Excuse me, your issues are showing

The things that people say or the way people react can give you little clues about what their lives are like. Sure, it’s possible that our conclusions are totally untrue and come from baseless extrapolation, but I prefer to think of it as secret peepholes into other people’s issues. Here, have some vignettes:

1. In our pharmacology lecture one day, Professor P started talking about the mechanism of action of Viagra. This was probably our 2nd or 3rd time learning the mechanism of action of Viagra, since starting med school. For some “unknown” [sacasti-quotes] reason, the professors in med school really love talking about how Viagra works and why it’s awesome. But Professor P’s quote during lecture really was the best of the bunch. Paraphrased, he basically said something like [you have to think of this being said in a Tennesseean, Al Gore-esque accent]: “Now, as men get older, the reproductive equipment doesn’t work as well as it used to. And it’s not anybody’s fault, it just happens, and it’s perfectly natural and Viagra really gives those people that function back.” Of course, those of us sitting in the audience (well, those of us who are awake) are a bit taken aback, and kind of looking down at our notebooks thinking, Um, awk-ward…

2. Last week in a lecture on psychotherapy, Dr. D started telling us about what couples therapy is. He says, “You would not believe the number of couples who do not have sex.” We’re nodding our heads in understanding and writing notes. He continues, “You would. not. believe. They are in committed relationships and they are partners, but when the lights go out at night, [sound effect that basically means, "nothing"].” We’re still nodding our heads, and he says one last time, “So many people. So many.” Gotcha, Dr. D. A lot of people, even the people we would least suspect. Ahem.

3. This week, one of my patients slapped another patient in annoyance and anger. My patient is a 30-year-old, autistic and mildly mentally retarded man who doesn’t actually have a mental illness, just difficulty coping with his emotions and expressing his feelings. In a sequence of events that feels like gentle irony, I ended up being assigned to this patient to work with him on verbally expressing himself, and helping him deal with feeling emotions in a healthy manner. I KNOW, you guys are totally laughing at the idea of me doing that, right? It’s like the blind leading the blind, you guys. Anyway, we were doing just fine, until I started talking to him about the difference between an “acceptable touch” and an “unacceptable touch,” meaning that hitting people in unacceptable, but shaking hands or high fiving is acceptable. And my patient says that hugging is also an acceptable touch. My response was, “Sometimes we have to ask permission to hug, before we just give a hug.” He didn’t understand and kept asking, “But WHY?” Without really thinking (but definitely in mild tones, because this guy is so sensitive I have to be really careful), I said, “Well, not everybody likes being hugged.” And he gave me this sideline look and said, “Sue, I am gonna hug you one day.” I’m a dead woman walking, you guys.

I know kung-fu

This is my favorite story from my Internal Medicine rotation, and it didn’t even happen to me. But, the hilarity and the moral of the story make it worthwhile to pass around.

The paramedics and EMTs often drive around our parts of the city, responding to calls or just looking out for people in trouble. One very hot mid-morning in July, they brought in an 80-something-year-old Korean man who we will call Mr. Kim (I never actually knew his real name). The EMTs found Mr. Kim looking unkempt and disheveled, diaphoretic (sweating), and leaning against a really fancy-looking apartment building. They brought him into the hospital, thinking he had dementia and heat stroke or dehydration. He had no ID or wallet, just a pair of keys. He spoke no English, only Korean. While in the ER, he kept trying to get off his bed and leave the hospital, and all he could say in English was, “I teach kung-fu!” All the doctors and nurses and ER techs were like, “Whatever, silly demented Asian dude who keeps trying to leave the hospital and doesn’t know what’s good for him,” and slapped on some arm restraints to keep him stuck to the bed. So, all afternoon he was sitting cross-legged and strapped to his ER bed, telling anybody who would listen that he taught kung-fu, and pantomiming random kung-fu movements at passers-by.

Finally, one of the interns on a different team was down in the ER to pick up his own new patient, and looked over and said, “Hey! That’s Master Kim! He taught me kung-fu when I was a kid!” Everyone went, “FOR REAL?!” And the intern said, “Oh yeah, he’s really famous — he teaches at West Point and stuff like that. His kung-fu studio is nearby. And actually, I think his apartment is close to here, too, because I went there once as a kid when he had a big party for our class.” So, of course, everybody is freaking out because maybe he’s not so demented and not so silly and didn’t need to be rescued.

