"We need to end black on black violence"

...is what one of the patients said today.  She was convinced that her ex-husband was the anti-Christ and that her cousin was shot, her husband is cute, she doesn't need anti-psychotic medications, her 401k wasn't being adequately maintained, there is going to be a war in California, etc.  She mentioned the above things in that order when most of those things were not associated with one another at all.  She at least stuck by her guns though.  When I spoke to her a few hours later, she was very sure and could not be convinced otherwise about her beliefs mentioned previously.

Psychosis isn't what media outlet has led people to believe.  It's not usually the desire to kill people and wear their skins or something gruesome like that, but it is simply being unable to function correctly due to the lack of control over our own minds.

With some of the patients being around my parents' age, I got to thinking, "this isn't just interesting, it's extremely sad, especially to the people who are in that person's life".  And so I was reminded yet again that patients are much like myself, human.  I wonder how many times I'll forget and remember again before I have the association down completely.

Study day

I've been studying for the past 2 days.  Actually, I went to the bar for a second last night with some people to talk logistics about school events that we have to plan.  Anyway, I'm studying at the moment, aside from writing this entry.  I have my neurology shelf tomorrow and I'm feeling okay about it.  I took a practice test that is sold and administered by the same company that makes the test that I'll be taking tomorrow and I did fairly well on it.  Well enough to pass anyway.

In any case, I feel like I've come some ways with dealing with exams.  During the first year of medical school, I freaked out whenever there was an exam.  In second year, I was just tired and feeling ragged inside from having exams every 2 weeks or sometimes weekly (because failure is not an option).  But this year, things are different.  I'm calm about my exam preparation.  I still cram, because I still believe it helps to a certain extent, but I'm better at preparing earlier on for the exam too now.  In fact, I kind of enjoy the day before the exam because it means that I have control of what I can do with my day.  Being at the hospital is different in that your time is not your own.  It's your resident's, it's your attendings, it's pretty much anyone's time except yours.

But I digress and complain.  In the 3rd and 4th year of medical school, students are expected to fulfill their duties at the hospital each day and go home and study more for the next day and also for upcoming exams.  And so we're somewhat forced to study every day.  Except that's a horrible way to think about it.  We shouldn't be forced to learn each day.  We should set out on our own to study and to become experts in what we've committed our lives to.  I think this applies to all people.  Even those that feel hopeless and directionless - to learn something new each day that interests us, or may be of use to us some day is a valuable and productive thing to do.  For our sanity's sake.  For our future generation's sake.  For yourself.

"I'm jaded, Bro."

I'm working with a resident this week who's on his second year of residency, and has 2.8ish more years to go to finish residency in his specialty.  From what I've noticed, his demeanor towards patients isn't terrible, but it's not all that great either.  One of the patients said to him at the end of the interview "Your student's been smiling the entire time, but I haven't gotten a single smile out of you yet".  At that point, the resident gave the patient a meek smile and moved on.  Later on, I got to talking to him a little bit and he said to me "Bro, I'm jaded about all of this.  You should probably hang out with someone who's more motivated.  Working hard can be rough on a person."  His gave reasons for being jaded.  His friends whom he had graduated college with had all gone in different paths and those who had entered the financial world were already buying 6 figure houses in affluent neighborhoods and his dentist friends were making "real money" and enjoying their lives outside of the great hours they worked at their offices.  I wanted to tell him, "yeah, but none of them are doctors like you. none of them went through the med school and residency experience that you went/going through," but I don't think that it would have made a difference.  This was a man who had already made up his mind to be unhappy about where he was.

And this is my first experience with a doctor who is unhappy with their lives.  I think I may have been fortunate up to this point to only meet doctors who loved what they did.  And today made me question if I would be happy in the specialty that I'm thinking about.  It is THE most important question that a med student, or any human being has to ask him/herself before entering into something that could potentially direct him or her down a certain path for the rest of their lives.  But you know, the answer is that I don't know for sure but I probably will be happy.  Happiness/the state of being content is such a subjective thing.  Most of the time in our lives, we have direct control over it.  Even through times of adversity, we can decide to celebrate it and work with the situations that we're dealt, or we can also choose not to.

Even within the most hopeless situations in our lives, we almost always have a choice.  The challenge is remembering that we have that choice.

I don't like what you have to say. Good bye.

I saw a patient today who got into a verbal altercation with her partner while in an automobile.  Several things led up to that point, but long story short, she had had enough of the conversation and decided to jump out of the car.  Considering that the vehicle was moving, she fared well.  No major injuries and could not recall the event, the events leading up to the event, and the few days in the hospital she spent after the incident.  The extreme lengths to which people are willing to go in order to do things their way amazes me.

Another patient came in because she fainted a few days ago and had no recollection of it happening.  Apparently this happens on a very regular schedule, but years removed from each event.  Peculiar, interesting, and most likely more to the story than the patient shared.

I'm not sure that patients ever share their full stories.  There may be rare occasions, but none of us are perfect story tellers, whether it be due to conscious decision to withhold information, or just because we don't want to divulge too much.  Regardless, it's a physician's job to work with a puzzle that may be missing pieces, but to put it together to construct something cohesive and sensible.  As a student who formerly trained in engineering school, this inexact science is a daunting and unattractive task.  As a medical student and future doctor, this is the rest of my life, and I'm looking forward to each day and patient that's left in it.