mental exhaustion

today, one of our more vocal psychotic manic ladies was muttering, "no feelings, no feelings! they don't allow you to have feelings in this place..." as i walked out the door. she was looking at the mirror and doing her little jerky dance of madness as she said it, but i felt like she was talking to me. but now, for a short while, i'd like to share some of the feelings that i normally have to suppress in order to get through the day.

inpatient psychiatry is... challenging. we see the sickest of the mentally ill, and it ain't pretty. most of the rules of medicine and inpatient care that i've learned last year and in med school don't apply. patients' histories and diagnoses are often a mystery. most of them DON'T want to be there, and tell you so- over, and over, and over again with varying degrees of hostility. they also don't want to take medications, which is usually what landed them in the hospital in the first place. so, as you can guess, patients who don't want to be there and don't want your stinking meds also aren't interested in building a therapeutic alliance, or in giving you more insight into their psyche. they just want out, and I'M the one standing in their way. how do they know this? because i'm the one who has to go to their court hearings and testify about how they're unable to take care of themselves because of their mental illness... which means that they need to stay longer and take those goshdarn meds. some of the patients have gotten past the anger and are just there, waiting, until we can find a place for them, which depends on funding and just how crazy they seem because i have yet to hear of a living facility for mentally ill that wants mentally ill patients... then there's the scariness of it all- potentially unpredictable, crazy patients who could lash out in violence. i've already gotten over the verbal lashings- my favorite printable name that i've been called thus far has been "psych witch".

so how do we get through all this? how do i cope... well, it helps that my time there is limited- only a few more months, then i'm done. it's really important to use my sense of humor- to chuckle when my previously very sick, manic psychotic lady calls her even more manic and psychotic roommate "nuts". to smile when the very scary stocky pacific-islander male patient who mumbles to himself and stares me down suddenly breaks into song and starts doing the hula to "pearly shells". i've heard that the friday night dance is pretty amusing- the recreational department turns on some hip hop and lets the patients get down with their bad selves. sugar is also a temporizing measure- my fellow resident stocked his desk with jelly beans, which never fail to uplift (briefly) on a tough day. and i talk it out- to my co-residents, my husband, to anyone who will listen... or read ;)

but it is tough, even if the hours aren't bad, because i feel so drained most days. forget about working out- i'm pretty happy if i put some dinner on the table and do a few loads of laundry. my reading selections from the library have gotten progressively fluffier. they say it gets easier, and it's certainly better now than it was the first week... so i continue to hope that things will get better- and not at the expense of my optimism/idealism.

.... and i'm spent.

that's enough uploading for the month.

my pet peeve of the week: people who expect respect because of a title. respect is earned, and is not correlated to the grouping of words (or letters) following your name. argh.

oh joy and happiness- love, LOVE our new FP/Psych interns. and ridiculously happy that betza has joined me on this long, crazy journey that is our 5-year residency. yay for great comrades-in-arms.

totally did NOT love my first week at our inpatient psych ward, but i'm slowly getting used to the barely organized chaos. one thing i'm not getting used to- teaching med students. you'd think this would come easily, after all i was JUST a med student, so i should know what was helpful and what was not. you know, like i used to tell myself when i was a kid that i would never be one of those adults that "didn't get" children because i would always always remember what it was like... but no. sigh... i may not be able to teach much, but at the least i'm hoping that they have a great experience with psychiatry, to encourage a little empathy for the extremely mentally ill.

alright, enough blogging. time to whip up some grub for the hubby, who's now on internal medicine (as a SENIOR, craaazy) and working late most days. and then, off to bed early to recover some hours of precious sleep lost last night while on call- *sigh*... only 4 more years of call to go :P

potpourri of pictorial randomness

you know the thing about waterproof cameras? you never finish them, so they stick around for ages and then when you finally develop them (if you develop them) the pics have this grainy, ancient look- BUT i had to share these pics of our honeymoon!! check out the turtle!!! ... yes, i'm very excited... as we kayaked around, there were turtles all over the place but i was so afraid we wouldn't get a nice underwater pic. anyhoo, i'm definitely looking forward to some more watersport fun on our next trip to hawaii, this october.

my bro graduated!! some pics from the happy event... i was retarded and left my digital camera behind, so these are from an old-fashioned disposable. what can i say, i have a soft spot for the old school.

rafting, moi??

i rafted down the american river the other week... and survived. this was an awesome opportunity set up by alvin for our housestaff- man, it was fun. it was seriously great to try something NEW and potentially risky, if for no other reason than to push my normally risk-averse boundaries a bit. my Michigan visor was sacrificed to the river gods, but in return i think i regained some of that ole adventurous spirit that i've been mourning this year.

here are some pics of the group, signing forms before the trip, then happily grouped together for a picnic lunch. also, joby and shomir picking wild blackberries for dessert.

