Jun 28, 2009

Outpatient clinic

Just finished three days of that... well, not today, more like Friday.

In psych, we do 6 weeks total, and the vast majority of that is at Manhattan Psych, which is an inpatient facility. Three days of the rotation; however, is at the outpatient clinic in Harlem, aka, right down the street from the Apollo, which is cool. Should have gone over there, but ended up wandering into H&M instead, and spent the evening at Arlene's Grocery over in the Lower East Side, the LES being "where I spend most of my time when I'm not at the hospital". My roommate's love of LES got me hooked and the music kept me going. So far it's delivered two fantastic live music venues, a 'burlesque' show that... uhhh... well, has a serious case of Glen or Glenda, a hookah bar, good food that isn't hideously overpriced, and so on.

Today, I caught a ride to and from Jersey to a wedding party, which was fantastic. I got to see the "Garden State" part of Jersey with winding green pastures going up through increasingly dense forests to arrive at a sprawling beautiful property with a salt water pool... and an open bar... and bbq. The bride is one of my sister Tori Amos fans and presented me with both the cd I'd lent her, and a jacket from Scarlet's Walk, which means if we're the same blood type, she's owed a kidney. I think I already owe someone else my other kidney, so if both collect at the same time, I'm going to be in some serious trouble.

But, going back to psych, because what continuity? Uhhh... outpatient clinic was interesting, but not interesting in the same sense as the acute psych ward is, which was not unexpected, which is why I spent part of Tuesday sulking that I had to spend the rest of the week doing outpatient. Then I remembered that since the outpatient clinic is in Harlem, that means not having to take the Ward Island bus, which means I got to avoid things like people that stare fixedly at you for forty minutes saying "Your skirt's chocolate brown. You like chocolate brown? Melts in your mouth, not in your hand... chocolate brown... yeah.." Fantastic.

Why are there weirder people on the buses than on the subways? Well, usually.

Being at the outpatient clinic also means we spent quite a bit of time between patients no-showing and such reading charts... which sounds uninteresting until the backstory on some of the patients is revealed, which is kind of like watching true crime shows. Even saw two charts for a serious case of folie a deux, which sadly, I know about because of the X-Files. This dorkitron knowledge bank did not start with House, nor will it likely end there.

Jun 18, 2009

Staying in tonight

At long last...

Sooo the stuff they say about the psych rotation is pretty true. I'm actually learning a lot, but it is still pretty much like being on vacation, particularly since it's my first rotation and I just got my loan check.

But where was I. Ummm... whew, awesome parties; awesome clubs; awesome bars; awesome restaurants; awesome sites; awesome free Fridays at MoMA; awesome friends; awesome experiences.

That sounds about right. But you people may actually want to know something about what I've been doing school wise.

I'm getting more comfortable in the psych hospital environment. I'm getting to know the patients on my floor and which ones are pretty benign and which ones it's a good idea to make sure I'm standing behind a nurse if I talk to them. Today, due to the rain and a bit too late of a hookah night, I walked in a few minutes late. My patient says "OOOOOOOOH, you gonna get fired! You late!" She then tells me I should have my hair in a ponytail and tries to sculpt it into one. Then, as I was being let into the morning meeting, she yelled "SHE LATE AGAIN!!!" over my head, to the staff's amusement.

There's a new patient who's apparently King Allah and a kung fu master. He's got crazy eyes. I'm looking forward to that transition.

The nearly catatonic man is actually making demands, claiming he wants to see the doctor because the man talking to him is "just a nurse", and upping his activities. The staff refers to this as "You woke him up; you fix him".

It's cool stuff. Nearly every day, our doctor gives us an assignment to read from the Blueprints Psych book, so we present, and then he gives us about an hour lecture on whatever the topic is. He's not a big fan of personality disorders, so the psychologist borrowed us yesterday as none of us had anything to do, so we got a close on personal contact on all the Cluster A, B, and C disorders, complete with him doing imitations of the patients. I really like the people at this hospital.

Oh, though there's one medical doctor that's after anyone with small obnoxious habits, so naturally I'm patient zero. He's grabbed my wrist once (I was playing with my watch band), my pen once (no bad habits in front of the patients!), and the psychologist's pen twice. Noooo idea.

We have some lectures; some of them are really good and helpful; some less so. They also have grand rounds and case conferences that a ton of people in the hospital attend, so I've been to a bunch of those. I've been up to the treatment mall to watch some of the patients' classes. We learned about some famous people that had gone through the program as well as the profiles of a few of the more... uhh... criminally memorable people in Kirby.

So no complaints! In my non hospital time, I've pretty much been finding a new venue every night, but tonight I needed a night off to catch up on sleep.

Jun 13, 2009

Favorite conversation of the week

Staff member, referencing a patient that keeps acting out and getting sent back to our floor: "What's wrong with this guy?"

Doctor: "He's an asshole."

Staff member: "Is that an Axis II diagnosis?"

Doctor: "It's Axis 6. He's an asshole."

Jun 7, 2009

No more stupid flu

And on a related note, I'm so in love with sudafed and Mexican sweet chili tea that it elates me. Pretty much, I spent Friday aching, sleeping, lying in front of the tv, and feeling sorry for myself. Saturday, since our porch is inexplicably leaking onto the falafel place, I got to watch them send people up through our apartment for like three hours, but then felt okay health-wise. Sniffly, but nothing my friends sudafed and tea couldn't handle!

