SURRENDER

***

My name is Erica and I could be an alcoholic someday.

Seriously.

Many of the people I've interacted with who are battling addictions have life stories that are somewhat similar to my own: some family history, drink alcohol socially in their 20s, sometimes falling short of my expectations for myself, and as a future physician, I actually have a higher risk of becoming an addict than many other people (although also a higher chance of recovery if I do)

This morning I went to an AA meeting and there were all sorts of people there. It was an open meeting, meaning it was not just for alcoholics, but also family members, significant others, and curious medical students. We decided to go to this meeting because there was a speaker, a man we'll call Henry, so perhaps it would be less obvious if we did not talk. Henry is an ex-marine, a recovering methamphetamine and cocaine addict, as well as an alcoholic. He said that at first he did not think he was an alcoholic, but a drug addict. But through treatment, he learned that every time he drank, he would get the uncontrollable urge to use other substances, as well as drink more. Henry spoke about how his lowest point was when his 18 year old son was in the ICU after getting high on coke and drunk and crashing his car. Henry said he came to see his son in the ICU from a concert; he was strung out on coke and drunk, and just yelling at everyone. He kept asking the nursing staff if his son was going to live. "because I was worried about him, but maybe even more because I knew I couldn't leave the room and go finish the 8ball [of coke] in my pocket until we knew he was okay". As soon as the nurse said his son would live, he ran into the bathroom and finished several more lines of cocaine furiously before the rest of his family arrived. When his whole family showed up at the hospital a few minutes later, he felt so high and drunk that he could not stay in the same room. He told them that he HAD to leave and drove home where he promptly drank and did more drugs, resulting in a three day black-out. When he came out of his haze, his son was in rehab for his drug addiction.

But even then Henry did not stop using. It was not until he went to visit his son at the inpatient rehabilitation facility where he was staying that it became apparent just how much his use was affecting the lives of the people around him. Henry’s family, including his son, stages an intervention at the treatment center telling him all the ways his addictions had negatively impacted their lives, including his son telling him how his own addiction had been influenced by Henry’s. After that, Henry checked himself into the rehabilitation center and for the first 60 days, he worked really hard – not for himself, he says, but for his son. He says he was worried that his son was getting the wrong idea about drugs from his behavior ("I was a 'do as I say, not as I do' - kind of dad", he said) and wanted to change that. Things seemed to be changing for the better. On his son's 90th day sober and his own 60th day sober, he found his son dead in his basement from an overdose of cocaine. For some reason at that moment of horror, he heard a voice that he calls god - the higher power he has chosen - and surrendered; something that his childhood, the marines, his rebel bike crew, and his entire life had taught him never to do.

Henry said that he has now been sober for 6 years and works at a treatment center in Florida and still goes to AA meeting every day if not multiple times a day, if not multiple times a day “because I think about drinking and using drugs every day, if not multiple times a day”. He always sits in the same seat, right in front of the placards expressing the 12 values of AA because he needs to be reminded of them every day. The first one is Honesty ("I am an alcoholic") - and he says, some days, he struggles all day to embrace just that one.

After he finished his story, other people shared pieces of their own stories. There were people who had not had a drink in years and people who were on their first weeks of sobriety, including a patient we saw in the outpatient clinic only a few days ago who came to her appointment completely drunk, telling us how much her life had fallen apart.

The theme of the meeting was definitely the importance of surrender - to whatever higher power you have chosen. I liked that they made a really big deal of that actually - the CHOOSING of your higher power – because I think what worries people about going to AA meeting is that they do not want to feel like someone is preaching to them. I had this own worry myself.

However, as I have worked with more people battling addiction, the necessity of the involvement of a higher power makes more sense to me. People view addiction as an incredibly powerful force outside of their own will that drives them to do things that they know are not good for them or the people they love. It is logical then that, for some, recovery necessitates accessing another incredibly powerful force that people can view as something outside of their own will

I've written about my struggle with connecting with a higher power - and that continues for me for sure - but I definitely feel the presence of a force greater than just me, whether it's a light in all of humanity or in all living things or the force of destiny or what. I think we can all identify with feeling strong pulls in various directions that don't always feel logical or what we think is best for us.

Since Lent began, I've been trying to meditate/pray every day, mostly just saying thank you - first and foremost for soundness of mind and body. I've also been trying to do yoga by myself for a few hours a week. I guess I'm trying to connect with that force within me in a different way than I have in the past. I like it. I think the combination has made me feel more centered, more patient with the other people and circumstances in my life.

