I have decided to start numbering the blogs because I can't tell if they are displayed in the right order or not. Helpful? Who knows.
I have been dreading my psych rotation for the last year. We did not spend a lot of time on this subject in school, and what I did see did not capture my interest very well. I guess the subject may be a little too close to home. The diagnosis seemed to vague and intertwined to be very clear, and in actual practice this still remains true. Diagnosis seems to depend more on who is making it than any real structure.
The drugs that are prescribed are a crap shoot. Nobody seems to know beyond generally how each patient will be affected by the drugs, so they pretty much just ask if anything has helped in the past, and use that as a starting point. If the patients have not been on anything, the starting points are either the side affects you would like to have , or those you wish to avoid. Some for example make you sleepy, and you start with that one if your patient has insomnia, while others may rev you up, so they go to the people who can't seem to get out of bed....you get the idea. Not an exacting science. The psychiatrists do have a ton of experience with these medications, and seem to be pretty good at predicting what will happen. The one thing that seems common is that they will routinely prescribe medications beyond the recommended dose, again resiting experience as the reason. Much of what I have seen leaves me with the feeling that this will be something I will refer to a "higher authority" if I run into it in the future.
At this point I can't believe I spent so much time dreading this rotation. Observationally, it has been one of the coolest rotations I have had. Incredibly interesting. The patients I have seen are nothing like what I had envisioned in my head, and are actually quite a bit of fun. Anybody who knows me knows how much I love a story, and baby these people have some whoopers!!
So far I have worked in the childrens, teen and adult units in a couple of hospitals, and I also did some drug and alcohol detox in a another hospital. As you might guess, the drug and alcohol was where I felt most comfortable...my peeps ya know. It was a great experience and my past history was a valuable asset. The doctor I worked with was a little surprised that I was so comfortable, and that I knew so much about the program. After a couple of visits with the patients he looked at me and I just said, "January 26th, 2000." His reply...."December 14th, 1987." Guess I don't need to tell you we kind of hit it off.
Even though this has been a wonderful rotation, and interesting beyond belief, it is certainly not my cup of tea. As much as I enjoyed the drug and alcohol work, I spent most of my time with the kids, and the teens wanting to cry. Of the 50 or so that I worked with, only about 10% had a pathological illness. The sad part is that most of these kids just come from crummy homes, and received no training in how to deal with their emotions and feelings. They were not bipolar, schizophrenic, or have some other DSMV IV diagnosis, they were for the most part suicidal because they didn't know how to manage the way the felt. I had this one kid who was so cute, and had the most gentle face I think I had ever seen. He had been admitted for cutting himself. During the interview I asked him why he did it. His answer was that he just felt terrible (emotionally) and needed some relief. He had a friend who had been cutting himself, and told the boy that it gave him relief...so he tried it. When I asked him if it helped, he just teared up and said "No". He had no one in his life to teach him how to deal with his feelings. His father was in jail, his mother was a meth addict. I wanted to take him home, along with about ten others.... How could I?
To make it even sadder, because of insurance, or other monetary forces, we were only able to keep them for 3-5 days. This is just not enough time. So they are medicated, and released, with the hope they will get outside counseling... which is short supply, and not very good quality for these kids. No one expects the parents to get counseling, though they would like to see it, it just doesn't happen, so the cycle continues. No end in sight. These kids will probably not get the education they need, and soon they will be producing children who will not have the skills, because you can't give what you do not have. And that is why I don't think I could do this. I can't bear to watch.
On the other hand, the adults with the pathological illnesses can be sooooo funny. Some of the stories they come up with are hilarious!! I often catch myself laughing out loud (with the patients, not at them) and several times during interviews I have caught myself saying, "Are you crazy?"
A good reason why I probably should not do this.
rto
Saturday, March 21, 2009
Friday, March 13, 2009
My First Geriatric Patient
I had only been working at my new preceptor’s office for about two weeks. I had been following him and learning what his program was, but was still not comfortable with dealing with the geriatric patients he had in his practice. I guess however he felt it was time for me to get my feet wet.
