Monthly Archives: August 2015

Psych Rotation, how my own well-being improved and why that speaks to the medical profession

Third year of med school can be a grind: Long, relentless hours. No time to study, let alone take care of yourself. Rotations that just keep coming with nothing but a “golden”, rotation-free weekend in between. That is, until you get to your psychiatry rotation. Some have even called it psych-cation. So is the psychiatry rotation the vacation of 3rd year?

The answer is…not quite, but close. In comparison to inpatient medicine and my neurology clerkships, psych has been a welcome change of pace. My hours are 8 am to 5 pm, with a workload that can include maybe 2 or 3 new patients a day. I am currently on psych consult service, meaning I get called when a psychiatric patient comes through the ED doors or a hospitalized patient requires a psychiatric evaluation. As you can imagine, patient loads can ebb and flow. For unknown reasons, psych patients rarely show up at 7am to the Emergency Department, but combine a full-moon, a pleasant Friday night and our service can get pretty busy.

Being able to sleep 8 hours at night and come home around 5pm with enough energy to go on a nice jog has done wonders for my mood and my marriage. Because we have lulls throughout the day I can get my studying in while I am on service and that leaves my evenings free to do something I haven’t done since 3rd year began…relax. My husband is shocked to suddenly have me hanging around the house with free time. I’ve been so busy previously, his go-to answer anytime our friends call was “Maja is at the hospital.” Now, here I am asking if he’s up for a movie or binge watching TV shows–on a Tuesday night!

On a personal level, having this extra time to re-connect, even if for just a few hours a night is super important. I find us laughing more, talking about meaningful things (you know, going beyond the logistics of who is making dinner) and waking up smiling. So without trying, my psych rotation is improving my marriage and mental and physical health.

The hours of 3rd year had began taking their toll on my health by making me too tired to work-out. It turns out walking around the hospital and eating free cookies do not make a healthy routine. And de-conditioning is pretty much the worst thing you can do for POTS. Sorry folks, nothing can replace the heart benefits of a good cardio work-out. Luckily, I am back at it, logging some miles with my running shoes.

It wasn’t until I had time to slow down that I looked back to notice the unsustainable pace I was moving at. Of course when you have the time it’s easy to say here’s all the things I need to be doing to stay healthy– it’s when you are in the thick of it, sleeping 5 hours, feeling overworked and burnt out that your focus turns simply to surviving–who has time for the other stuff? So therein lies the dilemma.

My hope is that all the healthy choices I’ve been making in the last 2 weeks will continue as I move into my Ob/gyn rotation…at least those are my intentions. This slow down in my schedule has got me thinking a lot about how exhausting the other weeks felt at times. As a medical student we are lucky in the sense that those hours are fleeting and we can move on to more humane rotations (enter Psych). But as a resident those hours– the daily grind– it becomes your life.

For decades medicine has asked of us to become super-humans. The humans who need only a few hours of sleep, who can see the worst in people, who can face death and tragedy, who look in the face of hopeless situations and “fix them”, who can continue to log work hours when others are at home with their family….all with a smile and understanding heart. Thankfully my generation is seeing the ridiculousness of the above, no one can be that superhuman indefinitely–not without a cost. I won’t go into the depressing statistics of physician depression and suicide, or the abysmally low satisfaction rates. All I know is that a culture shift is way over due.

I don’t have the answer but I do hope that we can incorporate more balance into our profession. After all, physicians who are healthy and happy are more empathetic, productive and innovative, and more likely to stay in the field (just look at this wonderful research Stanford is doing). Somehow we must find a way to sustain the enthusiasm and dedication seen in medical students throughout our careers. The future of our field depends on it.

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Kids as Patients vs Brain Surgery

I’m wrapping up my Neurology rotation with 2 weeks at a children’s hospital–aside from having (mainly) adorable patients here is a list of things that have made this service particularly awesome. If you go to my school this list of “perks” may help you decide when picking between peds neuro, neuro surgery or ICU care.

  1. The hospital is colorful. Like seriously, there is a theme to every floor. You can’t help but smile when even the architecture of the building has color in mind. It is also a brand new hospital so everything is very modern.
  2. Parking is free. FREE!
  3. Parking is close! (when you savor every minute of sleep you can get, saving yourself 5 minutes of walk time is worth its weight in gold).
  4. Breakfast is free! The food is amazing with fresh fruit, pastries, yogurt parfaits, bagels, coffee. When you are a poor med student you can be easily swayed by the little things in life like starting your day with a full-healthyish- stomach.
  5. Lunch is free! I can’t rave as much about the lunch, but I will say it is 100% better than any of the other free lunches at other hospitals. It is always catered, so if you are not a vegetarian like me, you’ll probably love it.
  6. The electronic medical record is easily one of the best choices around. Super easy to look up stuff.
  7. The residents are super nice.
  8. The attendings are super nice.
  9. The patients are hilarious. Case in point, I was trying to examine my first little patient of the day and he looks at me and says “excuse me, you are interrupting my cartoons.” Absolutely the cutest.
  10. You have NICU patients. The tiniest, sweetest, humans around.
  11. The hours are very tolerable. Typically I start my day around 7:20 am so I have time to see my old patients and read briefly about any new ones I will be picking up. You have morning report (free breakfast!) at 8 am, which includes an hour discussion about one particularly interesting case and the teaching points involved. Followed by time to see and examine your new patient before rounds start around 9:45am. Rounds typically wrap up by noon lecture (free lunch!) followed by time to write your notes, check in on your patients before you head over to the main medical center for afternoon lecture at 4pm. You are free to go home after that, which is usually either 5pm or 6pm.
  12. Being able to put parents at ease is very gratifying. It feels tremendous when you can send a child home and they are all better.
  13. This hospital sees some of the rarest childhood illnesses you’ll come across. In one week I’ve already seen two cases of Guillane-Barre (overall incidence of 1 to 2 per 100,000 per year). You are guaranteed to learn a tremendous amount. The cases are all very interesting.

