Let Me Show You A Glimpse of My World

I’m 1 week away from being done with Psych. 1 week away from being done with 3rd year. I can't quite grasp the full impact of what this means...

I find myself starting to get quite reflective...

As I get ready to finish up Psych, it dawns on me that I occupy a really weird space right now…

I currently work at a Veteran’s Administration (VA) Hospital. The one here in Richmond is supposed to be one of the best in the country. If this is the case, there needs to be a War Crime Tribunal convened to discuss the pathetic services we provide our veterans. To start with… when I walk through the doors every morning, I am greeted by the smell of stale urine. It is everywhere. How is this possible? HOW is this possible? How does someone not stop one day and say… it smells like pee? We should do¨ something about that? I can tell you this… if I owned a hospital… that’s probably something I would NOT be able to deal with… my hospital smelling like pee. And it’s not like the place is dirty per se… it just… smells. It's a bad way to start off the day.

The other odd part of VA Hospitals is that it’s a perfect example of why a communist/socialist system doesn’t work. Everyone here is a government employee with guaranteed salary and benefits. No one gets fired. No one gets raises based on how good a job they do. Promotions are based primarily on time served and not having killed anyone. So, there is no incentive to work hard or efficiently. If you just sit around and suck at your job… you’ll get paid just as much as if you work your butt off. So no one works hard. This becomes a vicious cycle, too. Because then, anyone who IS a good worker doesn’t come here. Why would they? There’s no gain for them. They are better off going someplace where if they do well, they will get paid better based on performance. So… the people that end up being employed at the VA… not exactly what you would call the 5th string all american team. As a result, the entire building just has an air of… lazyness? slowness? dysfunction?

So, then I head to my student office. To get there, I have to walk through the lobby… down a hallway that takes you past the primary care clinics, the ER, the outpatient pharmacy, the outpatient psychiatry offices. To say that this results in my walking by some strange individuals would be the understatement of the year. There are wheelchairs everywhere. There are also the spinal injury boards, where the person lies on it like they’re getting a back massage and use a joystick to drive the board like a wheelchair. There are hats on just about everyone I walk by. Most of the hats have some military reference on them. There is the occasional ridiculously flash suit… complete with incredibly bright colors, shoes so shiny that you could blind God, and of course… the pimpin’ hat that I secretly covet but know I could never pull off. There is the cross-dresser that I walk by almost every other day. He’s kind of in… transition? He’s got the weird wig, the eye makeup, and the jewelry… but then he wears a randy travis baseball tee, jeans, and boots. He just looks… so off… It’s as if he decided to cross dress and after putting on the wig and eye makeup called it quits. There are the old couples that walk through the hallway arm in arm… not so much out of love but out of desperation and a need for stability. There are a lot of people, both employees and patients alike that walk the halls dressed circa 1982. This is what I experience every day… just getting to my office… before I even see a single patient of my own.

My patients… Hmmm… I think the one thing that Psych has been if nothing else is… eye-opening to the full extent of people’s problems. We learn about psychiatric diagnoses in very straightforward terms. This patient has (schizophreniform disorder/ bipolar I/ borderline personality/narcisstic disorder/ major depressive disorder/ substance abuse/ post traumatic stress disorder). Take your pick. Any one of these diagnoses could be the flavor the day. We learn about the specific criteria that must be met in order for each diagnosis to be true. And obviously… this is how we need to learn it… clear cut definitions… well suited for categorization and classification.

But… these patients are almost never just that diagnosis. You start to talk to them… and you realize there’s an entire world of pain and hurt and scars and misery underneath it all… that you just don’t know what to do with… You start to hear their stories and as each layer unfolds, you find yourself internally thinking, WHAT??? I saw a 65 year old gentleman who was newly diagnosed with ALS or Lou Gehrig’s disease. For those that don’t know what ALS is… it basically involves this degeneration of the nerves that control body movements of all kind. It’s an absolutely awful disease. Because it keeps progressing to the point where your mind is perfectly intact, but you can’t move at all… and eventually die from respiratory failure. I had to evaluate him for depression. And when I met him and his wife, it was clear that he was depressed. I originally thought it was due to his disease… because if I had it… I would be inconsolably depressed I think. But then it turns out that he has been depressed for quite a while. After digging some more it comes out that he’s had a serious alcohol problem for the past 40 years. After digging even more, it turns out he served in Vietnam and was shot 3 times, and saw a convoy of his friends die after driving over a cliff. They drove over the cliff because his truck was in front and had caused so much dust, they didn’t see the turn. And now he was riddled with guilt. On top of all this, he was abused when he was younger. Add insult to injury, before he was diagnosed, he had started to do some serious home repair to replace structures due to termite infestation. Now that he can’t move, his entire house is gutted open like a fish.

So, on paper, he’s a patient with Post Traumatic Stress Disorder, Alcohol Abuse, and Depression. But how do you help him? Nothing is going to take away the ALS. Nothing is going to take away the long-term effects of alcohol abuse. Nothing is going to really help him stop feeling guilty about his friends that died. What do you do? What pill do you give him that makes all this better? What therapy is going to help someone who can't talk anymore because his mouth muscles don't work?

I think Psychiatry is an important field. I respect the hell out of those that choose to work in this environment. I couldn’t do it. It breaks me up to see these folks in so much frustration and pain. It breaks me up to not be able to truly help them. I wonder how one holds on to their faith as a Psychiatrist? I really do.

I go home having done less work in one day than I would have done in an HOUR of surgery or medicine… and yet I’m completely drained and find myself unable to do anything productive.

