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Archive for the ‘Mind’ Category

Unfortunately for me, not the super awesome fun theme park kind.

Just the run of the mill, woe is me, life change sorta one. The kind where huge changes are going to be taking place and all of the sudden you realize, wait, what the fuck? For reals? And then start to get all shaky and worried. I have been working towards this whole DVM thing since approximately second grade, give or take the few years I suffered under the delusion that I might be at all interested in the field of human medicine (emergency and critical care for the curious).  And now, in just a couple weeks, I’ll be there.

The fuck?

Then what? I mean, I’ve had the same life goal for a couple of decades and now all of the sudden, it will be accomplished. What on this earth is a person supposed to do with that? Just go and BE a veterinarian? I dunno. It’s not that I feel unprepared for my chosen career at all, it’s that I don’t know how to be a person now. I’ve always had a driving goal, an end I was working towards, a direction. Now I feel adrift, helpless and worried. I don’t know how to do anything other than strive and push forward to get what I want, but now that it’s in reach, I don’t know what to do next.

I really want to go to a retreat. I think a few weeks of meditation would do me a world of good, but there’s no time for that. I have to go and start this whole career thing up. I worry that I’m going to cling to the next thing that comes along, just so that I have a new goal, a new distant star to follow, because I find this rudderless, drifting feeling very unsettling. It’s new and unknown and I don’t like it.

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There was another cardiac arrest I worked on recently that was (more) unexpected. A neuro patient (weakness, muscle atrophy, etc) had an MRI late in the day and was kept overnight for observations mostly because he was still too sedated to go home during normal hours. Anesthesia went off without a problem, but he’s had some respiratory infections or pneumonia in the past so we were checking him every hour or so just to make sure he was doing okay and not having any issues.

At midnight he started having some respiratory noise and a little cough, but his lungs sounded okay, so it was likely just some tracheal irritation. At six he was pretty much the same as he had been all night, lethargic but rousable and able to move/walk/interact and mentally there. At seven a colleague ran into ICU and let us know he was either already dead or on his way.

There was running, there was gurney-ing, there was emergency giving of drugs and shocking. There were lots of chest compressions. During a round of these I realized that my recent trainer was correct, compressing along to the beat of a song definitely helps keep the speed and depth of compressions appropriate. Now, the two songs offered to me were “Another One Bites the Dust” and “Staying Alive.” Which you choose, I was told, was based on how cynical you are.

I really wanted to go with “Another One Bites the Dust” because as we know, the survival rates for non-anesthetic arrests are crap, and it amused me quite a bit. That and I really hate the Michael Jackson song. Wouldn’t you know that the one I didn’t want decided to nest its little irritating self into my head. I was grimacing even as I was in the midst of the CPCR because I HATE that song but it would not go away. Alas, I suppose that’s how it goes when it comes to my brain’s emergency defaults.

I wonder which song the King of Pop’s doctor preferred?

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Generally speaking being extroverted is touted as a positive thing in society. Extroverts are comfortable public speakers, network easily and can close a business deal, at least according to the stereotypes. Introverts are quiet, and maybe smart?

I’m really not too sure about all of this, and this is coming from an extrovert- I much prefer to go out with friends after a hellish day than sit at home and stew. After a day of surgery where nothing went exactly as planned and one thing went completely sideways, it was a quick run to the gym and then out with friends in person and on the phone to tell them about the crazy, get some sympathy, and get rid of the complete and utter frustration and doubts about my skills. Had I gone home alone it probably would have ended with a bottle, which is not really a good option when you have to be back bright and early for some ICU patient care.

That doesn’t mean that I am not shy or that I am the first person to say hi when someone walks into the room. I’ll do my public speaking, sure, but I’m not jumping up and down shouting, “Me! Me! Oh please, pick me!” I am not the whirlwind who comes in, crashes the party and gives everyone else some stories to tell. In my element, among friends, I certainly like being center stage and cracking folks up, because that’s fun, but it doesn’t equate to “good” or “better” than folks who don’t.

Introverts are not stupid. They are not necessarily shy any more than extroverts are necessarily bold. They just need time to think and recharge by being away from others rather than in the thick of them. Some of the best public speakers are introverts, more often than not because they actually take the time to [i]think[/i] about what they’re going to say before saying it rather than blurting out what comes to mind or narrating the reasoning process. The speaker who has one powerful phrase uttered after a moment of contemplation is most likely and introvert. The speaker who was a crackup  may have been an extrovert. Which message sticks with you longer?

It just gets me down that introverts can be given such a rough time in our world. Some of my best friends, the ones I rely heavily upon to reconnect me with reality are the ones who stop and think and are a little more reserved. I’m flying all over the place all by myself, I don’t need help with that, I need the help of those who can grab me and bring me back, sit me down, and shut me up with a well planned observation. I am fortunate to have a few of these wonders in life and I feel they are unjustly denigrated, or at least not appreciated nearly enough for their worth to society and to me.