I do feel more connected.

The meeting felt a lot like Church (we ended with the lord's prayer), but mostly the good parts of church. The message was much more encouraging, more solidarity, more "we're all just human" and "we all need each other", all messages that I think if we had more of in life, we'd all be better people (not to mention less likely to become addicts of any sort). It also definitely made poeple finding a way that worked for them the MOST important thing, not just subscribing to the doctrine. I guess it would be like if a church said, "here's the bible, but you have to find the interpretation that works for YOU. which may be totally different than what works for me, and that's not just okay, that's how it's supposed to be. It certainly does NOT mean we can't get along or discuss it.

In case you don't know them (because even though it's probably the #1 most recommended treatment for addiction by physicians, I didn't) - here are the 12 steps.

To find AA meetings near you check out this website.

~~~~~~~~~~~~~~~

"Addiction is just people looking for god in the wrong places"

-unknown

(said to me by the Director of the inpatient psych hospital on my first day)

the world inside your head

psych is a lot of listening to peoples stories, then sorting through very emotional interpretations of events (real or imagined) to get to what they're really trying to tell you, which is what they think is wrong, what they're worried about, and why they came to you for help.

it seems like this could be all of medicine, but I feel like getting to the meat of the story is harder in psych because often to help, you have you treat someone within their own insight into their illness.

and also because often the stories people tell are vivid and exciting or terrifying but fascinating or tear at your heart strings to the point where all you want to do is hug them

often I find myself wanting to get lost in the story with the person instead of trying to pull out the important parts so I can help them. but maybe that's the struggle of a good physician? You listen to the whole story but you know what parts to hold onto. It's not as intuitive as one might think...

One woman I admitted the other day was incredibly scared and frustrated because she believes that there are bugs, "ringworms" she calls them, crawling under her skin and tunneling through her fascia. She believes this so much that she has actually scraped off a good portion of her skin, leaving huge open wounds all over her body.

After hearing her story about how the bugs got into her skin, what they look like, and how she thinks I should treat them (SO FASCINATING),

here's how I weaved through her story to help her:

(1) looked at the medical examiner's note (no parasites)

(2) examined her back (the only place she can't scratch - and coincidentally, the only place the "bugs" missed; it's a good check if you suspect people are picking/scratching unknowingly)

(3) reminded myself that "ringworm" is actually a fungus, not a worm at all

she has delusional parasitosis, a disease that cannot be treated by telling the patient what it is, as they do not have any insight into the cause of their illness and truly feel like the bugs are real.

the bugs aren't real, but her fear is, so we cleaned her wounds and gave her antibiotic cream that she could put on them (to kill the bugs?), then put her back on her medications for anxiety. two days later, she's glorious.

and sometimes, even though I know it's not real,

I can't help but getting sucked into the story.

a patient today told me that he could hear the thoughts inside my head.

which at that moment, were mostly about what it would be like to be inside his head

and he looked at me so intensely, I found myself wondering,

for just a moment,

if maybe he could.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"In telling the story of my father's life, it's impossible to separate fact from fiction, the man from the myth. The best I can do is to tell it the way he told me. It doesn't always make sense and most of it never happened...

but that's what kind of story this is."

-Will Bloom in Big Fish

glimmer of hope

these photos made me happy

~~~~~~~~~~~

since I've been chronicled mostly the really difficult parts of psych, I thought I'd give you a brief tour of a few patients I saw today who made me smile

(HIPPA-protecting all their important info, of course):

*a mother of five kids with ADHD (ages 3-7) who was seriously the peppiest person I have ever met.

**

*a 45 yo man who had been diagnosed with severe bipolar 1 disorder at age 25 along with an even more serious stutter had figured out a perfect combo of meds, and that if he kept a pen or a cigarette in his mouth, his stutter virtually went away.

**

*a 30-something Columbian man with mental retardation who was just lovely. Whenever he was asked a question he would say "awesome!" (as in, how are you doing today? "awesome!" how are your medications working out for you? "awesome!")

