my life, my pace

After 1 week of psych consult, I learned that I do not, under any circumstance, want to go into Internal Medicine. How anyone can stand the smell of someone else’s diarrhea is completely beyond me. And I’m from psych consult! I probably had to smell it for, what, five minutes? Yeah, well, five minutes is far too long. I cannot imagine being on Medicine and actually having to do a physical on someone who stinks of poo. Let’s just say that I was actually glad I hadn’t eaten before seeing this patient because I would have surely vomited otherwise.

We get a lot of consult requests from the various Medicine teams in the hospital. So I’ve had the distinct pleasure of visiting many Medicine areas in the hospital. And they all have that distinct hospital smell that I have now grown quite sick of. Sometimes, this smell is intermingled with the distinct smell of poo. The people in these areas tend to be pretty sick with multiple problems. And MRSA. I guess I should be glad I’ve learned how to gown up for such situations. But, really, I just don’t like it.

At the end of my second week, I learned that I don’t like talking to patients. Or their family. Or anyone else, really. Sure, I already knew that, but I thought it would change when I started wards. That something inside of me would magically change and I all of a sudden wouldn’t be socially awkward anymore or hate talking with people. No such luck. There’s nothing like knowing nothing to really make you not want to open your mouth when speaking to patients. Patients who expect you to know everything.

By the end of my third week, I decided that I’m going into Radiology. Over the weekend, I debated whether it was really what I wanted because I never really liked what little Radiology I had been exposed to in my first two years of med school. And it’s also 4 years on top of an internship year. Plus I’d want to either do a Neuro or Interventional fellowship, which would add another 1-2 years, making it 6-7 years total, far too long a time for someone who has already wasted 4 years on a PhD that she’ll likely never use. So I had my doubts.

Then, yesterday, my attending insisted on watching me interview a patient. These kinds of situations are particularly painful for me because of my social awkwardness and nervousness when being watched by other people. Of course, I get a psychotic patient. Which I’ve never seen before. So I really concentrated on making sure I asked the right questions on the timecourse of his symptoms as well as things to rule out depression and mania and the like. And because I was being watched and didn’t want to waste the attending’s precious time, I directed the interview more than I usually do, sometimes cutting off the patient’s rambling answers to interject my own questions, but never too brazenly. I also took this approach because I’ve gotten quite a few delirious/talkative patients who would talk and talk and talk without making much sense, making for really long pointless interviews and I was kind of tired of it. Also, I was modeling the interview style of the other attending, who I’ve worked with more than this particular one, who keeps things nice and short. Well, at the end of it all, this attending called me an unempathetic information gatherer. Now that might sound painful to those who aren’t used to hearing themselves being described that way. But it didn’t surprise me at all. I actually wanted to respond by saying, “Tell me something I don’t already know” because I didn’t find that assessment particularly useful. I know that I suck at empathy. That’s because I suck at social interactions, period. Sometimes, I think I have Asperger’s. And the sad thing is that I was actually trying during this interview. Though not as much as with unwatched interviews because I always feel so fake doing such things and didn’t want the attending to call me out on it. Yeah, that plan worked out well.

So, that’s how I’ve come to decide that Radiology is for me after just 3.5 weeks on rotations. The only thing that might change my mind is Surgery. But I doubt it. And I’m sure my attendings will be glad to know that I won’t be spreading my unempatheticness wide and far.

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1. i took the plunge!So part of our third year curriculum includes the much-loved warm-and-fuzzy doctoring class that kicks my ass because I'm so not warm and fuzzy. I've been trying to not be super quiet, but it's been hard because my group consists of people I don't know who all seem to know each other so well and because there are a couple of extraverted people who tend to dominate the discussion. But I am thankful that there are only about 2 extraverts instead of 6 when I got screwed during my second year. Well, the other day, our session was about dealing with family members of someone in the ICU who isn't going to make it. The discussion centered on how difficult it is to handle such a tough, emotional situation in a way that makes the family feel better. And, of course, just to make things hard on us, there was going to be a standardized patient interview. We decided to fly by the seat of our pants early in the course, with the interviewer volunteering on the day of the interview instead of pre-assigning days to people. Of course, I did not volunteer. Not because I was afraid of it being too emotionally draining or heartbreaking or whatever. But because this case required loads of empathy, which I severely lack and I didn't want to be evaluated doing the thing that I am weakest at (these stupid mock interview evaluations go into our Dean's Letter to residency programs!). Someone else...
2. in response to my dear reader post…Ages ago, I noticed an onslaught of new user registrations without much in the way of comment-posting, so I wrote a post requesting that readers give me some input about what they want to see on this blog. I am now finally getting around to responding to loyal (I hope so still...) reader 314's questions listed below. 1. Did you ever have any dream careers as a child? When I was in elementary school, I wanted to be a scientist. I even went so far as to draw a picture of myself in a labcoat working with chemicals at a lab bench when I was in second grade or so. So I've always been interested in the sciences. In high school, I wanted to be an astronomer until my mom told me that I'd never find a job (she was probably right). Not very interesting, huh? 2. What did you think being a doctor meant when you first decided to go to med school? I lived a pretty sheltered life until my mom passed away when I was in high school. Even afterwards, I remained pretty sheltered (thanks to a psycho possessive ex-boyfriend). I had never really been exposed to what it is that doctors actually do except for what I saw whenever I went to my own doctor, who was invariably either a family practician or a pediatrician. So I thought that being a doctor meant having my own general practice and that was what I wanted to do....
3. one week down, 47 more to goSo I'm done with my first official week of third year. And it sucks. I don't know if I'm supposed to feel this way, but I kind of hate it. Maybe it's because I'm on psychiatry adult consult and all I've seen this week is malingering, delirium, and dementia, all of which involve pretty hard to interview patients. I suppose my malingering patient wasn't that difficult, except for the fact that he was a prison inmate and kind of scared the crap out of me. But I definitely didn't figure out the malingering part, which makes me an idiot. I'm so tired that even 10+ hours of sleep last night wasn't enough to make me not feel dead tired today. And this is just psych. It's not medicine or surgery. I wake up at 5 in the morning so that I have plenty of time to preround on my one patient (I have two now, so I'm not quite sure how I'm going to pull it off on Monday). That's how slow I am. At this rate, I might as well not leave the hospital when I'm on medicine and surgery because there's no point when I'll probably have to come back in an hour or so since I'm so slow. Not only am I slow, but I don't know shit. My fellow psych consult-ees all claim they don't know anything either, but it sure doesn't sound that way when they present their patients. I'm just waiting to get yelled...

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