adult inpatient ward

"i died twice."
-50something year old male talking to me about his suicide attempt taking lots of pills and drinking alcohol. he was shocked twice in the ambulance on the way to the hospital

"I have nothing to be sad about in my life. But I just cant help but want to die."
-40something year old man who checked himself in to the hospital with the support of his wife. The patient has 2 daughters ages 1 and 5. He has a great family with support from everyone. He is a high school English teacher and his life is 'stable.' But 1 month prior to this hospitalization he tried to commit suicide by taking a lot of pills. He has been battling depression since his teenage years. Talking with him, he seemed so normal. He was well educated, realistic, in touch with his feelings. Yet, when I read his chart, i saw that he has been severally depressed for years and cuts himself with razors on his arms and stomach [which i did not see because he always wore long sleeves]. Makes you realize to never judge a person by their exterior appearance. This patient was on an involuntary hold last month after the suicide attempt, went home, and realized that he was having suicidal thoughts again and with the help of his wife and parents, he checked himself into the hospital again.

"I just could not handle life"
-30something yo female. suicide attempt by slashing her arms bilaterally. she showed me the scars and they were huge. she was also a normal, healthy looking female but under that exterior, she was unstable and severally suicidal. "this is a disease. just like diabetes or HTN, depression has to be dealt with everyday. i didnt pick to be this way, its a disease."

kids inpatient ward

half the kids in the inpatient ward are there because they legitimately have mental problems such as depression, substance abuse issues, or anger management problems. i think the other half are there because their parents have psych issues. they are so messed up themselves and don’t know how to parent that they call the cops when they think their kid is acting up when really, they are the ones that need to be checked into a psych facility.  its really sad.


some kids here hate it [most hate it] but some like it. those that like it have a very rough life at home either with their families or at board&care facilities/ foster care homes. makes one really value life and see how lucky we are. the kids that like it know how to 'act up' to make sure their stay is extended. another sad way to watch valuable resources be wasted.

post-call

"whoever came up with the bumps in between lanes...genius! saving postcall lives everyday."

-laura

Belly tap

saw a paracentesis. that was cool. not as cool as a central line though. i think its because it was an easy one. still havent been able to do a central line.

damn

Mental Patients

On a psych H&P:

patient was "speaking jeberish in full sentences"

soul searching

Me: im kinda starting to forget why i went into medicine
need to do some soul searching but im pretty bad at that

Daniel: yeah i think there was some validity to what dr white said about burn out month
i felt it pretty bad my first week on GI
its a busy service and i was coming off vacation
i was pretty overwhelmed and got discouraged and had a day i was like fuck why did i go to medical school
but i think when you get the hang of the rotation your on it changes really fast

Me: agreed

 Daniel:  so im sure youll find your soul real fast
i think only you know whats the best for you since you know your limitations and strengths the most

 Daniel:  you need to make the decision and not someone else

 Me:  i want someone else to make the decision so im not held responsible for it

 Daniel:  haha yeah i feel the same way

Daniel:  how important is having free time

 Me:  important
as well as sleep, i need sleep

 Daniel:  do e med
 done
i decided

 Me:  good. thats all i needed

emergency medicine!

i got some cool psych stories but they are gonna have to take a back seat because i shadowed at the LA county/USC emergency department trauma center yesterday [3pm to midnight] and holy shit was it cool. not only did i meet the most amazing people and get some great networks, i got to see a ton of cool medicine. highlight of the day: around 5pm paramedics brought in a lady who was found unresponsive at home and was found by EMTs to be in arrest, she was practically pronounced there but they shocked her and got a rhythm back. she came to us and they worked on her for about 2 hours. she went into every rhythm possible and ended up on 5 pressers! we even shocked her about 3 times [looks NOTHING like on the TV show] and each time she went back into normal sinus. it was truly amazing. she rolled in and immediately had 3 doctors, a ton of nurses and 2 pharmacists helping. she was getting a subclavian line on the left while getting a heimlich valve on her right chest for pneumothorax. they couldnt find an IV line so they ended up doing an IO her her R tibia [basically drilling a small hole into her bone to get into her bone marrow for venous blood access]. they also ended up doing a femoral line on her which i have never seen, the resident did it blind with no ultrasound. awesome.
so that all happened, the patient ended being up tons of meds to keep her heart going and a vent to breathe for her. by the time family was called and updated, they told us she was in stage 4 pancreatic cancer and all life sustaining efforts were removed per their request. i wasnt there at the time but apparently she died in minutes.

at that time, i was meeting the most awesome doctor who said she would help me along my EM path and become my mentor [did i mention i think i am going into EM...just still not 100% yet].  shes a DO from Western and did her residency in EM at USC. she is badass and i am looking forward to her helping me along the way.

Yesterday was awesome and it opened me up into a new network of doctors. the biggest thing i have learned from this and the EM conference is that everything is about networking...its about who you know and who you contact. so im gonna start putting myself out there more and more. cant hurt i guess?