**

*a 60ish russian jewish man with a lovely accent who said (another direct quote) "psychosis is just like one big umbrella to describe everyone; I just don't think that even a psychiatrist can determine what 'abnormal thoughts' really are"

**

*a 40something man who is in remission for a very serious addiction to opiates and now runs a cute cafe down the street. (maybe because we've seen so many people struggle again and again to kick their opiate addictions, it is SO inspiring to see that it can be done)

**

*two brothers, one with bipolar disorder caused by a traumatic brain injury who found animals to be the most therapeutic thing for him; the other brother who decided he had to dedicate his life to giving back to what saved his brother, and is starting his first year of vet school.

this may have been the first day where I came home and didn't feel like I was suffocating...

yesss.

and for my roommate who really gets this guy,

a real life russell

~~~~~~~~~~~~~~~~~

"I was hiding under your porch because I loooove you"

-Doug, the Dog from Up

Red Queen Wisdom

Q: how do you escape?

My Answer right now:

I have found re-discovered my love for novels (or maybe just rediscovered how to create time to enjoy them ??) since classes have ended and clerkships have begun. My favorite escapist genre is fantasy/science fiction, I think because it allows me to explore possibilities beyond that which we believe exist.

I also think working in something as emotionally exhausting as psychiatry for the past few weeks has had me seeking comfort in other sorts of worlds, at least temporarily - though as I write this, I wonder if it isn't actually more of the same questioning of reality that surrounds me all day at work.

**

"Oh my dear, sometimes I've believed in as many as six impossible things before breakfast"

- The Red Queen

**

image source

A Little Weekend Reading

(this is a little bit how I felt this morning -

but a nine mile run and a very very large smoothie perked me up

a bit - enough to catch up on some reading)

To entertain you this weekend, here are two awesome articles to check out addressing two MAJOR questions in health care (and in my life right now).

(1) Is it legitimate when people refuse to have doctors-in-training or even just young doctors involved in their care? Would we do the same thing?

The answer from recent research is a definitive NO! In fact, it shows that having doctors-in-training participate in operations and care actually DECREASES MORTALITY. Add to that that the learning a doctor-in-training gleans from working with an actual patient is critical to creating doctors you want operating on you and taking care of your health in the future. Plus, I think medical schools are really training students to be more holistic, better listeners, and better advocates for patients health. Definitely qualities I'd want in anyone helping me with my health.

That data revealed that while patients who had residents participating in surgery did develop more complications, those complications were not necessarily serious. And once one complication occurred, those patients with residents involved in their care were more likely to recover and less likely to fall prey to the so-called domino effect of complications, where one leads to another and ultimately to death. “It may be the fact of having a whole team of surgeons rather than just one that ‘rescues’ patients from these complications and even death,” Dr. Ko observed.

(2) Can we come up with a treatment algorithm in medicine/psychology for patients who have suffered childhood events that lead them to worse health?

A pediatrician in San Francisco says YES. Dr. Nadine Burke's clinic treats some of the poorest children and adolescents in San Francisco, many of whom are living in foster care, have dropped out of school, and/or are using street drugs. Recently she has been researching whether many of her patients health problems can be explained by what she calls "adverse childhood experiences" creating "ACE score", where they give each person a point for each event, such as growing up with a parent who is an alcoholic, being assaulted or neglected, having a parent die, or whose parents went through a divorce. The research shows that YES they can be - that not only are children who have a higher "ACE score" more likely to participate in risky health behaviors like having sex at an early age, drinking alcohol at an early age, using illegal drugs or cigarettes, but also have more health problems even in the absence of these behaviors, including heart disease, COPD, and cancer.

The article discusses how Dr. Burke is collaborating with other researchers to A) find the biological basis for this and B) create a treatment algorithm for people based on their ACE scores.

One of the biological explanations for how adverse childhood experiences affect health is by adding methyl groups to specific genes, called "methylation" which is one of the ways the body turns off genes . Researchers have found that the genes turned off when people experience adverse life events are involved in the stress hormone response (fight or flight type stuff), making people less adaptive to stress. This is shown by increased inflammatory markers of people with high ACE scores much much later in life, regardless of their health behaviors.

The treatment algorithm is a little more tricky, but in addition to more typical medicine, Dr. Burke is testing out biofeedback treatments, insight-oriented therapy, mind-body awareness, child-parent psychotherapy, and yoga.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"listen to me, he said, when your dreams are of some world that never was or some world that never will be, and you're happy again, then you'll have given up. Do you understand? And you can't give up, I won't let you" -Cormac McCarthy, The Road

