Archive | May, 2013

our sweet little ol’ misogynist

29 May

I am now on the Mood Disorders team at Pennsy.  Today we had a new patient: in her seventies; bright white hair; seemingly docile albeit unkempt appearance.

She was calm though a bit confused when we went around the table introducing ourselves.  She smiled and nodded politely at our male attending and resident, then pointed a boney finger at me: “YOOOUUUU!!!  YOU need to puke in your own face!

She would later tell the female psychologist interviewing her, completely out of any context I could decipher  “You wouldn’t know a man if you saw a man.”

But she was appropriate with our attending, ending the interview with, “You’re a very nice man.”  I have to give her points for creativity, making the morning interesting.

On the upside, this little one has been off zantac for almost two months, and she now only rarely pukes in my face:

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passeata

24 May

It’s become our little evening ritual before dinner.  When my daughter sees me take our Beco carrier and secure it around my hips, she starts to pant, becoming more canine by the day!

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Despite being snuggly strapped upright, without her head really supported by anything, she doesn’t always make it back awake.  I can’t say she’s thrilled when she’s wakes up and realizes we’re back at home.

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blurry with excitement

23 May

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Doesn’t matter that she was pissed a mere moment earlier.  Get this girl naked and she couldn’t be happier!  And her excitement is contagious!

Wish I had been able to focus these pictures a bit more, but Ari was all over the place.  I just love her muppet-like tongue in the second picture.

Poor thing is now sleeping off the effects of the Benadryl we’re giving her for an allergic reaction to the Amoxicillin she was given on chance her ear infection was caused by bacteria (I know, I know…).  We’re working on getting her back in tip-top shape for Leo and Jen’s wedding this weekend!!  (And, ya know, for her general health and comfort as well.)

 

the peec

22 May

(Psychiatric Emergency and Evaluation Center)

I have some very intelligent, kind, thoughtful friends who are absolutely opposed to universal health coverage.  Their arguments are sound and logical.  And I disagree with them wholeheartedly.

During my training to work as a waitress at a local pub in Charlottesville, the owner told us, “In my ideal world, everyone would have to work at least one year of his/her life as a server.  What you learn about others, about yourself, about what it means to be at the service of others–it’s invaluable.”

In my ideal world, everyone would spend at least one night meeting and interviewing patients in the PEEC, the place where patients who presented to the Emergency Department with possible psychiatric problems are evaluated for admission.  In what world would it be better for society for these patients to not have health care coverage?  In which the alone schizophrenic woman who is beaten and raped, and almost smothers her infant child during a period of postpartum psychosis (like one of my patients), is denied treatment for her condition?

The drift hypothesis is an argument that mental illness causes one to have a downward shift in social class that often, in turn, exacerbates the problem and causes further drift and isolation.  A famous, albeit controversial, study by E. M. Goldberg and S. L. Morrison examined the relationship between schizophrenia and social class.  It determined that there was a strong association between schizophrenia and a lower social class.  However, the social class in which the participants were raised was found to be similar to that of the general population.  Schizophrenia led to a fall in social class, rather than the reverse.

The vast majority of my patients are either without health insurance entirely or on medicaid.  Medicaid provides some assistance, for sure, but it’s still disheartening to put these young men and women on second-line antipsychotics that are going to leave them with irreversible side affects later in life because the first-line drugs are outside their coverage.

Just a piece of the argument…a far stretch from completely thought out on my end.

medical choices

15 May

This post was not intended as a complaint.  Still, I wanted to qualify the light-hearted mockery of the situation since I hit “publish” the same day this thoughtful article hit the stands.  The latter is a beautiful contribution to the discussion about the choices of women who carry a mutation in the BRCA1 gene.

I don’t know what I would do.  If I’m honest with myself, I think I would opt to have my breasts removed after I was done having children.  Ovaries are more tricky.  On my Ob/Gyn rotation last year, we met with ovarian cancer survivors, all of whom had their ovaries and uteri removed, launching them into “early menopause.”  It’s kind of gentle terminology for what happens to your body when it abruptly loses a crucial component of a delicately balanced hormone supply.  It affects your body in more ways than we understand.  I don’t know what I would do.

But, similar to Jolie, I lost my mother early (at 57 to liver cancer).  Unlike Jolie, I’m not at an increased risk of developing cancer.    I’m very, very lucky that I don’t have to choose painful surgery, months of reconstruction, a body that’s not entirely my own, and perpetual hormonal instability in order to lessen the risk of death while my children are still kids.  Jolie is confident that she made the right choice for her and her family–either way, any decision at which those with the BRCA1 mutation arrive, it is so brave, and so constantly thought-provoking.

It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that’s it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can. On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.

Angelina-Jolie

pumping on a psych ward

14 May

Alternative title: anna’s tatas on display in the most unflattering way

For the first three weeks of my psych rotation, I’m on the dual diagnosis unit at Presbyterian, where patients are treated who have both a substance abuse issue and some other psychiatric disorder.  It’s a fantastic learning experience.  But, on a ward where you require a key to get in to a linen closet-size hallway bathroom and there is exactly one break room for all staff, you can imagine that places to pump are limited.  And Presbyterian is an old hospital.  With decade-old sugar packets and rancid peanut butter jars lining the cupboards of the break room, I would not be shocked to see a rat, or at least a cockroach, scurrying across the floor.

This is where I’m pumping between patients, crouched behind the deep dish-washer sink.  I’ve hit my head three times on the damn paper towel dispenser.  My attending has gotten a full-on view of my cattle-like breasts at least twice.  And I think I’m starting to get carpal tunnel due to awk pumping positions.

The first time my attending saw me pumping, he turned around quickly and apologized emphatically.  In an effort to make him feel not so embarrassed, I thoughtlessly stammered, “Oh!  No no, I don’t care at all!”  To which he replied, “But dooo!!!”

Fair enough.

(Side note: I have received nothing but support and encouragement in my efforts to continue breastfeeding.  One of the therapists recently offered the use of her office on another floor, I just haven’t been able to take advantage of it due to time constraints.)

Right now, my experiences have only added a little extra comedy to my days back in clerkships.  But they have made me think about what I’ll choose if I have infants while in residency.  I’m thankful for the wealth of options I, and more women, have.

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exactly right

12 May

For the first time in maybe two weeks, bonita Aurelia slept until 5am.  At 6am, Vovi woke up and we had a peaceful Sunday morning coffee together.  At 7am, she told me to go back to bed, and I slept another blissful two hours.  I woke up to a smiling husband and well-rested daughter wishing me a happy first mother’s day.

The day wasn’t perfect.  Our girl is still visibly and audibly pissed to be not quite feeling like herself and, to add insult to injury, she has seven more days of the an unappealing emulsion of amoxicillin.  But we had a few moments like the one below, the photos of which I’m letting distract me in the midst of memorizing the side effects of different anti-psychotics.

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Happy Mother’s Day not only to the mothers but to all who nurture, teach, love in her/his own way.  xoxo