On Tuesday I watched as, so far as anybody knows, ECT (electroconvulsive therapy) was performed for the first time ever on a patient with a cochlear implant. Based on the complete turnaround in the kid's condition, I am now an ECT believer. Oh, and it's not nearly as dramatic as its portrayal on TV or in movies. (Nothing in medicine is, I've found.) In fact, the first time I saw ECT done, I had to literally bite my lip to keep myself from blurting out, "That's it??" I got more of a rush out of striding purposefully through the OR suite before and after the procedure.

Wednesday was remarkable for being my last day in the hospital, and a day in which I didn't have to do much. The attending was in meetings all morning, and the fellow had teaching conference from noon to 2pm. I had lectures from 2-5pm. So by the time all three of us could actually get together, the day was all but over.

On Thursday morning, I only had to attend morning report and Grand Rounds. Before morning report, the other students sat around the table and had a good laugh at yet another hilarious story about the wacky hijinks of the psychiatry clerkship. I, along with the other student who did the winning combo of Addictions and Child Consults, literally sat off to the side in a corner of the room. Instead of joining in the laughter, we were talking about how we've both needed to see counselors due to nightmares, insomnia, etc. since starting the rotation. I feel compelled to warn future generations of third years not to believe the hype. Psychiatry isn't a time for fun and hilarity, though many, many people will say otherwise.

Yesterday, I took the Psychiatry shelf exam. I thought it was okay. It seemed like every other question was about the indications for the different kinds of psychotherapy, which I didn't study as much as drugs, diagnostic criteria for the various conditions, etc. Nothing to be done about it now! After the exam, each of us had an individual exit interview in which we discussed our experiences with the clerkship directors. He didn't seem too perturbed by the fact that both of the Addictions/Child Consults students were emotionally crushed by the rotation. He said it's really "the luck of the draw," and sometimes other services are slammed with really emotionally tough cases. I have my doubts about that. But anyway, it's over now. As is third year!! I'll share my thoughts on the year as a whole a little later.

The work week that just ended was a definite improvement over the one before. On average there was about one new consult each day, as opposed to three or four. Furthermore, the consults we got did not involve child abuse. Apparently last week's flood of abuse cases was an anomaly that left even the peds attendings shaken. So it wasn't just me!

That's not to say that last week was all puppies and rainbows. We had a pretty steady census of eight patients, six of whom are in intensive care. One of them is now headed toward hospice care. I sat in on the care conference during which the parents realized for the first time that the miracle they'd been hoping for probably wasn't going to happen. When the mom asked, "How do you let go of your child?"... hats off to anybody who can answer that question for a living.

Logged into the Portal (school interwebs thingie) today, and what do I see at the bottom??

"Portal page for: LaKedra Pam, VMS IV"

Guys, it's happening! This year might actually end!! Back in July, I remember settling into things with the thought that the end of the year was so far away, I might as well just accept the fact that I'd be a VMS III for the rest of my days. Now look at me! The Portal just called me a VMS IV!!

I haven't been writing much recently because I've been depressed ever since starting psych. Probably not true depression, but guys, this rotation sucks. It's just so hard. Not just the hours: I've had long days before, and I'm willing to accept 11-hour work days as karmic payback for thinking that having Psychiatry last would be like starting my summer vacation five weeks early. What really gets me is seeing kids who are extremely sick, or come from extremely bad home situations, or both. In this respect I really think the pediatrics clerkship does students a huge disservice. It involves zero critical care time, and most of the time the third years are shielded from seeing suspected abuse victims. All well and good, until one of those third years strolls into a child psychiatry rotation expecting to spend their time hanging out with cute kids!! My not-quite two weeks of child psych is probably tied with my five weeks of Colorectal Surgery when it comes to time I've had to spend in intensive care units. That Pulm rotation that bothered me so much back in August is laughable in comparison.

Every single day feels like it stretches on forever. I just have to make it through the rest of today, and tomorrow, and then I get a weekend. Which I have to spend studying for my shelf exam. Then I have four more days before that shelf exam. And then I'm done.