"there's an anger to everything in our culture right now. and I'm sort of ready for a kind of sweetness and softeness to things" - Tom Ford

photo source

into the light

This is (completely unrelated to the rest of this post) a photo of me and my grandma when my grandparents came to visit me in Florida! We went to an awesome state park where we saw sting rays and lots of fish, as well as tons of flowers and trees that we had been missing - SO MUCH COLOR! Then we had delicious fresh fish at a little Italian restaurant we found. Later we discovered a sculpture garden to wander through where we saw more exotic plants as well as sculptures ranging from Theodore Roosevelt sitting on a bench to modernist art of forms walking up steps. It was pretty perfect.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

I think I've figured out the hardest thing to treat in medicine.

At one point I thought it was PAIN -

because pain pathways continue to send signals even after limbs are amputated and ends of nerves destroyed.

Another time I though it was DELUSIONS -

because how do you convince someone that their reality is false?

Now I think it's HOPELESSNESS.

A man came in today to our inpatient psychiatric unit and in a complete defeated, but not flat (devoid of emotion) voice, told us that his life was to the point where it just wasn't worth anything anymore. He made a bunch of bad decisions, ended up on the street, found out that he was a pretty good thief while simultaneously learning that certain drugs can take away not just all your pain but all feeling altogether. So his life has slipped even further into not caring about anyone, not caring about himself, just stealing for dealers in exchange for pain pills day in and day out. I wouldn't even say he was depressed, he just felt completely depleted of hope, and clearly had felt that way for a while. He then told us that while he would "contract for safety" on the unit, meaning that he would enter a contract where he would ask for help if he thought he might hurt himself, he would most certainly kill himself when he left.

what do you say when someone says that to you?

I asked one of the nurses and we talked about how it's possible that once we help him get medication for depression, find a place to live, and connect him with other people in the unit, he'll feel like perhaps he has something to live for.

So that's the hardest task in medicine: helping someone find something to live for. as the quakers would say, helping them find the light.

I'm still hopeful.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"there'll be no more hiding in the shadows of fear

there'll be no more chains to hold you

the future is yours - you hold the key

and there are no walls with freedom

side by side we are not afraid

because the train is coming to carry you home

come dance with me

come on and dance into the light"

-phil collins

also, for fun: easy peanut sauce

all the knowledge in the internet

I have to share with you a really awesome mental health website:

www.mindsontheedge.org

which I actually learned about from one of our lecturers who taught us about schizophrenia.

they follow two imaginary patients, Olivia and James, as they develop and are diagnosed with psychiatric illnesses. Throughout, they have many different types of experts, including Justice Breyer, psychiatrists, psychologists, college professors, parents of people with mental illnesses, people with mental illnesses, program directors of halfway houses, ER doctors, etc. who all comment throughout on what they think should happen. There's even ways where you, as a viewer, can weigh in about what you think should happen.

it's kind of like my dream come true for all of my patients here -

everyone's talking all together -

they're ACTUALLY USING ALL THE KNOWLEDGE IN THE ROOM.

or better, all the knowledge in the internet

ahhh if only that happened all the time.

the liars club

After almost three weeks of my rotation on psychiatry, I’m still fighting not to become cynical of everyone. Every day I talk with people from all walks of life, of all ages – all of whom have had horrible things happen to them, have done horrible things to other people, and feel trapped in a world where only horrible things happen. It makes sense that they develop alternate realities – whether that’s an altered perception of the world or an altered perception of themselves.

I know this, yet recently I’ve spoken with a lot of patients who are about my age, come from pretty similar backgrounds to me, and at least generally seem like people I could have gone to school with, played soccer with, or even have been friends with. Because they seem more relatable to me, I have a much harder time not believing them – a much harder time thinking that they aren’t really seeking help with 100% of their capacity, because I hope that that’s what I would be doing if I were in their situation.

Talking to a friend about his own experience with addiction, he said that it took him over a year to get to the point where he was able to see the distinction between the persona he was trying to convince everyone (including himself) that he was, and the person he really is, and even longer than that before he was able to leave the persona behind and accept himself as he really was.

