Sunday, July 22, 2007

The first day of the rest of my life (or something like that)


Every day we meet people on the worst day of their lives.

-Grissom to Sarah, in one of the seventy thousand episodes of CSI I've watched over the past three weeks. According to a Google search, and subsequently, this site, the episode is called Too Tough to Die. So there you have it.

I kept thinking of this line on Friday. Which is not to say that I saw a whole hell of a lot of patients, or even that I'm doing psychiatry yet, really, mind you. I am, for these three months (well, now, nine weeks) working on the Internal Medicine service at the state psychiatric hospital with which my institution is affiliated (there are actually two in the area, which are going to conglomerate into one big new one, allegedly last spring, oops). So it's general medicine, except, on psychiatric inpatients. And as far as I can tell, usually ones who've been committed against their will, or they'd be at one of the "nicer" hospitals (although, this one is pretty decent). It's an interesting idea, and actually, I think the fact that we get to do our general medicine in this setting is a serious strength of the program. Because, really, whose general medical problems am I most likely to be treating in my career, except, psychiatric patients, with all of the comorbidities and special issues that label evokes?

But I digress.

My first day went fine, and thank you all for being so eager to hear about it (I actually tried to leave a blurb on here Friday night, but Blogger was having an off day or something, it wouldn't take....anywho...). It actually was fairly uneventful. I sort of picked up one decidedly now-stable patient, took a very disorganized history on her, took bloody FOREVER to write my note on her (because, seriously, the last time I wrote a gen med note was, what, four years ago when I was a third year medical student?), and then my cohort discharged her back to the psych service at the end of the day. I got orientation-ed to within an inch of my life again. I got very lost and confused on a couple of occasions. And we had a nice talk about acid-base disturbances and another about benzodiazepine withdrawal. All in all, a good time.

On the whole, no one was mean to me, I like my co-residents, and one of these days I'll be able to find everything. And my attending seems cool, and he teaches a lot, which I really appreciate, rather than being demoralized for my lack of telepathy. But I couldn't quite shake the feeling of being a fish out of water, still, which was a very weird thing for me in a setting where I used to feel quite, well, wet and fishy. I think part of it was coming in late when the rest of the team already knows their way around and gets the routine. I think a lot of it is still feeling like I'm supposed to be the gynecologist, and where does a gynecologist fit in the medical unit of a psych hospital? And part of it, certainly, is still that feeling of not being worthy of being on any unit, left over from my last experience (my therapist once referred to this component of said last experience as "brainwashing"...).

Those last two are going to be pervasive themes this year, I think.

The latter, well, it's just something I've got to work on. But I do miss that feeling of...not even of knowing what I was doing, because I still do, but of knowing that I did. Of course I didn't have all the answers; we never do. But there was a time when I knew that I could find them, or the people who knew them, that I was intelligent and well-trained and facile enough to do what I was doing. There was a time when I felt worthy of what authority I carried and confident that I could manage what I was given. There was a place when I questioned my decisions a reasonable amount - and I do think that's wise, it keeps information fresher and perspective sharper - but I did not question myself to this unreasonable degree. I miss that. I feel like that's been forcibly taken from me, like so many other things have. And I'm sure, with time, it'll return, but you know something? It really does suck.

As for the former...I'm certainly not the only one in my program who's coming from a non-traditional background - two of my colleagues were out in practice elsewhere. So, they didn't just come out of their fourth year of medical school having done a boatload of psych electives, either. And no one here seems to expect me to be a font of psychiatric knowledge right out of the gate, especially since my first four blocks are primary care. It's going to be fine.

But it's also definitely an adjustment, and that's where that quote kept popping up on Friday. When I was a gyn, I saw a lot of people on the best day of their lives. Or, the first day, for that matter. I saw them on some anxious days and some complicated days, but, like...I had this very simple case, medically speaking, on Friday. Yet, for my patient, there was absolutely nothing simple about that day. It was scary as hell. She ended up in my care through almost no fault of her own. She ended up needing psychiatric care because something unthinkable had been done to her by someone she trusted. She didn't have nine months to plan, even poorly, for what happened. There was no pre-op visit, no explanation of risks and informed consent to sign when her life was shattered. I'm sure the sheriff was occasionally involved in my old practice, but rarely if ever did my patients come to me as a direct next step after meeting him, and I don't remember anyone waking up in handcuffs. If I were ever to go to court and sit opposite my patient (which, let's face it, as an OB, I would have eventually), it would've been by their charge, not by some third party's, not by mine, and I certainly wouldn't have wandered across the street to some little stone house (which is where the magistrate's court or whatever it's called is located at our state hospital) to do so. The day you come in to the hospital to have a baby or to have an ovarian cyst removed or, really, even to have your cancerous tumor removed, it's probably a remarkable day. But not in the way it the day you come to the psych ward, especially if you don't come of your own accord. I'm not really qualifying that as better or worse than the OB/G populace; it's just...different. And going to take some adjusting.

Oy.

In totally unrelated news, though, I have spent a good portion of my weekend reading the seventh Harry Potter book, and I have to say, I was pleased. I liked the ending. I even liked the epilogue. I really liked Chapter 33 (partly because I also really like being right, and I called that, like, three books ago). I have some minor complaints about it, and things I really appreciated, neither of which I'll air here just yet for fear of being stoned for spoiling the plot, but I will say, I thought it a fitting end to the series. Which, as much as I enjoy them, I agree that they need to conclude. But I look forward to whatever else Jo Rowling decides to write now.

No comments: