A year at U of R

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Thursday, November 30, 2006

Adolescent Psych

I've started yet another new class and rotation - Psych Mental Health. Like the other rotations, I have didactic coursework where we learn about schizophrenia, mood disorders, suicide, etc. I also have a clinical rotation two days a week. In addition, I'll be attending Alcoholics Anonymous meetings and doing a day of observation at an outpatient psych clinic.

For the rotation, I was assigned to a locked, inpatient teenage psych unit. There are only three of us students in the unit, so it has a very intimate feel. There are about 17 patients on the unit. At any one time, there are two nurses, and several patient care technicians staffing the unit. The teens have diagnoses ranging from major depression, bipolar disorder, autism, attention deficit disorder, mood disorders and personality disorders. Often, a patient has a combination of disorders, sometimes combined with substance abuse. Almost all of the teens are on suicide precautions, and many are on violence precautions as well. You see lots of teens who are suicidal and homocidal. Many have pending conflicts with the law. Some have molested younger children.

I often wonder how much of the disorder is about the kids, and how much is due to the environment. Many of the kids have been abused, or have parents who are in jail or are drug addicts. Some come to the hospital from group homes, or from long-term psychiatric care facilities. Some will be discharged to long-term psychiatric care. Some of the patients can't be discharged because there is no where for them to go home to.

The saddest part about it is that I really like these kids. Most of them are cognizant of their problems, and surprisingly willing to discuss them with me. I get the feeling that for some of them, being in a locked psych unit is a much better environment than being at home.

They are also just teens. The some of the girls are real drama queens. They zig-zag around the halls in the morning, into and out of the bathrooms and each-other's rooms, with wet hair wrapped in towels. They spend huge amounts of time on their make-up, even in a locked psych unit. They come running to the nurses station to announce that "EEUUUWWWW, there is soap on the bathroom floor!" and "What should I do? My purple pants are still wet from the laundry!" My main function in the morning seems to be handing out mascara from patient's personal bags.

The boys are just as teenagish as the girls. They are gawky, awkward, and a little oblivious. They wear pants hanging so low that I can't figure out how they walk. Standard male fashion is also baseball hats, possibly to cover the fact that they haven't washed their hair since they were admitted.

During the day, the kids attend school hours, two hours a day in a classroom staffed by two public school teachers. They work on schoolwork from home. Since I don't have much else to do on the unit, I usually help out whoever looks lost in the classroom. Today I helped a patient write a paper on the Abolition movement. Yesterday I helped look up the genus and species of wolves, dogs, and coyotes. The day before, I went over to one kid who was poring over a math textbook.

"Can I give you a hand?" I asked.

"Sure," he said. "Can you help me figure out the derivation of this?" he said, pointing to an equation that looked complex enough to stump Einstein.

"What math level is this?" I asked.

"Calculus," he told me.
He spent the rest of the class hour teaching me how to use the quadratic equation. I never expected I'd spend my clinicals in a locked psych unit, relearning the quadratic formula from a patient.

The kids also attend other sessions, such as goals session, art therapy, and skills sessions. I usually participate in the session along with the kids, and talk to them while I do. Often, I'll sit down next to someone who isn't participating, and try to involve them.

Then there is free lounge time. The girls sometimes choreograph dance routines to the latest music, and sometimes they just mill around in the lunch room and talk. Often, one kid will put a DVD in the player in the lounge, and they'll all sit around on sofas and the floor, eating popcorn and watching a movie. Of course, since they're my patients, I watch the movie with them. So far, I've seen Independence Day, and part of the Truman Show. It's a very tough rotation!

One day, a fellow student was working on charting. She had a question, so she went into the lounge to look for the nurse who was monitoring the kids during lounge time. The kids were all there, intently watching a movie. And there was the nurse as well, fast asleep on a chair in the midst of the kids, snoring gently. My fellow student had to wake him up.

Wednesday, November 08, 2006

Signs of trouble

Today was a busy day in my final week of pediatrics. It has been a challenging and exhausting rotation, and I will definitely miss it. I enjoy working with kids and teens.

I was pretty tired and distracted in the med room today, with my instructor. I couldn't find one of the meds in the patient's drawer. I was talking to myself, almost oblivious to my instructor. "Hmmm, I wonder if it's in the frozen food section?" I asked myself out loud as I opened the mini-refrigerator where some special meds are stored. My instructor cracked up.

Tonight I'm writing a paper. You know you're in trouble when the grading rubric for a paper, listing all of the information which must be included, is three pages long. What ever happened to conciseness?

Monday, November 06, 2006

Spilled milk

Last week my winning experience was with a two year old. She was very shy, and in her world, any contact with someone in a uniform had to be painful. She cried anytime you touched her.

It took quite a while to take her O2 saturation. First I showed her the red light inside the monitor, and asked if she could see the red light. Then I put the finger clip on my finger, and showed her how the little red light shone on my finger. "Can I shine the light on your finger?" I asked. She was fine as I took the reading. Of course, I let her put the clip on her mom's finger too, just to be inclusive.

Next came the stethoscope. "Can you help me out?" I asked. "Can you hold this right here for me?" I said, pointing at her chest. She willingly took the bell of the stethoscope, and held it in place. "Now can you put it there for me?" I said, and pointed to another area. Once she was in control, it was no problem at all.

That was my moment of glory. I was a real nurse, a pro!

Of course, the illusion only lasted a second. With the parents and child all watching, I casually went about my next task, hanging a new bag of IV fluid. My instructor came in to watch as well. I deftly removed the old IV bag, grabbed the new one, and spiked it with the tubing. I guess I need to work on the spiking technique, because the minute I hung it up, the spike and 500cc of normal saline came gushing out on the floor like a waterfall. I cringed, and my instructor stoically grabbed a towel. The two year old, however, was delighted. She had never realized how much fun people in uniforms could be.