In my interviews with patients, both the ones I can relate to and also the ones I cannot, many seem to feel like victims, but sort of guilty that they feel like victims because some part of them recognizes that they’ve hurt a lot of people. Sometimes that guilt is obviously real, sometimes it’s hidden, and sometimes it’s totally false but it works.

Many people I talk with have had experiences that make it hard to trust people – including themselves, that have shown them coping behaviors that work temporarily but end up causing more harm than they can prevent, that have proved to them that manipulating the system to get what they want not only works, but is right because they know they’re good people and the system is mostly designed to mess them around.

I keep thinking back to what my mom said about all problems being caused by people not feeling either valuable, loved, or competent – and how grossly obvious the effects of that are at my work. Because when people don’t feel one or all of those things they develop coping mechanisms to protect themselves from feeling those things more, and also to try to gain those things in potentially unhealthy ways.

But all that means that my biggest struggle every day is to look people in the eye, ask them incredibly intimate questions about their struggles, relationships, and fears; about their most retched moments and the things that are the most important to them, and then decide if I should believe them. It takes so much emotional and mental energy for me to sort through what is real and what’s not, what they think is real and what they know is not, what’s important to figure out if it’s real and what’s really not – all of it preventing me from forming any sort of actual trust with any patient I meet.

My hope is that in my medical career that’s not true, at least not most of the time; I hope that I can find a place in medicine that lets me trust, that lets patients trust me, and puts me in a position where I can use that trust to help them get better.

“I remember, I remember when I lost my mind.

There was something so pleasant about that place

Even your emotion had an echo

And so much space

When you’re out there, out there

You’re out of touch

But it wasn’t because I didn’t know enough

I just knew too much”

-Cee-Lo, from the song Crazy

International Women's Day

Since Tuesday was International Women's Day, here are some fun articles to check out about women followed by some fun quotes:

*Why is a picture of Obama, a man, my photo for international women's day? Because I believe that feminism is a belief that women and men are equally valuable that needs to be shared by men and women alike. Check out Nicholas Kristoff's article about the many men who are involved in women's rights around the world and how women leaders aren't the only step in promoting women's rights - and that often by time women leaders get to the top, they have had to compromise so much of their "women" agenda to become accepted by a very men-dominate power structure, that they no longer seem like women's rights are tops on their list, whereas men leaders have the luxury of getting to be pro-women's rights AND at the top. I think - and I think Kristoff agrees - that it all comes back to feminism being the belief that men and women are different, but equally valuable and must be equally empowered. Check out the article here and let me know what YOU think.

*A video by some folks at Wesleyan University in response to ideological attacks on Planned Parenthood, called "I have sex". One of the most critical ways we can empower women - in the US as well as around the world - is by allowing them to control their own reproduction. Having kids when you aren't ready or don't want to have kids is one of the easiest ways to change the plans of the rest of your life. This can be in a really good way, if you're ready and excited to have kids, but it can also mean that you don't finish school or don't take that leap at a great career or don't get to travel around the world or spend as much time with friends and family, that you aren't able to wait for the partner who completes you. Institutions like Planned Parenthood allow women to have this power and must be supported.

*and perhaps the most touching article of all, a report on the many mothers who leave their children in order to provide a future for them sent to me by my sister

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

some fun quotes about women:

Because I am a woman, I must make unusual efforts to succeed. If I fail, no one will say, "She doesn't have what it takes." They will say, "Women don't have what it takes."

~Clare Boothe Luce

I myself have never been able to find out precisely what feminism is: I only know that people call me a feminist whenever I express sentiments that differentiate me from a door mat or a prostitute.

~Rebecca West

Feminism is the radical notion that women are people.

~Cheris Kramarae and Paula Treichler

Men are taught to apologize for their weaknesses, women for their strengths.

~Lois Wyse

I see my body as an instrument, rather than an ornament.

~Alanis Morissette

"Somewhere out in this audience may even be someone who will one day follow in my footsteps, and preside over the White House as the President's spouse. I wish him well!"

- Barbara Bush

White Elephant Alien Army (Psychosis)

Somehow I made it to the end of week 1! After a pretty busy morning, we video-chatted into lectures for a few hours in the afternoon (mandatory) from our condo, then went for a long run around the golf courses nearby.

But don't let that make you think my week was easy - this week I've learned firsthand about psychosis:

Q:

What does psychotic mean?

(1) they could have a diagnosis of schizophrenia; 6months or more of either hallucinations/delusions, flat affect, PLUS a significant disruption in the person's life - either in their job or relationships or with the law or all of the above.

