Island Med Student

Even the most floridly psychotic patients have many important things to say. Sometimes, their words are profoundly wonderful.

Today reminded me of this fact.

To protect confidentially, I’ll change the words, but the gist is this.

Today, I sat in on a music therapy group.

After listening to the Bill Withers song, “Lovely Day,” a patient said, “that’s a biscuit song.” When asked why, the patient responded, “because it’s fluffy and has lots of layers.”

That remark is one of the millions of reasons why I really do love my job (that I pay to have).

The abbreviated lyrics are below:

When I wake up in the morning love
and the sun light hurts my eyes

And something without warning
love
bears heavy on my mind.
Then I look at you and the world’s alright with me

Just one look at you and I know it’s gonna be -

A lovely day - lovely day

When the day that lies ahead of me seems impossible to face

And someone else instead of me always seems to know the way
Then I look at you and the world’s alright with me

Just one look at you and I know it’s gonna be -

A lovely day - lovely day

When the day that lies ahead of me seems impossible to face

A lovely day - lovely day

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Oh my goodness, I have learned so much in my seven days of rotating at St. Elizabeths hospital. But, as I have mentioned already, I am suffering from amotivational syndrome right now, so I will give a very abbreviated list tonight, and try and post more often in the future.

Here is a short list of what I’ve learned so far:

1) TONS about pharmacotherapy for schizophrenia and mood disorders including indications, side effects, contraindications, etc.

2) Capgras syndrome is when you think your family has been replaced by imposters.

3) How to classify various disturbances in thought process such as circumstantiality, tangentiality, loose associations, and echolalia. I’ve seen patients with just about every one of the various disturbances.

4) How the laws of psychiatric commmittment work in DC.

5) Some nurses can be a little mean at first, but once you gain their respect, they are incredibly nice and helpful.

6) The DSM criteria for many different psychiatric disorders.

7) How Freud had his research in cocaine as a topical eye anesthetic stolen from him.

8 ) How to distinguish between the different subtypes of schizophrenia, and that paranoid schizophrenia doesn’t necessarily mean that a patient has paranoid delusions.

9) My experience as a psych tech is incredibly helpful to me on the wards.

10) The difference between bizarre and non-bizarre delusions. For example, thinking that you are being followed by the FBI is considered a non-bizarre delusion, whereas thinking that your heart was removed and replaced with Jesus Christ’s heart, giving you supernatural powers, is a bizarre delusion.

More goodies to come!

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Check out my post on Medscape about my renewed passion for psych.

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I’m terribly tired from the first day of my psych rotation today. I have so much to write about, but I’m going to wait until I have more energy. My interest in psych has again been ignited! Anyway, here is a quote to sum up my current thoughts:

“Be who you are and say what you feel, because those who mind don’t matter and those who matter don’t mind.”

-Dr. Seuss

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Okay, so if I were actually faced with a real life code, I’d probably pee my pants and run screaming in the opposite direction for a doctor. But, hypo-the-tically I can actually run a code as a team leader. Over the past two days, I’ve had my Advanced Cardiac Life Support (ACLS) training. I know everything about identifying various heart rhythm abnormalities like atrial flutter, ventricular fibrillation, and supra-ventricular tachycardia. I know how to use a defibrillator, and when to give shocks and at how many joules. I know which drugs to give like epinephrine, atropine, etc, and I know the dosages and maximum quantities you can give. I also can place advanced various airways like combitubes and endotracheal intubation.

We practiced a million times, and eventually I memorized all the algorithms, and got over my fear to the point where I could manage anything they threw at me, including a dummy that was in asystole for like 10 minutes!

So, I’m now officially certified, and ready to be thrown into the mix at US hospitals. After the training, I took some more pics of Princess Margaret Hospital, and shot some video footage that I’ll be posting soon.

This is it. I’ve done everything I need to do. Only 4 days, 19 hours, 25 minutes, and 16 seconds until I leave Dominica!

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I spent the day at Princess Margaret Hospital taking a Basic Life Support (BLS) course for healthcare providers. I was certified in the past, but my certification had expired so I had to take the class today. Basically, I spent the day doing chest compressions, giving respirations, and using an automated external defibrillator (AED) on a variety of non-alive patients of various colors and sizes.

I’m kicking myself in the butt for not bringing my camera with me. Since I had no camera, I got creative and used my laptop to snap some pics and a short video, but they’re of low quality. Thursday and Friday I have my Advanced Cardiac Life Support (ACLS) class, and then I’m audi TT! Next time I will be bringing my real camera!

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Check out my post on Medscape about the cultural differences in trusting physicians.

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Friday I did my psych rotation at PMH. The cool news? It was my very last day of rotations! All I have left is one practical exam on Monday, one written exam on Thursday, and 3 days of BCLS and ACLS training the next week. I can’t believe how quickly 5th semester has gone by! Today or tomorrow I’m going to post about my overall experience at PMH. Many people have asked me how I liked it and whether or not I’d recommend staying in Dominica for 5th semester. The short answer is yes, STAY!! But I’ll post an official post soon with details.

The psych rotation was awesome. Even though I didn’t get to see too many patients, it was still quite interesting. I think on some level I expected psych patients to be different here in Dominica. Well, for the most part, I was wrong. I met a few patients with schizophrenia and a few who had manic-depression. For the most part, they were strikingly similar to patients I’ve seen in the States. Listening to their stories and getting to know them really reminded me of how much I love psych. Mental health issues can affect peoples’ lives much differently than a physical health complaint. Living with schizophrenia, or having a friend or relative with schizophrenia is an incredibly challenging undertaking. It would be an understatement to say that it’s very difficult and frustrating at times.

After seeing the patients, we spoke with the psychiatrist for a while. He was absolutely amazing and very intelligent. He spoke to us about issues relevant to mental health in Dominica. I was shocked to hear him say that there are very, very few attacks on staff by psych patients in the hospital. I was used to being attacked verbally and physically almost every day at my old job in a psych hospital in the States. When I asked him what he thought the difference was due to, he said that it’s probably because of respect. The patients in Dominica tend to trust and respect medical professionals very much. In fact, I’m always surprised to hear the patients respond “yes, doctor” to me almost every day. They trust what you say to them and respect your knowledge. I guess it’s very different in the States. There is a general suspicion of doctors. And when it comes to mental health patients, there is a lot of mistrust and even downright hatred. Take, for example, a patient with paranoid schizophrenia. They are the epitome of distrustful. Yet here in Dominica, they still tend to trust the doctors and nurses (at least to some degree). This is absolutely amazing to me. I’d like to write a much longer article on this topic, but I don’t have the time right now.

So, more to come soon!

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Check out my post on Medscape about how the beat goes on…

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I forgot to write this post on Friday, so here goes:

1) Soaking gauze with adrenalin is a good way to create hemostasis.

2) Surgery on someone with a heart murmur can be an indication for prophylactic antibiotics.

3) When performing surgery on the nasal sinuses, it’s a good idea to pack the throat with gauze to prevent blood from accumulating.

4) When extubating someone who has a lot of blood or secretions near their airway, you should try to put them on their side.

5) Forced expiration against a closed epiglottis can cause acute pulmonary edema.

6) Acute pulmonary edema is a life threatening emergency. Also, I had learned about pink frothy foam in class, but seeing it in real life was a totally memorable experience.

7) STAT furosomide works well for acute pulmonary edema. Discontinuing IV fluids is also important.

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