I found a B&N in Park Slope and was able to reserve two of the Blueprints books at it, and when I went over, found the other ones, so now I have the complete series for the cores, plus the Pharmacopoeia. Okay, the latter is 15 dollars, and the thing is the size of a fast food calorie guide. I know it's absolutely wonderful and essential and all that good stuff, but come freaking on. I thought these things were a drug company handout. Are they destroying *all* the perks?

So that venture was hideously expensive, but wound up with me finally getting the B&N membership because it made things cheaper. When I got back, I signed up for the full year USMLEWorld for the step 2 CK, because I figured it would help focus my direction of study for the cores and make sure I know the questions in and out, especially with drugs, where I'm weak.

This all resulted in me spending on study supplies nearly what I spend for a month's rent. So I bought myself a pair of Italian sandals because... I mean, come on. And they were on sale. The books were not.

Ended up heading over to the East Village with Lori for good and pricey Mexican food complete with homemade cheese, followed by live jazz at a place a few doors down.

New Yorkers don't seem to really care how other people dress, which is awesome for me since I have no fashion sense and no money (though I'm waking up latent shopping instincts I've never seen except when I shop for scuba gear), but I discovered the benefit to dressing in those cute little cocktail dresses every woman in the city has rather than the jeans I was kicking it in... people think you work at the restaurants. I got asked when I was walking back to the bathroom and was just "Uhh... no, just passing through."

Which, since NYC is expensive, might be helpful in picking up tips. Also, since a lot of these places charge 7 bucks for a Brooklyn lager, which I can get in 6 pack form at TJs for 8 bucks, I stand to make 34 dollars worth of profit sans tip. Hmmm...

Eh, prolly illegal.

Park Slope has some great brunch deals (like 4 dollar all you can drink sangria, which is a *great* idea), so did that with a big group this morning, followed by climbing up someone's fire escape to a HUGE roof space connecting all the apartments. Cue Dick van Dyke impressions.

Tomorrow, back to the hospital to present my SOAP notes and hope clinical skills has prepared me well. Problem is, the SOAP notes we did for physiology were pretty different, plus relied on a medical history (not psych) that was written up, not gained from an interview. The write ups we did for clinical skills were ridiculously long and involved questions that annoyed the doctors and made a patient interview take 45 minutes on a simple and focused procedure.

We'll see how it goes.

Jun 5, 2009


So I have the stupid flu. I don't know whether I have the stupid *swine* flu, but death doesn't seem too imminent, so I'm not all that worried, though it did mean missing a day of my psych rotation because I woke up feeling like I'd been beaten and the perpetrator had stuffed all my head holes with dead jellyfish.

Weirdly, due to the surprisingly interesting nature of this rotation, I'm less worried about my grade and more irritated that the new admit to our ward had promised some really interesting fireworks today, and I had to miss them because I was lying in bed or in front of our new (LCD!) tv playing the "drastically varying temperature" game with my fever.

Psych is... hmm... I can't say I want to go into it as a specialty because there's too many hopeless cases, and for criminal psych, I don't like people with antisocial personality disorder (who does?), but I can say the rotation is proving way more elucidating and fun that I ever expected. Nearly every day that I'm there gives me some new "holy crap, this patient..." story, and our attending is really good. He's a really good instructor and likes to give us sort of mini assignments rather than just pimping us, and then focuses a specific lecture around it the next day, largely geared toward the boards, but illustrating examples with memorable patients we've seen during rounds.

So never forgetting what schizoaffective, bipolar type looks like. It's uh... memorable.

The deal is that there are eight of us assigned to the hospital (up off Harlem, so kind of a gnarly commute from Brooklyn), and then we're split off into twos and assigned to different wards. My cohort and I had the good luck of being assigned to the acute psych ward, which gives up the weirdest cases and the best excuses for being late to lecture "sorry we're late, there was a woman blocking the door that was trying to grab us while calling one of the doctors many varieties of MF, and it took a minute to get her out of the way because everyone else on the ward was getting an extremely noncompliant patient down the hall so she wouldn't kick the social worker halfway across the room again."

It's a good program though, but the patient population frequently is from a criminal background and extremely difficult cases, so the rehab can be hard, but they have a whole series of classrooms in the upper part of the building called the "Mall" where patients are expected to report for classes that can teach them anything from art to activities of daily living, the latter of which has a kitchen to learn how to cook, a room they have to clean, lessons on how to apply for an apartment lease and how to open a bank account, so the ones that can eventually be discharged are able to function in society through a variety of community outreach programs, which is cool.

It also helps stimulate their minds, even for the patients that do need extensive inpatient care, and most of them really seem to look forward to it, so you don't get that "screaming in a tiny room at the walls all day every day" thing we saw in Grenada.

It's weird; because the hospital is such a "last resort" place, people keep asking us if we're surprised by it. I say considering what we saw at Mount Gay, it was surprising in a good way.

I think we are getting the chill rotation though, and our attending is particularly chill, so the hours are good, thus last Wednesday, after getting off at 3, we all met for the pre-Happy Hour in Manhattan, which was quite cool.

Oh, I'm going to have to turn in my first patient write up, which makes for interesting reading, since the patient goes extreme flight-of-ideas mode, so my write up included looking up what on earth ma'afa meant, as well as the word "bullshit", just like that, in quotes.

So, so far (except for the flu), I'm really enjoying NY and I'm really enjoying the rotation.