(2) schizophreniform disorder, which is basically schizophrenia symptoms for 1-6 months

(3) brief psychotic disorder, which is all these symptoms for <1month

(4) schizoaffective disorder, which is the symptoms of schizophrenia PLUS changes in mood (depression/mania/anxiety)

(5) delusional disorder, which is when someone has a very specific delusion but does not have any of the other symptoms of schizophrenia

you also have to rule out:

(1) bipolar disorder with psychosis

(2) reaction to a medication or a drug (e.g. cocaine, marijuana)

(3) a medical student at the end of her first week of psychiatry rotation.

some direct quotes from my patients this week: (misquoted slightly so as to not violate hippa or anything), and leaving out the more vulgar and disturbing quotes to spare you THAT fun.

"so then after I stopped working on that paper on genetics, I began my research on the white elephant alien army because the words leap of the page and into my head"

- all said in the same perfectly normal tone, affect, and emphasis.

"I am just a bubbling idiot and I am just flying away"

mumbled under his breath over and over

"but I know everything, I see everything, I am everything"

-as a reason why he should be discharged

"I see snakes all over the hallways"

"I hear demonic sounds coming from the walls"

"I just want to go home! why are you keeping me here?!"

- from a man who is homeless, was just discharged a few days before, then came to the ER and demanded to be readmitted to our inpatient psych unit. He is paraplegic and somehow "lost" both his prosthetic and his wheelchair. Leading us to wonder not only why someone would show up at the ER demanding to be readmitted and then protest for keeping him there, not to mention how someone who is paraplegic loses their wheelchair?

what a first week.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

one of my grandfather's favorite quotations, and perhaps true in these cases as well:

"insanity is doing the same thing over and over

and expecting different results"

-Einstein

BI-WINNING - aka "I just blinked and fixed my brain"

why the picture of Charlie Sheen? well, because when I watched this video today, recommended by the staff of people I work with because it is waaaaayyy too familiar.

here's a sorta breakdown of my day:

5:30 am: wake up because

7:30 am: arrive at inpatient psychiatry unit and begin "pre-rounds" with the nursing staff.

this involves going through all the new admissions files and try to figure out who is here because of what, what they have been diagnosed with, what medications they are on, and what problems they have to overcome in order to get their life in order.

8:45: greet the staff and patients as they begin to swarm around the central nursing station, plan for group that day, and handle any problem that arises.

9am: Patient Intakes. this involves sitting in a room off a holding cell where people who have been Baker Act'd or otherwise brought in are waiting - usually sleeping or pacing - and begin asking them questions (one by one) about what happened, why they're here, and what's going on. this initial assessment is designed to figure out if they are a danger to themselves or anyone else, if they are going through withdrawal, and get a basic history of their entire lives so far.

10 am: Community Meeting: all the patients who are on the inpatient unit will sit in one room and introduce themselves, say how they're doing today, and one goal for the day. Sometimes this also becomes a Medication Meeting, where the other medical student I work with and I talk about the biological basis of psychiatric illness and try to explain how treatments, including medication work. We also make it one of our main goals to talk about side effects and help patients be better advocates for themselves when they are put on a medication. Ask about side effects, ask about WHY you're on the medication, ask about what doses are normal to start on, how fast you can increase, what are the long term consequences, etc.

11 am: Rounds with the treatment team, including the psychiatrist

see all 35-45 patients who are in the inpatient treatment center, beginning with most immediately pressing problems (people who are decompensating, or getting worse) and new admissions

2:30 pm: break for a ten to twenty minute lunch of PB&J plus orange juice

3:00 pm: depending on the day, attend group sessions with the inpatient patients or outpatient clinic with our attending psychiatrist where today he saw 64 patients in an afternoon.

somewhere around 7pm: return home to the condo, try to work out and make a delicious dinner

add into this mix that we have lectures twice a week that we are supposedly video-conferencing into so that we can be with the rest of our clerkship, and spend all day Friday at a drug and alcohol rehabilitation center working with a completely different psychiatrist and group of patients. but no night or weekend call, so when we leave work, we only have to vigorously look up drug names, diagnoses, how to write good notes, how to do assessments, and all the other millions of things we need to know already.

I'm pretty exhausted but so excited to be really in the hospital instead of in lectures and studying all the time.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Charlie Sheen on Whether or not he is worried about relapsing:

"No. Not going to. Period. The end. I blinked and I cured my brain. Can't is the cancer of happen"

welcome to CLERKSHIPS!

http://doccartoon.blogspot.com/2011/01/tips-for-third-year.html