You have one emotional breakdown, and suddenly the whole psych department treats you like you're made of glass. I'm fairly certain my attending was actually afraid to break the news that one of our kids had gotten worse over the weekend, for fear it might crush my spirit. There was also the change in the department seminar schedule to include a discussion on dealing with emotional difficulties. Also, every sentence directed at me so far today has begun with "Would you be okay with..." as opposed to the usual "We need you to.." of third year.
I'm not complaining, just noticing.

Food for thought: I have more popsicles in my freezer (11) than I have work days left in third year (9).

Y'all, I will guarantee you that if somebody says "Oh, I got some great stories from my psychiatry rotation," that person did not rotate through Child Consults. I've gotten stories all right, but none of has been great. I've been spending most of my day seeing kids on the burn, trauma, oncology (cancer), and critical care units. Sad stuff, but I've been seeing really ill people all year. Seeing victims of child abuse in the emergency room... that's probably the biggest reason I cried every single day last week.

(Purposely being vague for patient privacy reasons:)
One of the patients I'm following is a kid under 7 who comes from a home situation that, at best, involved frank neglect with very un-awesome parents. As the medical student, with lots of time, one of my duties was to get the kid to talk about their emotions, considering the events that led to them being in the hospital. By Friday I'd formed some rapport with the kid, but they were still mostly very withdrawn and very very sad. At one point, the kid said that they couldn't be friends with me, because "I'll get in trouble with Mommy." Of course I asked why, and got the answer "Mommy says I'm not supposed to talk to black people."

Hokay. Well, having met the parents (who weren't in the room at the time), and with the gift of hindsight, this was not a surprising answer. But actually in that moment, I was flabbergasted. Even though I know full well that a child that young is only parroting what they hear at home, I was hurt, too. I think I recovered well, and went down the path of asking the kid if they thought people could be nice, "even if they don't look like you." The kid agreed, and we ended up playing a game of Candyland and talking a little more before I had to leave.

So at the end of the day, the attending, fellow and I met up to discuss all the patients we'd seen. The attending especially wanted to know how my "therapy session" with the kid had gone. I talked about how I'd gotten the kid to talk about some stuff, but they still wouldn't talk about feelings. I talked about playing Candyland. Then I told the above story. And my attending leaned forward, folded her hands over her knee, and said, "And how did that make you feel?"

Well, that was all it took. Every single raw emotion from the preceding week came flooding back. Out came the tears that I'd managed to hold in until getting home on previous days, and I broke down sobbing right there in the Child Psychiatry office. At first I was horrified to have lost my cool like that, but the attending and fellow were both very nice and very understanding. Of course, they had me explain just what has made the rotation so difficult for me, and how I've been dealing with it, and "What are you going to do this weekend to take care of yourself?" All in all, I think it was really helpful to finally talk to one of my 'superiors' about how rough things have been. I can only hope that the next nine days I work don't cause total emotional burnout.

As you might have gathered from the last entry, I had a great weekend. casibeth came up from ATL for the weekend. I had a blast hanging out with her and giving her a little taste of Nashville! (Seriously... most of the weekend involved eating.) And then, of course, there was the concert Saturday night. I found it amusing that I got to hear two of the staples of the mediocre cover band from Flying Saucer trivia*. Needless to say, "Chasing Cars" is much better as performed by Snow Patrol, and "Yellow" is much better as performed by Coldplay.

*Recent upheaval in my life: as of two weeks ago, trivia no longer happens at the Flying Saucer. It's now at a different place with fewer beers on tap, more items on the menu, fewer waitstaff (longer waits for food), fewer people (no need to tablesave), and fewer mediocre cover bands. It's taking some getting used to.

Moving on, I'm now on my last rotation of third year, Child Psychiatry consults. The team consists of two attendings who work on alternate days, a first year fellow, and me. One of the attendings has been one of my small group leaders since day 3 of med school. (I have a distinct memory of her welcoming my Ecology group to Vandy, introducing herself, and then telling us "I'll be your Master Clinical Teacher when you're third years." Third year seemed so impossibly far away, I couldn't imagine why anyone would have us look ahead that far.) Anyway, it's great, because she really really knows me. It's not so great, because she really really knows me. As in, if I'm not on top of things tomorrow, she'll know darn well it's because I spent two hours at trivia tonight.

Highlights of last weekend...