Now to the alternative….instead of peds neuro you have the choice of picking either neuro surgery or neuro ICU care. I was able to get a glimpse of the high of neurosurgery while on-call one night. This was the first time I’ve ever scrubbed for a case and it will easily be a memory that stays with me for a lifetime. The excitement of being in an OR is hard to describe. Furthermore, being in the OR when emergency neurosurgery is involved is like putting that excitement on steroids. Few things in life are as surreal as looking down on a human brain. The whole time I was standing in that OR I just kept thinking to myself how lucky I am that I am in this profession and have the absolute privilege of being in this room right now. The whole world disappears when you have surgical tools in your hands and get to watch someone literally fixing the human body. Of course, as thrilling as that experience is, picking neuro surgery as your elective comes with a price. You will have exhausting hours (think 5am start times), high stress, high pressure–yet all that comes with the prize of being in the OR. So choose carefully.

My favorite part of my neurology experience has been the camaraderie with my team. Everyone has been so eager to teach and learn. I’ve enjoyed all my co-workers. Actually, maybe I just miss having co-workers. Being in school full time was certainly an adjustment. Now I get to have a little bit of that feeling back of what it’s like to be around people you work with! Although I don’t get a paycheck, and the teams change all the time, it is nice to feel like I am working again.

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Brain Attack! and other Neuro adventures

Beep, beep… beep, beep….ahh the sound of the stroke code pager. It has its own distinct ring tone and whenever that pager goes off you can’t help but get a rush of adrenaline. Time is now a precious commodity. It is the only thing standing between intervention and inaction for our stroke patient. It doesn’t matter where we are, you drop everything and run. NIH stroke scale in hand, we burst through the doors of the ED with a singular mission–determine if this patient is eligible for TPA. The clot busting thrombolytic (TPA) can be life altering if given within 3.5 hours of onset of symptoms.

I’ve spent the last two weeks on the neurology stroke service. It is fast paced and full of heart break mixed with moments of joy. When someone presents to the emergency room with stroke symptoms, often paralysis of half their body, or slurred speech and drooping face a “brain attack” or stroke code is called. The stroke team arrives within minutes and is responsible for figuring out 1) is this person having a stroke and what kind (ischemic vs hemorrhagic) 2) when their symptoms started 3) and are they eligible to receive TPA–currently the patient’s best shot at regaining function.

The saying “time is brain” has been ingrained in my head. With every minute that passes a crucial window is quickly closing. With so much riding on finding out the correct “last known well” you start to feel like a detective. The stroke team usually divides up the tasks with someone doing a complete neurological exam to find out the patient’s NIH Stroke Scale number, while other members of the team work on getting the whole story. It may sound easy but when a patient arrives in the ED without family and is too altered to answer your questions you have to start digging…this includes calling people in their cell phone, co-workers, and anyone else who might have spent time with them before their symptoms started. Team work is crucial. We all rush to gather the most information we can to make the best clinical decision for the patient.

The highlight of the rotation was seeing TPA delivered and then having the patient improve right in front of your eyes. Yes, these times are rare but so rewarding when they happen. It is also crushing when a patient is either out of the treatment window or has some of the TPA contraindications and we can’t treat. At that time all we can do is prevent another stroke from happening again…often not enough when our patient now has devastating deficits. TPA is certainly not without its dangerous risks but it is among the only things we can offer.

I’ve gained a huge appreciation for stroke prevention. The best thing we can do for our patients is optimize their preventative medications and lifestyle. The tragic consequences of uncontrolled high blood pressure or high cholesterol are a lifetime of disability. Stroke is the number one cause of disability in the US, and the number 5 cause of mortality. Seeing our patients struggle to learn how to move, talk or walk again has made me feel so thankful for all the things I am able to do that I take for granted. The last two weeks have been incredibly humbling.

When I first started neurology I really didn’t it like, mainly because the brain is so complicated and it didn’t come as easy to me as other subjects. When you have to work to understand something often our initial reaction is simply to say eh, I hate this. But I have to say, I’ve learned a tremendous amount in a short amount of time and I am starting to come around on the topic. One of the main perks of spending 12 hours a day somewhere is that you learn a lot quickly! The rotation is fairly comparable to inpatient medicine in terms of hours, usually I am there 6:30 am to 6:30 pm. However, I am no longer fazed by 12 hour days, they seem pretty normal in fact. Perhaps the best “perk” is having 3 out of 4 weekends off!

I’ve had a lot of very sad cases these last two weeks so I’ll end this post by saying be kind to your body. Watch your diet, get some exercise and find a good family doctor who is interested in helping you prevent disease. Also, never forget “time is brain”–if you even suspect someone is having a stroke get them to the ER as quickly as possible. The stroke team will be waiting.

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