I really live in a weird world right now. I'm just grateful that in one week I get to leave it.

Finally A New Update!

It's been a very long tme since I updated. It's July 1. In 4 days, I turn 37. In 17 days I finish my third year of medical school. I feel like there's so much to write about...

Some big things that have happened since I last wrote... I decided what I'm going to be when I grow up. Those that have known me the longest will know that I used to think I was going into ER... then Peds Oncology... and basically since I started med school I was certain I was going to be a Pediatric Hospitalist. But I have chosen none of the above. I'm going into Family Medicine. The fit was just so perfect that it actually caught me by complete surprise. There are a million reasons why Family Medicine is right for me. I've had a lot of people try to dissuade me... mostly because they somehow think that Family Medicine is somewhat beneath me... hahaha... little do they know... flattering yes... but please... The truth is... I'm not that into the specialties... The truth is... I treasure relationships, teaching, counseling, advising, and being able to know everything about everything... It's what makes me tick. It's the right fit. I am a Pediatrician at heart in so many ways. I love kids... and they love me. But I love being able to help parents be better parents. I love the fact that I can take what I enjoy doing outside of work and make it a part of work. Like I said... it's a perfect fit.

So with that in mind... I find myself in a cool situation... because the perfect residency for me... is at Fairfax Family Medicine... I get to go back to the hospital that I worked at as a Tech... only this time... I'll be an MD. As soon as I start residency... I can actually start seeing old friends as patients... I have a built-in practice already by virtue of the fact that I have an extensive network in Fairfax already. It's crazy to see how in one instant, God focused my heart on Family Medicine and everything automatically seemed to line up.

So... the great thing about Family Medicine is that my 4th year, when I do all my electives, will be filled with rotations that are very educational... but exceptionally chill. So... in 17 days... I'll be done with M3 year... and I'll follow that with 3 weeks of studying for the Boards... and I should be set... I'll have a year of relatively painless education.

And I really need it.

I am tired.

I'm more tired than I've been in quite some time.

I'm on Psychiatry right now. It is the rotation that I have dreaded all year. Psychiatry has always creeped me out. I hate being in close proximity to people with psychotic breaks or severe personality disorders. It truly bothers and shakes me. There are those that can talk for days about how funny and how interesting these cases are. But ultimately it bothers me because there's nothing I can do for them. Absolutely nothing. And I'm not used to being so guarded around people. I am usually an open book... and I usually pour out empathy and compassion and love... it's just who I am... In Psychiatry... I have to be a whole different person. And I hate that.

But I've done well so far... actively recruited to go into Psychiatry in fact... and I'm almost done... and I keep trying to remember that... it's really hard... it always seems like your last few steps to the finish line are the toughest.

I can't believe what I've endured this year. 80+hrs of work per week. Waking up at 4 am more times than I care to remember. 30 plus hours on at a time. Living off of nutrigrain bars as I go from one surgery to the next. Standing for 8 hrs holding open a surgical wound. Being yelled at by flaming a-hole residents. Watching completely incompetent doctors brush through a patient in order to get them out. Wanting to strangle fellow medical students for being either completely annoying or for being a complete jerk. I've passed all my Shelf Exams. I actually did well on some. I've gotten great remarks and comments on my evals. I've gotten a couple of high passes. I've delivered babies. I've stitched people up. I've been able to cut and bovie during surgeries. I've seen people die. I've seen people survive illnesses I never thought possible. I got to touch a human heart, lungs, kidney, liver, intestines, uterus, ovaries, and numerous blood vessels. I got to deliver a kidney to the operating table for transplantation. I convinced a person to stay in the hospital and not kill themselves. I met the Messiah (who happens to be a 45 year old white woman with dirty hair and fake seizures). I've done about 15 miles of walking in the hospital per day. Had families come back to the doctor's office and request me as their doctor. Prayed every morning over a baby that had been abused. I've had patients tell me that I made their day. I've had patients tell me that I'm already a good doctor. Survived being in the OR with Dr. Posner, Kaplan, and Matthews. Still managed to speak at CCF and Agape twice. Went to Servant's. Still went to SSCC Youth Retreat. Still held onto who I am.

I am really tired. I feel like I could sleep for weeks. I'm not healthy. I have been having migraines again for the first time in about 8 years. I wake up every morning feeling like someone beat my brain up overnight. I go to sleep every night hoping that a storm will take over Richmond and I won't have to go in. I feel very... lonely... I think it's just that feeling we get when we want some kind of physical solace or help. I think a lot about a dream I used to have... I would go walking into a house to find a woman waiting for me... and I would just go lay my head down on her lap and cry as she comforted me. I feel like that lately... Living by myself has been great... I wouldn't want a roommate and never really have... but times like this... I regret the fact that I'm not married or involved at the moment... because I would love to lean on someone right now... I know God's got me covered... I know I will bounce back. I'm just... tired. I miss my brother. I miss my sister. I wish they were here.

But 17 more days. I can do 17 more days in my sleep. I'll have a 3 day weekend soon. And before I know it... I'll be ecstatic at being done with school... even if I still need to study for my boards. I know I'll be alright. It's just hard right now.

I hope to catch everyone up on this past year with stories... This year has been tough but incredibly rewarding. I've had some incredible patient interactions. And I've also really connected with so many people. I feel like I have so many new younger brothers and sisters now. My parents are great. And I have felt God's presence in my life all year. I feel very blessed and loved.

As always... I'm glad to be able to share... I will write again soon.