re wrong. It felt good, and even for all the stress I had throughout the process I appreciate that he made me go through it and also didn’t make me feel too stupid when I said dumb things. Overall I’d say it was a good day for learning.