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Horseback 1

I think my riding instructor is trying to give me a swollen head. Too many compliments, which I don’t know how to take well to begin with, and I get a bit suspicious. He’s the expert though, and I love gold stars, so no complaints here. Sitting the trot is going well, very well even according to a random observer a couple of weeks ago, and even better today. I do like hearing that I pick up faster than some people do. Posting is still a work in progress, mostly because I do not have the muscle strength to do it like I WANT to be doing it. Only off on the wrong diagonal once, and I knew it and was in the process of confirming and correcting it even before I was prodded to do so.

No wibblywobblyspooky bits today, which is fine by me. I also remembered to look where I was going, which sounds obvious, but is in fact harder to do than you’d think when you’re also trying to remember to tell 42 different body parts to do certain things in certain ways that they’re unfamiliar with and don’t really know how to do. Got the gas pedal working a bit better as well, which is a bit of a relief since I know it’s (in part) a confidence thing in that yes, I’m asking properly, but just need a little more emphasis rather than that I am not asking in an understandable way.

How does Dressage competition stuff work? What is “A” level? Apparently I could get there? I think that’s good, it was said in a ‘good thing’ tone anyhow. Hmmm.

The only bad thing is that I’m out of ibuprofen.

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Today was an interesting day at the hospital. It was interesting on the medical side since I got to play with some of my favorite toys: allergies/dermatologic issue and behavior medicine. There were kittens too, which is always a nice bonus. And some blood draws that made me feel like I might be a doctor yet. The terrible, no good, very bad case from Monday is stable and happy, and seems to be doing quite well. It appears that no more urine is leaking into her abdomen at least. If the ureteral reimplantation takes is still yet to be seen. If not, she’ll have surgery to take out that kidney next week. She is happy and playful though, and as usual, her appetite is voracious. Today was busy in part because it’s the edge of a three day weekend, when everyone realizes, “Oh shit!” and decides to walk in at once. Finally got to leave after 13 hours today.

So, it would be fair to say it was busy, and even somewhat stressed since we had some legitimate emergencies come in including a foreign body ingestion and a basketball sized spleen. Also had a ginormous retroperitoneal abscess and an anterior lens luxation. Neat cases… in the medical sense any way. We have to handwrite our files and our discharge instructions though, which is a curse for me. I cannot write quickly. I joke about being dyslexic sometimes, but sometimes I wonder if I should do some research.

Reading, silently to myself, has never been a problem. Not a problem that I remember anyway, but I was a shy child and practiced a lot. Reading aloud is torture. I skip words and half sentences and I hate it. Writing is much the same. I don’t write things in the correct order. One particular doctor was looking over my shoulder as I wrote out a prescription today. I was writing in the patient’s weight (23.6kg) and wrote the ‘3’ first, then the ‘2’ and then the ‘.6’ which earned the comment, “dyslexic much?” I dunno.

Maybe.

I then got the drug all jumbled up as well, which made me wince. I didn’t mean to write the letters or words in the order I did, that’s just how it came out, and I have to be very careful not to skip ahead and leave words out when I’m writing. I have a helluva time saying things in the correct order too. You know that joke about drunks who are switching parts of or entire words around? I do that normally. Especially if it is something like “neoureterocystostomy” which, I later learned, is actually “ureteroneocystostomy” and I just had switched it. In other words, I am not so think as you drunk I am. On a daily basis. What really gets me though, is that I will even do it with a freaking keyboard! That ‘remember’ a couple of sentences ago was originally typed in as rememper. Thank MS for spell check. Oh, and could we get rid of the whole pbdq thing too? They are not my friends. In real life they wind up being a ball with a line straight up and down bisecting it (think of the greek capital phi) or being completely scribbled out so I can start over.

At least with keyboards and electronic records, or even a word program I can type and print them out with, records and discharges are less painful, way faster, and far more readable for any poor sap who needs to extract information from them.

ETA quotes/links that interest me:

Signs/symptoms: letter reversal or mirror writing, difficulty with word retrieval or naming problems (which is easily overcome, just describe what it does or looks like and people will give you the word), difficulty distinguishing between similar sounds in words; mixing up sounds in polysyllabic words (auditory discrimination), for example, “aminal” for animal, “bisghetti” for spaghetti (Doesn’t everyone do this? Most people seem to think it’s funny), and difficulty reading out loud, reading words in the wrong order, skipping words and sometimes saying a word similar to another word. Apparently dyslexia actually runs in my family too… as in, my dad. Still don’t think I’m actually dyslexic though… I can read, and well, after all. Isn’t that one of the big things?

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Apparently I have  a new career ahead of me in public speaking. I recently completely one of my graduation prerequisites which includes a research paper and a 20 minute presentation on the same subject of my own choosing. As mentioned in yesterday’s post, the paper wasn’t much of a stretch for me, especially as my subect related to one of my previous posts. It was something I am interested in, so doing the research and learning about it was fun. The paper writing was not a problem, and while referencing everything was a downright pain in the ass, it wasn’t really a challenge. And, best of all, it is pretty much a humanities subject, which saves me from typing “it was found that” and “it was observed” twenty million times, which always makes things easier to write. Not that I was out there using first person, but the research article mode just kills me.