The doctor said, “OK, this one is all yours. You do everything..treatment, meds, charting her case, writing the orders..the whole ball of wax." Then he looked me up and down and said, "You may have a problem with those shoes..." I thought he was nuts. What in the hell did my shoes have to do with seeing patients? Well, I walked in and introduced myself, and my first patient’s words to me were..."You’re a fat old man, and I don't like you!!!" So I said, "Well I guess we don't need to examine your eyes! But please, don't beat around the bush, just tell me what you think...I can take it." She had her arms crossed on her chest and wouldn't let me examine her. She said, "You need to leave!" When I finally convinced her that I couldn't leave till I had examined her she uncrossed her arms, and let me in. I put my stethoscope in my ears, and bent over to listen, and she grabbed a hold of stethoscope, and just about flipped me over the bed. My ears are now a quarter of an inch forward from where they were originally. She is 93 years old, and only weighs about 85 pounds, but this gal is strong!! By the time I wrestled my stethoscope away from her, I was worn completely out, and had to buy a new diaphragm for my stethoscope. After about 15 minutes I had completed my exam…the longest 15 minutes I can remember.
When I came out, my preceptor was about to choke he was laughing so hard. He said, "WOW, she really went personal on you...with me she just hated my shoes!"
She is terminal, and has complete kidney failure, so she will probably not be around very long, but over the last week I have won her over, and the other day she asked if I would hold her hand for a while. At first I though it was a ploy to rip my arm off, but we sat and talked for a while, and it was a wonderful moment. After a while, she turned and looked right at me and said, "Would you sing me The Yellow Rose of Texas?" It was so sweet.
So I leaned over, got real close to her ear and as gently as I could sang..."Boomer Sooner, Boomer Sooner..."
Justice is a wonderful thing...
rto
Follow up…
My patient’s condition was irreversible and terminal. A week ago we made the decision to take her off of all her medications, and only provided her with comfort care. Within a few days however, her condition began to improve, and last Friday she was doing so well we could not keep her in the hospital any longer. I wrote her discharge to send her to nursing care, had my last visit with her and said good bye. She was awake and alert, very kind, and as I was getting ready to leave she squeezed my hand and gave me a wink and a smile. I knew this was the last time I would see her.
Shortly after her transfer, she passed away.
This morning before I got to work I received a call from the receptionist at my last rotation which had been in the same town. She told me she was sorry for the loss of my patient, and that I needed to look at my patient’s obituary in the paper. I thought that was strange. Because of HIPPA laws, I had not told her who my patient was, and I had no idea how she knew of her death or my connection to her. She knew where I was currently working and had heard of the patient, but I had never identified her.
When I read the obituary, to my amazement, her family had named me as an honorary pallbearer. They told me they were sorry for the abuse that she had given me. The fact is I never felt abused. I had a relationship with this little old lady, and I would not change it for the world. As I told the family; years from now I may not remember any of the patients on this rotations, but there is no doubt that I would remember this lady forever.
I have learned a lot this rotation, but I think I will never forget the lesson this little old lady taught me…humility.
God bless her and keep her in the palm of His hand.
May she rest in peace and God’s eternal light shine upon her.
rto
The doctor said, “OK, this one is all yours. You do everything..treatment, meds, charting her case, writing the orders..the whole ball of wax." Then he looked me up and down and said, "You may have a problem with those shoes..." I thought he was nuts. What in the hell did my shoes have to do with seeing patients? Well, I walked in and introduced myself, and my first patient’s words to me were..."You’re a fat old man, and I don't like you!!!" So I said, "Well I guess we don't need to examine your eyes! But please, don't beat around the bush, just tell me what you think...I can take it." She had her arms crossed on her chest and wouldn't let me examine her. She said, "You need to leave!" When I finally convinced her that I couldn't leave till I had examined her she uncrossed her arms, and let me in. I put my stethoscope in my ears, and bent over to listen, and she grabbed a hold of stethoscope, and just about flipped me over the bed. My ears are now a quarter of an inch forward from where they were originally. She is 93 years old, and only weighs about 85 pounds, but this gal is strong!! By the time I wrestled my stethoscope away from her, I was worn completely out, and had to buy a new diaphragm for my stethoscope. After about 15 minutes I had completed my exam…the longest 15 minutes I can remember.