ACTION PICS!!!

and the view from one of the quiet portions of the river.

summer shenanigans

despite weeks of neglect and intermittent guilty (over)watering... we have our first tomato.

and now, a pictorial spread of some of the reasons why i'm so surprised our tomatoes are growing... june and july have been busy months for us.

above, the oh family (jason and sharon) battling it out with air hockey (p.s. she won, 7-0)... and below that, the reason why we were fortunate enough to have a reunion- sharon and david's wedding!

andy was charged with creating the slideshow for his program's graduation, along with cathy- one of his classmates, pictured above previewing the slideshow anxiously before the guests all arrived. thankfully, the long nights of editing paid off and the slideshow went off without a hitch. and, the culmination of one year's work- andy's intern certificate. moonlighting, here we come!

this was a wonderful treat- tim, one of andy's attendings, invited us to an argentinian dinner, which was sponsored as a school fundraiser at someone's beautiful land park home. we had gourmet eats, watched a little argentinian tango demonstration, listened to good music, and enjoyed a lovely summer evening outside.

summer may never be the same again, now that it doesn't mean three months of blissful vacation, but thanks to friends and family... summer is still pretty darn great.

time flies

the morning coolness that usually greets me on my walk to work from my car has been replaced by a foreboding warmth... another sacramento summer. already?! this year has gone by ridiculously quickly, though i suppose almost all chunks of time probably seem that way in hindsight. it's totally surreal though, planning for orientation events for the INCOMING interns... not to mention other life events, like the class of '08 LLUSOM graduation that we were fortunate enough to attend (no pics tho, forgot our camera :P) or my brother's upcoming college graduation, and of course- sharon and david's wedding?!! i can only imagine what the next "school year" will bring.

i started intern year at the VA on a substance abuse rotation, waiting in my little office for mentally ill and substance-abusing veterans to show up for their appointments... and it's also how i will end my *first* intern year. gotta love the VA, when i'm on a psych rotation that is... a nice, chill, outpatient rotation. it's definitely been nice to have some time to reflect on what i've learned, and what more i need to do to become the kind of physician i want to be- needless to say, there's a LOT. i'm starting to think that 5 years, though long, may barely be enough to time to learn what i want to learn.

but enough about work... here's what has been occupying some of my newly found time on this psych rotation: PHOTOBOOKS!! we recently got the digital copies of our wedding pics, which just happened to coincide with a promotion on mypublisher photobooks for costco members... anyhoo, we got a little carried away and created essentially copies of my original wedding album for our parents (though not as photoshopped and glorious as our original from the inimitable joe latter), then decided to make a "behind the scenes" album with cool "candid" shots, then decided- hey what the heck, we'll just make an album with "our story" including the engagement stuff and everything that followed, ending with the honeymoon. our books are currently on their way, so we'll see if it was ultimately worth it, but i was thinking... you know, i rarely print out my digital pictures and put them in an album, so why not create these books (especially at a reasonable price) for posterity?? anyhoo, feel free to click on the links for previews of the books i created... i hope you enjoy!

another subject that has been on my mind recently, now that i have time to think about it, is our lifestyle- namely, how unhealthy it has become. seriously, who knew it would be this hard to exercise regularly and eat healthily?! i was horrified to realize, looking back on this year, that we've basically adopted the "typical" poor family's diet- high in carbs, frozen foods, quick meals, eating out, ordering in... it's ugly. and the degree of my deconditioning is even more horrifying- just last year, i was running several miles without a second thought... now?! well, my waistline and extreme shortness of breath with ANY exertion are testament to the fact that it's been waaaaaay too long since i've done any sort of regular exercise. and irony of all ironies, my poor hubby- whom i've tried to fatten up since we started dating- has either maintained or lost some weight... which i blame on his inpatient medicine months, when i wasn't able to feed him properly :( in any case, i'm determined to make some kind of change- i've given myself some leniency this year, because it's "intern year" and it's supposed to be arduous and time-consuming, etc... but i cannot go two years without reclaiming the kind of lifestyle i want to maintain! so, here's a belated new year's resolution... or rather, a new "school year" resolution: LIVE THE WAY I WANT TO LIVE IN THE FUTURE... i.e. tasty but healthy diet, REGULAR physical activity, good sleep, etc. we'll see how it goes...

weekend warriors

it's pretty rare that andy and i get a weekend off together- one of us is almost always on call, or on an inpatient rotation that is q4, or we only get one day off a week... we're interns. so, when we DO get weekends off, we've been trying to make the most of them.

amazingly, while i was on micu, i was able to spend my days off doing OUTDOOR activities (though you wouldn't be able to tell from my as-of-yet pasty white & flabby physique). here are some pics stolen from Tara's blog (THANKS TARA! hehe) from one lovely weekend day spent outdoors with family med/psych friends playing soccer, ultimate frisbee, and bocce ball. twas the weekend diane came up for an interview, actually, and i'd managed to convince youn and suzie to visit from the bay area as well; all in all, a GOOD DAY of catching up with friends old & new.