And then there was the presentation. Now, I have spent a small amount of time on a stage in the past. School stuff mostly, no biggie. But there you have a script. You are someone else, so there’s nothing to be nervous about, since none of what you’re doing really is you. It is a shield in a way. This presentation was not the same, since I had no script, and it really was me and only me in front of seventy of my peers (well, some peers, some senior clinicians which don’t feel quite peer-y). Top it off with a powerpoint. I despise powerpoints and thus far in my career had only been clumsy enough to be subject to their whims once before. Yes, you read that right- before this, I had only made ONE powerpoint presentation, and even that was a group effort. I had been the designated speaker for other powerpoint presentations, but I didn’t actually MAKE those and more or less ignored them as I gave whatever blabber needed giving.

So I made this power point, barely staying this side of ‘too wordy,’ which was an effort. I practiced my presentation twice, realized that the two practice runs were dramatically different in multiple ways, and then surrendered entirely when I realized that I could not make a script for myself at all because I had internalized my information too well and I was just going to say whatever happened to come out. So I went, I talked about my subject  for 20 minutes while occasionally glancing at the slides to make sure I was still talking about whatever the heading on that slide was and got through to the questions portion without running terribly over time-wise. I had made notecards, which merely got bent and sweaty in my palm because I got too caught up in what I was saying to worry about them.  I looked at the audience, they looked at me, I got a few laughs, took a few good questions, and then time was up and I was done.

People said I did well, and I figured that was good. I was fairly certain they wouldn’t fail me even if I simply stuttered and wandered around like a lost duckling while flipping through slides, so I wasn’t overly concerned about how well people thought I did, but I was glad that people seemed to enjoy it. If you can get a laugh, the audience can’t be too miserable, right?

Then I got my reviews. People really did enjoy it apparently. I was rated highly on information, clarity, and most of all, poise and audience connection. Which is excellent and makes me happy. But two reviewers commented, independently, that I was a natural public speaker. Which just floors me. I am glad that I am comfortable talking to people about subjects I know well, but Public Speaking? That sounds big and scary and like it is something for people with Causes. I don’t have a Cause. I may have a few causes, but no unifying, evangelical Cause for which I could become a public speaker. I’m flattered, don’t get me wrong, I just think that any public speaking I do is likely going to be limited to a very select, small audience by virtue of the topics I am qualified to speak on.

 

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Being a professional is an odd headspace for those of us new to it. I have been a student all my life. Yeah, I graduated to secondary school, then to college and learned what life as a college student was all about. It was and wasn’t different than that of a high schooler in different ways. My college promoted responsible drinking, which is to say, they didn’t punish you for being smart and going to the health center (or your roomie for hauling your drunk ass there) if you drank to much rather than secretly hiding in your room and dying of alcohol poisoning. That was different from high school. And the easy access to pot.

Then again, that was probably just because I was too determined to get into college and follow my medical dreams to take advantage of the fact that one of the high school teachers dealt pot to students for nearly twenty years before he was caught/retired my senior year. Many of my friends smoked pot though. I still hold that if I was ruler of the world, pot would be legal and cigarettes wouldn’t be. Not that even in college I smoked much weed. I am a terrible smoker- I cough and hack and it’s just not fun for anyone. The high is fine, but getting there may or may not be worth it depending on my mood. Pot brownies on the other hand, those are good clean fun for everyone. I have fond memories of driving a (very) stoned friend to the store for brownie mix. Because that was how we rolled- no one was allowed to pressure anyone else to drink or smoke, and you sure as hell better not let anyone of your friends find out you had even thought of driving under the influence when there are plenty of folks about who would happily give you a ride for a tasty treat after the fact, or just the moral superiority and hilarity of watching your buddies behave like buffoons.

Undergrad was a good time. I enjoyed it. Not as much as some others maybe, but enough to have accumulated fond memories. I think being a humanities person had something to do with it though. Late night discussions about the history of the ramen noodle and the embargo on cuban cigars were always par for the course. Then I go and get myself into a professional medical school. Where people have NO humanities skills, FEW social skills, and can’t read literature or write a simple opinion paper. It’s all sorts of fucked up. You tell me you need a 20 page paper? I may bitch and moan, but there is no question I can get it to you by Friday if need be. Some of my soon to be collegues might have a heart attack.

How did you people get to (almost) be doctors when you cannot write? I have read some papers by these people, on topics of their own choosing, that made me want to scoop my eyes out with a rusty spork. Yes, they can do multivariate calculus (so can I btw, it’s actually pretty fun) but they cannot communicate in writing, and some can’t even do it verbally. The social and coping skills are to match. So I look at this group of professionals I will be sharing breathing room with for the rest of my career and I wonder.

I can do all the things they can do. To some extent, anyway, we all have our strengths and weaknesses of course. But I can do these things, AND I can also do other things. I WANT this to be my career, but I could make a living a dozen other ways too if I had to. So while I feel I am a complete and almost certified member of this professional circle, I also feel like I am still part of another circle. Another circle who knows that there is Art to Medicine, not just science. I hope that more of the folks in the one circle learn to come share my second circle with me too, or it is going to get lonely in here.

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