Internal Medicine with a Minor in Psychology

My clinic doth run over.

Officially each office visit should take 45 minutes of my time. Recently, however, this has not been the case. Instead I will have three or four 50 minute appointments and one drawn out and draining 1 hour and 15 minute one. This is not because I am just that thorough and kind hearted. But rather because my patients all seem to have a touch of the crazy.

Sometimes it's fibromyalgia with the patient reporting pain here, here, and here. Some pain there radiating back to the first here and sometimes becoming the second here. And that place over there has two types of pain. Oh and my hair hurts.

Sometimes it's chronic fatigue syndrome. Or myalgic encephalomyelitis as my patients like to call it. Or yuppie flu as I like to call it. They aren't the actual patients, their sick relatives in need of custodial care are usually who the visit's for, but patients' families can just as often be as much part of the problem as part of the cure.

Then there's the standard old major depressive disorder. Patient wants to kill himself, doesn't want to talk to anyone about it, and doesn't want to leave the exam room. Of course he didn't come in for depression. No, you cannot get a medicine appointment for a psych complaint. Instead you gotta be sneaky crafty. Don't want to ruin the surprise.

And lastly there's the undiagnosed bipolar patient talking incessantly, not answering questions, and generally providing no relevant information about his ailments to do either of us any good. Feel free to leave before I return from consulting with the staff physician about your diagnosis. It's not like you came to the clinic for medical care because, actually, I am still not sure why you came to the clinic today.

All in all it makes clinic interesting and for me leaving the hospital at 1900 or 2000 at night. The immediate frustrations aside I do not mean to convey that I dislike psychiatric patients -- and two of the disorders aren't even psychology related really. Crazy people are people too after all. It is just that I don't have enough time to take care of all the problems which actually threaten life and limb let alone the hours extra needed to take care of the problems brought about by bad humors and forest gnomes. I am training to become an internal medicine physician but to date it seems my end expertise will be that of a psychologist / orthopedist who occasionally dabbles in the diabetes and the common cold.

***As a general disclaimer: though I in general like to try and be an honest guy, with all the rules these days and the rise of the HIPAA fascist state I must resort to vagueness, generalizations, and outright lies when it comes to recounting my patient stories. Don't want to breach any privacy here and I definitely don't want a summary execution without trial.***

Ready, Set, You're Late

One of thirteen blocks for intern year complete.

Thank goodness.

In summary this is what the last month was like. I was given five brief lectures by five different individuals only three of which clearly pertained to my upcoming medical career and only one of which was delivered by anyone with a clear command of the English language (and it wasn't for one of the pertinent lectures.) I was then dressed up in costume, asked to spin around with my head on a baseball bat for two minutes, and subsequently thrown into a task I had spent many years hearing about but not actually pretended to practice to any great extent for over half of a year. They then kept me awake for 30 hours straight and upon my discharge told me I was doing it all wrong.

Ok, so there's some hyperbole there, but I will say overall life has not be pleasant. Of course this was to be expected. It is not intended to be pleasant. And so I keep telling myself this. Thankfully the disorientation and periodic despair are resolving as things settle and become routine. The military did -- in my own opinion and in the collective opinion of the intern class -- a poor job preparing us for the practical aspects of our work in the military setting, and I did a poor job of preparing myself during the fourth year of medical school for the practical aspects of caring for patients. So there's been some catch up. Now, however, the main problems are, and will likely remain, ignorance and inefficiency. It seems I do not know much and what I do know I do slowly. But, as stated before, this is to be expected. Hopefully at some point I will find a way to resolve them. Currently I am thinking more caffeine and perhaps some methamphetamine.

Medicine wards at Brooks Army Medical Center (BAMC) was, with rare exceptions, not fun. Overall I had a good team of resident, attending, and medical students, but I will not miss any of them. Much like Commissioned Officer Training was a hectic, unpleasant, but ultimately educational (sort of) experience, the last month has been a kick in the pants and a kick in the balls, but kicks that were both probably needed. Now it's ambulatory month so four weeks of two day weekends! Few things elicit a smile as much as the idea of a two day weekend does. Either this is an indication that I have found satisfaction in the simple things in life or I currently have only simple things in life to provide satisfaction.

Anyways, life goes on. Good times are still occasionally had. The Olympics are coming up. I am relatively content.

USA! USA! USA!