Sunday morning, I went with 7 other people to Monell's, for family style, all-you-can-eat, down-home Southern breakfast. It was very tasty, but it wasn't really anything I couldn't get any time I wanted at home. Grits, eggs, bacon, sausage, and biscuits has pretty much been my default breakfast every single morning for my entire life. Seriously, when I was home for spring break this year, I had to warn my mom ahead of time when I didn't plan on eating that for breakfast. It has only been fairly recently that I've realized that not all my friends, even the Southern ones, have had similar upbringings. Now I'm not dissing Monell's, because I'm not at home now, and I'm certainly not cooking all that food for myself every day. I would definitely recommend it to people who aren't used to giant southern breakfasts. And I would bring my parents there, since they like to go out to eat at places with familiar foods.

On Memorial Day itself, I was mostly a waste of space. In the evening I went over to Centennial Park with Paige and Jo for a blues festival. It was an all day event, but we only saw the headliner-- Bobby Blue Bland. Or "Bobby Blue Bland and the Bobby Blue Bland Blues Band," as I said repeatedly throughout the day. That was probably annoying... anyway, my mom and most of her siblings love blues music, so I was quite familiar with Mr. Bland. I sent my mom a text message about the concert, and she texted back, "I am so jealous that is wrong i am the blue person in the family have fun". She's still working on punctuation, and capitalization, but she's getting better at the whole texting thing every day!! Also, she's apparently blue in color. I hadn't realized that.
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So at the end of the long weekend, I had more days off Psych than days I'd worked on the rotation. It kind of felt like the rotation only just got started this week. I really like it so far. Still trying to tease out whether that's because I actually enjoy psychiatry, or because I enjoy it when the resident says "Bye! See you tomorrow!" shortly after noon. Maybe a little bit of both.

High point: The other day, one of my patients told the attending, "I was feeling bad, but then I talked to Laquita and I feel a lot better now!" She pointed to me as she said this, so I feel pretty confident that I am in fact the Laquita she meant. That felt really good, and not just because my attending gave me a huge beaming smile and approving nod. However, I later realized that if that patient comes back to the hospital relapsed or, God forbid, post-overdose or suicide attempt, my heart would break into tiny pieces. Reason #1 why I don't think I'm cut out for a career in psychiatry.

Low point: I recently had a vivid nightmare about being shot in the face after a different patient discussed his previous suicide plans in exquisite detail. That pretty much ended all my future sleep plans for that night. Reason #2 I'm glad my resident let me go home early, and reason #2 I'm not a future psychiatrist. (Also reason #17894823934634832 why I might need to see a mental health professional myself.)

This morning, I got to hear a lecture on disclosing errors. The same lecture that I thought was so awesome on the first day of medical school orientation. The same lecture that I'm starting to have memorized after hearing it at least four more times before today. I NEED to do my residency at another institution, if only to save myself from a future in which I hear that exact same lecture seven more times!

Hello dear readers. My Psychiatry rotation is now underway. The biggest reason I'm excited about this is it's my LAST ROTATION OF THIRD YEAR!!! So far things are pretty chill, which is exactly what I hoped for when I asked to have Psych and Neuro as my last block of the year. My resident called me a gunner when he found out I had no plans to go out last night. He stood by that assessment even after I told him I had no plans because I was on call.

Even in such a relatively laid-back environment, I am tired of being a third year, with a capital T-I-R-E-D. I don't know what I'd do if I were on Surgery right now. On that rotation more than any other, I think I wasn't evaluated based on any actual knowledge, or even technical skill, but on how happy I looked to be there. Or how well I faked looking happy when I wasn't. I think this because I recently got my evaluation back, and some of the comments basically said just that. I get the feeling I would have been better off had I studied less and devoted more energy to being loud and enthusiastic. At least in January it took me four weeks to "look tired." Now, I'm sure I look tired at baseline.

Call last night was pretty good. The intern who was taking evening admissions didn't seem too enthusiastic to have me there, but the overnight PGY-2 was awesome. He gave me some really good tips on taking a psychiatric history, and did some teaching about all the various psych meds. When I left at 9, he thanked me for being willing to "do work and stay late." With a q25 call schedule, it's not hard. The next time I have call, the rotation (AND THIRD YEAR!!!!) will be nearing its end.