Catch up

Here is my quick review of psychiatry - the hours are good, it is emotionally exhausting. Not for me! I couldn't possibly do something with good hours.

I did child psychiatry which was extra exhausting with its abnormal kids in abnormal situations. But it was probably the one chance I'll get to really watch the whole system at work - and break down in extravagant ways. And then sometimes work by sheer force of will of the people involved.

I am now on a 2 week independent study where I am trying to learn up on diabetes. Wednesday, I hung out with the dietitian and realized I really need to start cooking again. I think Huxley is almost independent enough to do so, but we're not quite there. Turing can definitely amuse himself for the 10 minutes it takes to chop something up. I realized the only time we all actually sit down at the same time to eat is when we go out (which is not very often - less than once a week). Instead, the kids get hungry and I put together things for them as they eat - so they start with some crackers or dried fruit while I put together noodles or eggs or soup or cut up fruit. And then while they are eating that, I put together my own meal - sometimes as complex as a sandwich and frozen vegetables. By the time I'm ready to eat, they're done eating.

I think I feel a new years resolution coming on.

I made for thanksgiving. It has been exactly one year since I baked a pie. I overcompensated and I made 4. Apple, apple and cranberry, lemon, and pumpkin. The fillings were great and the crust was not. It had been so long since I made crust that I made them far too dry to roll out well. Next time, I will do better. Especially if it is not in an entire year.

I need to figure out how to use my evening time better as I've totally developed a bad habit of spending all night surfing the internet. Some internet time is fine - I've got news to read and emails to write and stupid things to read - but the rest has got to stop. I need to do my yoga and cook something and if I actually just stepped away from the screen, I could probably even sew. Or study, but lets be realistic.

I will admit I've done a good job of staying focused at work. I don't screw around, I study when I have time, and I generally don't have to do a lot at home. So tough! And I've used my 3 hours per day per weekend day to get a paper turned around and do a silly little data analysis. This weekend, I'm going to review two papers (I'm such a sucker. I mean, good citizen) and write up a little document on my EEE about how I want to approach diabetes care.

Yoga would be good for me.

Being good

As a medical student, at the bottom of the heap of medical staff, I get a fair amount of time to watch the interaction of the other members of the team and think about team dynamics. And I've now been on enough teams that I've seen some that function really well and some that function really poorly. As such, here are Janel's list of four parts which are important in being an intern:
1. Knowing your medicine - know enough of the basics to get things covered as people walk in the door, know how to look up the more complex things you don't know, know when to ask for help. This is both the knowledge that the intern walks in the door with and how they pick up new information.
2. Knowing your patients. I actually don't mean "good rapore with patients" though that is separately important, it is not important in functioning with the medical team. I mean more knowing the history of [all] the patient's illnesses, both what happened before you meet the m and what happened during your care of them. I think of it as knowing the patient's narrative in detail - symptoms, lab values, procedures, diagnoses . . .
3. Organizing your time. There is a lot to do and there are a lot of intrusions, being able to prioritize and focus is essential.
4. Team player! Deligate, communicate, helpful. Trust people to do things, but then check that they got done right.

From my perspective, the people who are good (not necessarily excellent) at all four parts are excellent interns. You can also leverage excellence in part 1 or 2 if you aren't as strong in some other part to be a good intern. And the people who don't know the basics, can't remember details of care, are scattered, and insult the other members of the team? Terrifying.

First sole author paper

In press!

Damn, medical school would be so much easier without a family or research to do . . .

Reels

I have quite the collection of ID badges at this point - up to 4! I just clip them all together. I had been really against the idea of an ID badge reel, then I forgot my badge and key last week. One doesn't get very far in a Psych ward without an ID and key . . . so I used the you-forgot-your-stuff backup badge. It had a reel on it. It was awesome.

I've also learned other things. Like about my preconceptions. Since kids get referred to us, we hear a bit about their problems before they show up. Then my brain generates what it thinks they will look like. They are invariably better dressed and much easier to interact with than I expect. Despite having just tried to kill themselves or that they know other people's thoughts about wanting to stab them or whatever.

I also know that emotional boundaries come with time, but I'm ready now. This is very differently exhausting.

Asus Eee

I dropped my palm a couple of times. Then it finally broke. I had used it for a few things, but it had not become the indispensable attachment I had presumed it would be in medical school. But I have also not become indispensable as I'm still learning the basics. The palm is much better at looking up specific details. The screen is really tiny for scanning large volumes of information and the search functions are really slow. In any case, it broke and then I had to decide if I was going to get another one. And I realized how stupidly expensive they are for what they are.

I don't think I need a smartphone despite the incentive of getting a cheaper device. I don't need a phone which means it would be more expensive by the time I was done. Though I sometimes get irritated that Trouble has essentially stolen my phone since he got rid of his iphone. Mine! Despite not really needing it.

What I wanted was a DS sized computer. With a real keyboard and wireless, so i could just look things up that I need to be looking up. And most of those good palm programs I use have better web interfaces.

I spoke my dream to Trouble and poof, it happened. I had all this talk about how I was going to wait for Xmas, but after thinking about it for more than a day I wanted it Right Now. So, no Xmas gift for me. Trouble did some dealin' and found it for far cheaper than a new palm with enough oomph to run what I need.

It turns out to be pretty awesome. I got the 9inch screen. The keyboard is 82% sized and is taking me a little while to figure out, but far faster than entering info on the palm. After a few days of use, I'm only making about 2 times as many errors as I usually do by touch typing. It runs XP, it connects to the internet, it starts up pretty darn fast, it does not get hot in my lap, it has a solid state hard drive so might survive me dropping it as I run across the hospital. I wouldn't go so far as to call it pocket-sized . . . but that doesn't matter as my professional cloths do not involve any pockets (it sucks to be a girl with hips, life is soooo hard), but should fit easily into the pocket of my white coat. It is perfect for what I need, except that I was too cheap to buy the sexy slim one.

How long have I known you?

A fourth year student recommended writing up a summary of the rotations we finish as we finish them so that, when we apply for the next thing next year, we have a clue what we were thinking and why. This is all good and something I am good at. But I've now been around Trouble for so long that such an activity is not labeled as "journaling" in my head but as "postmortem" which is a good example of how some terminology does not cross disciplines well.

In other postmortem news, I have yet to see someone die. I've seen plenty of people who are about to die and are sent out to hospice and whatnot, but not in the hospital. There was also a distinct lack of codes to run to since something [handwaving] has been restructured in the last 5 years. 5 years ago, I saw 3 codes in 3 weeks. This year, I saw 0 codes in 8 weeks.

Now I'm on inpatient psych for which the mortality rate should also be low. I'm on child psych. Which is, as expected, a lot of eating disorders (girls) and suicidal ideation (girls and boys) and aggressive behavior (boys). And dysfunctional families. And, as expected, it is interesting but not really my thing.

And what is my thing? Perhaps the ward work. I liked the pace and the place and the thinking. The year is young, though, so no decisions.