Self Reflection – The Importance of Self Care

As part of the assignment for this rotation, we have to write a letter on the importance of self care. When we are in our intern year of residency, the clerkship director will mail these letters to us to remind us to take care of ourselves. I think this will serve as an important reminder during that stressful period of my life -- if I don't take care of myself, it's going to be pretty difficult to take care of patients.

___________________________

Dear intern me,

1. As Dr. X said, if you’re not waking up excited to go to work and see patients every day, talk to someone. Talking to someone can help solve a difficult work situation, or it just feels good to express your feelings and have someone listen and understand. Whether it’s your superior, a peer, a friend, or a therapist, just talk to someone.
2.   Keep exercising. It really is the best way to deal with the stress, exhaustion, and emotional baggage of the day. Even if you can’t make it to a crossfit workout, at least try and go for a walk or a run. You will feel better. I promise.
3. Make time for family and friends. Even if you feel that you have to study, read about a patient, or prepare a presentation, make time to spend with those people who make you happy. It will be worth it. There will always be another deadline to meet or more to do, but those who you love most won’t always be around.
4. Don’t sweat the small stuff. Try and let negativity roll off your back. You never know if someone else’s rude or insensitive comment was due to their level of stress, exhaustion, or personal conflict. Just remember that 99.9% of the time, it isn’t a personal attack. When it is, try and find the good in the situation. In that comment/attack could be something you can improve upon.
5.  Don’t feel that you have to be perfect in everything. You don’t have to be the perfect housewife, perfect doctor, perfect daughter, and perfect friend.  For example if you don’t have time to cook every night, don’t worry about it. Do what you can, and remember you have supportive friends and family who love you, understand you, and want to help you.

 You’ll be fine. You are a strong, capable woman, and you can handle more than you think.

Love,

M3 me

"This isn't The Notebook"

I've been spending some time in the neuropsychiatric ward, the saddest place I've ever been, taking care of some patients. I guess the neuropsychiatric ward is what people thing of when they think "psychiatric hospital." Patients are either so medically sedated that they are just passed out in their wheelchairs, heads on the table, or they are aimlessly wondering around, going into other patient's rooms, and following you wherever you go.

My first time in the ward, a patient came up to me, crying, asking "can you take me home?" It turned out that she was one of our patients. Talking to her was difficult through her broken sentences, confusion, and word finding difficulties, yet I felt I could follow some train of thought she was trying to convey. She pointed to the attending rounding, and said "I know him." I was excited by this -- she recognized her doctor, but when I tried telling the attending that, he dismissed me saying, "She just recognized a white male figure -- she doesn't know who I am."

Am I too idealistic? Am I biased in working with my patients with dementia to hope for the best, to only see the good? I have another patient with progressive Alzheimer's dementia with receptive and expressive aphasia, meaning she has trouble understanding and using language. Yet, I try and talk to her and understand as much as I can. I ask her name, and she tells me, "Penny*." I ask her where she is, and she tells me, "hospital." Every time I talk to her, I feel that I can see the person behind the confusion -- if I'm patient enough, I can understand what she's trying to tell me. When discussing her with my resident, I reported that she knew who she was and where she was, and that I thought she might know more than we give her credit for. My resident responded, "This isn't The Notebook. She is confused and doesn't understand us and doesn't know where she is."

It might not be The Notebook, and I understand Alzheimer's is a progressive disease that doesn't have periods of improvement/return to normal function, but that doesn't mean we shouldn't try and find the remainder of the person left inside.



*name changed for patient privacy

"They're trying to kill me"

I've started my psychiatry rotation this week at Wesley Woods Hospital.


1)
I've talked to my first schizophrenic patient. This Modest Mouse song, "World at Large" reminded me of him.


Went to the porch to have a thought. 
Got to the door and again, I couldn't stop. 
You don't know where and you don't know when. 
But you still got your words and you got your friends.


I know that starting over is not what life's about. 
But my thoughts were so loud I couldn't hear my mouth. 

2)

coun·ter·trans·fer·ence/ˌkountərˌtransˈfərəns/

Noun:

The emotional reaction of the analyst to the subject's contribution. (google dictionary)

3 days in and I'm definitely feeling it. I have felt unusually anxious the last few days, and it's not "the crazy rubbing off on me." Rather, I think it's the effect of talking about these incredibly personal details of people's lives and having to remain stoic and objective about it. It's sad. It's draining.

This sounds like a pretty negative post, but I am actually excited about the rotation. I think I'll learn a lot, but I also think it's going to be difficult.

3) 

I learned my "tell." 

Today we had to practice the psychiatric exam with a partner in the class. The clerkship director said he would be coming around to give us feedback and specifically let us know what our "tell" is -- what gives us away when we're nervous. He said by knowing our "tell," we could work to not let it show during patient interviewing.

My "tell" is that I flush -- my face and neck turns bright red. Awesome -- because I can really change on working that, ha.

12 Steps to Freedom

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

________

As part of the psychiatry/neuroscience II module, we are required to attend an Alcoholics Anonymous meeting. I went to one tonight about 10 minutes from where we live.

I was apprehensive about attending the meeting. I wasn't sure how to act and if I should introduce myself. "I'm Lindel and I'm not an alcoholic?" That didn't seem right. I didn't want to be perceived as judgmental. I didn't want them to think "Why is she here?."

As I walked into the building, I saw a room where a few people were gathering. Unsure if it was the right room, I stepped in and sat down. I then saw that everyone had the 12 Step Book with them and I was assured that I was in the right place. As I sat there waiting for the meeting to start, I was unsure of what to do. So, I started reading the 12 step book that was in the chair next to me, listening to the conversations around me, and contributing to them when I could (The extent of which was naming Simon as the third chipmunk of Alvin and the Chipmunks and remembering LaLa as one of the teletubbies.) Everyone was friendly and no one seemed upset that I was there. As I looked around, I was surprised at the amount and variety of people who were at the meeting. I had expected less than 10 people, and honestly, I had expected them to look...different. I'm not sure if I could have told you before this experience what I thought "an alcoholic" looked like, but I (ignorantly) expected them to be identifiable-- maybe a bit disheveled? looking like they've seen the harder side of life? I don't know. The people around me looked like people you would see in the grocery store, in church, at school. On other words...like ordinary people. I should have known better since I have a friend who is an alcoholic, but I guess I always thought that he/she wasn't your typical alcoholic. There were old, young, men, women, black, white, rich, poor....all different kinds of people.

The meeting started off with people around the room taking turns reading alternating paragraphs from chapter 11 of the 12 step book. This chapter/step is concerning prayer and meditation to gain the insight into God's will for you and how to accomplish His will. After the reading, people around the room would take turns giving their impression and thoughts of the 11th step. Some people spoke directly about how their thoughts on prayer and meditation. Others spoke about other issues tangentially related to Step 11. A lot of times, people spoke around their issue, never directly addressing it, which made it more difficult to understand.

Something that struck me was that no one directly spoke about their problems with alcoholism. Before anyone would make a statement, they would say "Hi, I'm ______ and I'm an alcoholic." However, none of them spoke directly about their problems with alcohol in the past, temptations they face in the present, or how they ended up in AA like I expected they would. It was a lot more focused on the individual step they were discussing for the night.

The meeting closed with recognizing people who's "anniversaries" of sobriety fell on today's date. There were two women -- one who had been sober for 1 year and one who had been sober for 5 years. The group then gathered in a circle, held hands, and recited the Lord's prayer.

This assignment really provided insight into who are alcoholics. By going to this meeting, I got the chance to see "the face" of alcoholism. It really can be anyone.