Cut to a few hours later, when Mr. Kim’s daughter comes into the ER in search of him. She’d been looking all over town for him when he didn’t show up for his afternoon class at the kung-fu studio. She had called our hospital’s ER, but we didn’t have him listed as a patient because we’d spelled his name in some ridiculous way (this is the same hospital that gave me a nametag that read “Sue Change,” so it is not so surprising). She came in anyway, because she figured a name difficulty might have come up.

And the truth? The truth was, he had been disheveled and sweaty because he had just finished teaching his morning kung-fu class. That really nice building he’d been leaning against was his own apartment building. He couldn’t tell us any addresses because he just walked every day from his apartment building to his kung-fu studio and back. He had been trying to leave because he knew he had an afternoon class to teach.

The only thing that made it slightly less embarrassing for us and the profession of medicine was that he really was dehydrated on a disgustingly hot and humid day, and really did have some dementia that had gotten him in some trouble before. His daughter was very understanding and nice and our ER department was really apologetic, but still.

What I love most about this story is that he didn’t need us at all, but that health care people, in an act of hubris, patronizingly took him to the hospital to “protect” him and dismissed his talking as rambling crazy talk. This will forever be known as the time we kidnapped a patient from in front of his own apartment building, then restrained him when he rightly kept trying to leave. Whoops.

Psych out!

This post comes to you from scenic Valhalla, New York. For my 6-week rotation in psychiatry, I have temporarily relocated back to Westchester. I’m living in a sublet at a friend’s off-campus apartment, about 10 minutes away from school and the psych hospital.

The psych hospital (technically, the Behavioral Health Center) is a separate building from the main hospital. It has its own ER, and 3 floors with 1-2 units each (for a total of 5 units). Since each adult unit can hold about 22 people, and each child & adolescent unit can hold about 16 people, that means the capacity of the hospital is approximately 98 people (not counting the ER, where people can supposedly languish for up to 3 days while waiting for a bed). That’s a pretty impressive number of people.

I am on unit B2, which is an adult unit. For good and bad, we do not rotate through different floors or units during our 6 weeks. Instead, the unit you get assigned to is the unit you stay with the entire team. Similarly, the two attending physicians you get at the beginning are the same ones for all 6 weeks. One of my attending physicians is Dr. D, the same person who ran the Behavioral Science course from my first year, and he’s now the clerkship director for the psychiatry rotation. This is… a mixed bag. On the one hand, I specifically chose this hospital to do my rotation because I’d learned so much during my first year. On the other hand, I really didn’t want to actually be on Dr. D’s unit — he expects a lot from his students. I didn’t want to directly work on his team — I just wanted to be adjacent to the team, and reap the benefits by being at his lectures. I mean, on the first day, Dr. D asked us what the definitions of psychosis and delusion were! The nerve! I don’t remember things I learned over a year and a half ago! I barely remember Internal Medicine, and that was 3 weeks ago! And now he expects us to read and learn and answer questions, God, I am so put upon. (Ha, now you all are hoping I don’t become your doctor in the future.)

So, obviously, the bad parts of being on Dr. D’s team have to do with being forced to learn and work, which is anathema to other students’ experiences on other psychiatry teams. The good part is that I will learn a lot of psychiatry. Dr. D truly loves his job, and basically spends those 6 weeks trying to convert people to psychiatry. Dr. D himself started out at an obstetrician/gynecologist, and then realized that he’d rather do psychiatry.

One point in favor of psychiatry? On Friday morning, we went to court! We had some patients who took us to court, to petition for release because they were being held involuntarily in the psych ward. Not to be mean, but some of the best times come from when patients prepare statements or speak out of turn, because then the judge gets to see just how RIDICULOUSLY CRAZY they are. For real, one of our patients prepared a long statement that started off with, “I am with the Israeli government. I am also with the CIA. I am a lawyer, and I taught special education for [redacted] County for 7 years.” The judge interrupted and said, “Wait a minute… the Israeli government and the CIA?” The patient said, “Yes.” And the judge, bless his heart, replied, “Okay.” The patient’s request to be released was, thankfully, not granted. Court was really, really interesting. It’s not so much that I love lawyers or confusing law-speak (sorry, Erika, but I do not), but rather that this specialty of health care interacts so much with other parts of the world. You have judges and lawyers and social workers and doctors and patients and their families and the police who maybe were called to the scene, all working together to try to help the patient. It’s enormously gratifying to be part of this overall plan, and not just work in a vacuum of the hospital, where we release our patients after they are mostly better and hope they continue to heal. I suspect, though, that the recidivism (is that even the right term? probably not) of our sicker patients is very high, and that this chronicity of mental illness would start to bring me down over the years.