When I came out, my preceptor was about to choke he was laughing so hard. He said, "WOW, she really went personal on you...with me she just hated my shoes!"
She is terminal, and has complete kidney failure, so she will probably not be around very long, but over the last week I have won her over, and the other day she asked if I would hold her hand for a while. At first I though it was a ploy to rip my arm off, but we sat and talked for a while, and it was a wonderful moment. After a while, she turned and looked right at me and said, "Would you sing me The Yellow Rose of Texas?" It was so sweet.
So I leaned over, got real close to her ear and as gently as I could sang..."Boomer Sooner, Boomer Sooner..."
Justice is a wonderful thing...
rto
Follow up…
My patient’s condition was irreversible and terminal. A week ago we made the decision to take her off of all her medications, and only provided her with comfort care. Within a few days however, her condition began to improve, and last Friday she was doing so well we could not keep her in the hospital any longer. I wrote her discharge to send her to nursing care, had my last visit with her and said good bye. She was awake and alert, very kind, and as I was getting ready to leave she squeezed my hand and gave me a wink and a smile. I knew this was the last time I would see her.
Shortly after her transfer, she passed away.
This morning before I got to work I received a call from the receptionist at my last rotation which had been in the same town. She told me she was sorry for the loss of my patient, and that I needed to look at my patient’s obituary in the paper. I thought that was strange. Because of HIPPA laws, I had not told her who my patient was, and I had no idea how she knew of her death or my connection to her. She knew where I was currently working and had heard of the patient, but I had never identified her.
When I read the obituary, to my amazement, her family had named me as an honorary pallbearer. They told me they were sorry for the abuse that she had given me. The fact is I never felt abused. I had a relationship with this little old lady, and I would not change it for the world. As I told the family; years from now I may not remember any of the patients on this rotations, but there is no doubt that I would remember this lady forever.
I have learned a lot this rotation, but I think I will never forget the lesson this little old lady taught me…humility.
God bless her and keep her in the palm of His hand.
May she rest in peace and God’s eternal light shine upon her.
rto
Maybe a little slow...
I may be a little slow getting started, but I don't see why things should change now. You don't get to PA school in your 50's by being real forward thinking. The fact is that I'm glad I finally got here, and now I have a way for people to keep up with what's going on.
Life in PA school is very busy, and I have been taking a lot of heat over the last couple of years for not staying in touch. When I started school they said that they only expect 2 hours of study for each hour of lecture. Next they told us they would lecture for 8 hours a day...do the math. I thought when we got into clinicals that things would slow down a bit, and I would be able to catch up....guess again. If anything clinicals have been more busy than the didactic portion. The intensity of taking tests is not there, but the time commitment is still the same. Like they said at the beginning, "You can sleep after PA school!".
I have had such an interesting experience through this whole adventure, and only some of you have heard the stories. I am going to try to at least give a weekly update on what's been happening so all who are interested can tune in.
To everyone who helped me get here let me say thanks if I haven't told you lately. The list is so long that I don't have the time to get them all down here right now. You have listened to me whine, and cry. You have held my hand and provided encouragement. And most of all you have been my friends. I love you.
rto
Life in PA school is very busy, and I have been taking a lot of heat over the last couple of years for not staying in touch. When I started school they said that they only expect 2 hours of study for each hour of lecture. Next they told us they would lecture for 8 hours a day...do the math. I thought when we got into clinicals that things would slow down a bit, and I would be able to catch up....guess again. If anything clinicals have been more busy than the didactic portion. The intensity of taking tests is not there, but the time commitment is still the same. Like they said at the beginning, "You can sleep after PA school!".
I have had such an interesting experience through this whole adventure, and only some of you have heard the stories. I am going to try to at least give a weekly update on what's been happening so all who are interested can tune in.
To everyone who helped me get here let me say thanks if I haven't told you lately. The list is so long that I don't have the time to get them all down here right now. You have listened to me whine, and cry. You have held my hand and provided encouragement. And most of all you have been my friends. I love you.
rto
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