It’s a wrap! (almost)

Hello All!

Hope you are all doing well! It’s been a while since I’ve posted and have since completed Surgery, ER and OMM! I’m on my final rotation–psychiatry at the State Penitentiary–and it’s going to be interesting, only four more weeks to go!!

Just to recap, surgery was a great rotation, I learned a ton and had a great preceptor. It was AMAZING to help resect a patient’s bowel and anastomose it, make incisions and suture them back up! The challenges were that surgery is sooo physically exhausting; my feet were killing me at the end of every day and the days were really long. I also realized how complex and incredible the human body is and how brilliant surgeons are to know what to cut or bovie. It’s hard work!

OMM was four weeks and was mostly like a family med rotation except that we spent Tuesdays and Thursdays with a fantastic preceptor who spent 4 hours reviewing material and going over techniques. It was like being in OPP lab again but everything came easier since we had learned it at least once before. I really like working with this preceptor twice a week, she was also an attending at a family medicine residency program for years and was able to give us a lot of insight and advice on applications and programs!

ER was four weeks as well and was great. We work 3 shifts/week or whenever our main preceptor is on shift. We do 12 pm- 12 am shifts which allow us to see the most. I got to fix a nursemaids elbow (the family was super happy), stitch up a prisoner’s face who got pummeled at the penitentiary, do OMT on a MVA patient, and learn a ton! It was awesome.

Now that my last rotation is here, I’m really grateful for the time I’ve had in Walla Walla. Our dean is so encouraging and our coordinator is fantastic–so organized! The doctors have been incredible teachers and I can’t express how much I appreciate all our patients and their patience!

So now it’s onto board exams, moving, weddings (Congrats, Jenny!), audition rotations and electives. I have a feeling that in the craziness of it all, I won’t get the chance to blog, so here’s to EDC. Could not have pushed through without the love and support of family and friends!  Wishing everyone an amazing end to an amazing year and luck with the next leg of our journey!

-Priya

 

A Little Spark of Madness.

Hello Women in Medicine,

I’ve just completed my Psych/Behavioral Medicine rotation and have many thoughts to share. Warning: it’s a doozy.

First: I loved psych.

  • This was not a complete surprise to me, but I didn’t think I would seriously consider going into this; I’m not Frasier.
  • I really enjoyed interacting with the patients. After just a few short conversations with this patient population, I was quickly endeared to many of them. Their honesty and realness and the challenges they face truly set them apart from the general patient population. Plus, I’ve always had a soft spot for quirkiness.

Second: I was able to see mental health care in a variety of settings

  • Outpatient visits at long-term housing locations and outpatient clinic:
    • Patients in a long-term facility were especially prone to being taken advantage of by the staff, their families, or sales persons. Many of the patients had difficulty forming safe networks and were often subject to being indebted to the likes of their family members, the facility for snacks, or Avon sales ladies. To be clear, these patients don’t have a lot of money, they are either on Medicaid or Medicare and have never held full-time jobs or lived independently in a safe space. It’s really sad.
  • Court hearings at Western State hospital:
    • Patients would be brought before a judge to assess whether they need to stay longer in an Inpatient setting (Western State) or can return home under a court order (Less-Restrictive Alternative – aka LRA). Patients on LRAs are required to take their meds and see their docs/ARNPs on a regular basis and this is often a really helpful option for many of them… until they are off their LRA, which often has devastating consequences.
  • Crisis Intervention team.
    • Waited for phone calls from patients that were immediately suicidal or struggling with their mental illness. The first patient we saw was suicidal but without a clear plan and it was essential for her that we established care for her with a Counselor. However, in order to meet with a Psych doc or ARNP she was required to see the Counselor at least 3x. If she was acutely psychotic or suicidal w/ a plan, she would go to the closest inpatient unit.
  • Mobile Health Unit:
    • See regularly scheduled appointments for patients with mental health illness that need care by a PCP.
    • Many of the anti-psychotics, anti-depressants, and mood stabilizers have serious side effects to the body and it’s important for a PCP to address these as managing their side effects can be much less complicated than changing the dose on their anti-psychotic.
  • Outpatient care for Cambodian and Vietnamese refugees:
    • Many of these patients had PTSD and major depression from being in refugee camps or seeing many of their loved ones die needlessly under ruthless government regimes.

Third: This is a topic close to my heart.

  • I think my mom has been grooming me to go into Psych since I was 8 years old. She is a Psych ARNP and has helped me to understand how psychosis shapes a persons life and what the expectation for their rehabilitation can look like.
  • Mental illness has touched both of my younger siblings, my former foster siblings, and recently one of my good friends. I spent the last half of my rotation trying to help this close childhood friend through a very rough spot in his life. Battling major depression and unaddressed bipolar disorder, he has been living out of his car and in despair for the past few weeks. There’s not much I was and continue to be able to do for him besides offer support, resources, and encouragement. It is devastating to watch someone you’ve known for your entire life succumb to their mental illness and refuse to accept mental health assistance. I drove home crying way too many nights.

Lastly: working closely with my favorite preceptor yet: my mom. I know we don’t look alike.  She has always told me, “If I didn’t laugh, I’d be crying.” This mantra, though not always funny, is very true and indicative of the constant challenges faced by many of those in the mental health profession. behav me and mom

Challenges in Behavioral Medicine:

  • Limited Resources.
    • Funding in behavioral health is consistently being cut, leaving practitioners and patients without resources or motivation to seek help.
  • Convoluted system and patient management.
    • There are a lot of players involved in the management of a single patient and depending on the patient, can get really involved.
  • Many patients in this population do not get better.
    • It is a sad reality and is one of the reasons that psych can be so challenging.
    • My mom has had a lot of the same patients for 25+ years and they will continue to need her support and social services for the duration of their life.
    • Continuity of care is essential to the long-term maintenance and well-being of these patients and understanding this can help make sense of your role in their lives.

COMAT Tips: 

I found that doing COMBANK COMAT questions + UWorld Questions was pretty adequate. The test itself felt much more relevant and specific to psych than the Family med COMAT.

Resources:

  • Case Files: Behavioral medicine
  • COMBANK COMAT Q bank
  • UWorld Q bank
  • Onlinemeded.com: sign up for free videos and lectures, very helpful.
  • Clerkship Review compliments of the University of Texas Health Science Center.

Glimpse through how psychosis can impact someone’s life: Mad Medicine. Enjoy! 🙂

Insane to the membrane | Psychiatry Rotation Tips

Dreams are most profound when they seem the most crazy – Sigmund Freud

Hello EDC!! I know this has been way past due but here it is! My first VLOG. Being the prestigious medical students that you are, I doubt that any of these things are ground breaking news to you. But I do hope I can inspire you to reflect on your own experiences. Feel free to treat it like tegrity and watch it at double speed. Enjoy!

Look forward to reading your next post so I may live vicariously through your experiences. Peace #wherearetheemojis