then, one weekend we decided to finally visit Napa... and found that there isn't all that much to do if you're a nondrinker :P sure, we could have visited the vineyards and done some tours, whatnot... instead, we decided to visit Copia- this museum-ish institution with herb gardens and exhibits and (of course) free wine tastings, which appears to have been heavily inspired by Julia Child. we spent the rest of the afternoon... eating, basically. sampled some tasty baked treats from model bakery, wandered through the oxbow market; enjoyed live jazz music during dinner @ Uva Trattoria Italiana, then headed home... totally stuffed, and with a little "seed" of an idea (if you will)...

after wandering through the fragrant herb gardens, we were inspired... the parks are going to try their hand at GARDENING. so, on another weekend, we went on a field trip.

several home & garden stores and a couple of hours of good ole sweaty soil-shoveling later, we have our very own garden- complete with Park's Whopper tomatoes :)

here's a little random note from our friendly neighborhood postman. a little while ago, andy and i were at the post office. now, this is the kind of post office where people go up to the window and actually have a conversation with the post-people. conversations that indicate that they know each other. totally unexpected, but really nice- a small-town feel in a medium-sized city. anyhoo, so our postman gives us our stamps or whatever, then starts asking us about our lives- somehow, we mention loma linda, and he mentions some old neighbors who were SDA missionaries, how he and his wife celebrate "day-versaries", and all the while is scribbling something on a paper...
<----- random, but lovely.

speaking of random, on the way home from church one day, we noticed this sign. wouldn't you like to live down memory lane? :)






so this tuesday is our ONE YEAR ANNIVERSARY. totally crazy how quickly this year has gone by... must be the wedded bliss overpowering the intern pain :) to celebrate, the hubby and i went to SF for a quick weekend getaway... if nothing else, to escape the oven that is sacramento (>100 degree highs already). we stayed at le meridien (see room & view), ate @ fleur de lys (and were surprised by a little dessert treat on the house), wandered around the city a bit, then explored sausalito the next day (with requisite touristy pic of the Golden Gate Bridge). ate lunch outside on the patio @ poggio, sampled some gourmet icecream for dessert, then drove on back to the sweltering heat of sacto.

it's been a fabulous, blessed, whirlwind of a year... and here's to many more ;)

i'm a believer of slow medicine

FROM the NY TIMES

HEALTH | May 5, 2008
For the Elderly, Being Heard About Life's End
By JANE GROSS
“Slow medicine,” which encourages less aggressive care at the end of life, is increasingly available in nursing homes.

it's gonna be a bright, bright sunshiny day

yes folks, i can see clearly now... indeed, the rain is gone. ;) i'm safely into my second week of neuro consult, which with its 9am - 5pm hours has singlehandedly restored my faith in sleep and humanity. strangely enough, there are definitely things i miss about the MICU... i definitely shouldered more responsibility and felt more competent than i do now on this rotation where essentially i'm treated like a med student (but PAID- cha ching!$!$ makes all the difference)... but hey, how can i argue with 8 hours of sleep a night?!

one of the things i miss MOST about socal is... ok, i have to rephrase that because of course i'd have to say FAMILY and FRIENDS but really what i'm trying to say is that one of the TASTY TREAT things that i miss the most is certainly pinkberry. however, andy has discovered yet another worthy substitute, which makes it all the more tolerable here in sacto- YOG YOG! i'm quite envious as it is RIGHTnext to his hospital, making for totally doable yogurt runs in the middle of the workday. yes, we're workin hard up here for our (piddly intern) money. ;)

tales from the crypt, aka MICU

my residents and i have jokingly called ourselves "the death team". dark humor and several gallons of diet pepsi are all that stand between me and total despair/apathy. i have realized, over the past few weeks of MICU, that i prefer to have patients who are able to speak to me, who are able to walk in by themselves to clinic, who aren't constantly trying to die on me. i'm on call tomorrow, but took a very ill-advised nap this afternoon, so now i'm half-awake/asleep but too anxious to rest. which pretty much sums up how i've felt this entire rotation.

if nothing else, i've learned how important it is to discuss one's mortality and one's wishes with one's family. the hospital is really one of the worst places to die... in my opinion. things can happen so quickly, and so often- people end up worse than they were when they came in... and i can't even express the WRONGNESS of having to discuss life/death issues and code status with someone- or even worse, someone's family member because they end up crashing in the middle of the night. i've decided to start bringing it up with my clinic patients- making sure they have advance directives in place, and that they've started this dialogue with their loved ones... i know, noone wants to talk about dying and perhaps this is all just a preoccupation because of what has been going on this month... but even so... i think part of my job as a primary care physician should also entail preventive care to ensure the best death possible... if that makes any sense.