Psych

My dear readers, forgive me. I have been utterly remiss in my med student blogging. But do not despair, you haven’t missed anything important. I can’t remember the last time we spoke, so I’ll just pick up from Psychiatry.

My rotation through the Psychiatry department at the University Hospital of the West Indies was illuminating in more ways than one.

Psychiatrists are a strange lot. More than any other physician, these consultants understand the blurring of lines that makes illness so hard to diagnose and yet their method of diagnosis is one of the most rigid I’ve seen.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is the most black and white layout of disease that exists, with clearly defined criteria for each psychiatric problem. It offers absolutely no middle ground. As if human ailment has ever presented itself in neatly packaged boxes. It bothers me that this book is their bible and that they continue to diagnose based on preconceived dictates rather than the individual patient.

Perhaps Psychiatry has the potential to become so uncontrolled a discipline that these criteria are there to ensure that no one gets labelled “mad” without sufficient reason. If this is the case I think they might have gone to the other extreme.

While I disagreed with the consultants, I was absolutely enthralled by the patients.

Psych patients are very convincing orators, and the more time I spent interacting with them the more I found myself wondering if these people really needed to be in the hospital, if they weren’t just some eccentric variation of normalcy. I have had some of their thoughts, have said some of the things they say. If a Psych consultant was to catch me on one of my stranger days, I’d probably be getting Haldol too.

Of course there are the obviously dangerous, disruptive patients who need to be rehabilitated enough to be functional. But then there are utterly fascinating ones who travel the world and want to become international rap sensations. Sure he believes that everyone in his native country loves him and the daily news is always talking about him BUT everyone has dreams. . . and fantasies.

Ultimately, the discipline of Psychiatry had less to offer me than the patients themselves. I don’t think I could work in a field where I’d be constantly questioning my own sanity.

Clinical Advice: “Wear Good Shoes”

If I could give you one piece of advice to surviving your clinical years, “wear good shoes” would be it. The rest of my advice has no basis other my own meandering experiences.

General Words

1. Be nice to the nurses, even when they’re not nice to you (and most of the time they won’t be). The phrase “kill them with kindness” has never been more appropriate.

2. Don’t be the student with the smartphone who spends their time on ward rounds tweeting.

3. Do be the student with the smartphone who looks up the answers to share while the consultant’s back is turned.

4. Never lose your consultant on ward rounds. They will prove impossible to find.

5. Patients will die. You will not be prepared.

6. Try to remember to sleep and eat.

7. Invest in a notebook that can fit in your pocket. Take it everywhere.

8. Don’t overdo it. Whatever people may believe, persons in the medical profession are just as human as everyone else. We all have limits; respect them.

9. Go to school. Please.

10. Don’t be a suck-up. In the future you’ll be practising medicine with the colleagues you spurned, not the superiors you kissed up to.

11. Be prepared to suck. Now, as a junior, being wrong is funny and correctable. As a senior, consultants will fail you for killing your hypothetical patient. Make your mistakes now.

12. Don’t take medicine personally. Your aptitude on the wards/in clinic is not a reflection of who you are as a person. Some days will be better than others but don’t let the horrible days make you doubt your self-worth.

13. Always take the opportunity to leave UHWI. Cornwall Regional and Kingston Public Hospitals are where you will get all most of your practical experience. And everyone is nicer there.

14. Get used to packing, un-packing, re-packing and doing it all over again in a matter of weeks.

15. Lower your expectations, of everything: doctors, patients, the government, the facilities. The joy of medicine is really more like a resigned indifference.

16. Don’t expect kindness or for things to be easy, so be grateful when they happen.

17. Balance your time. Med students study hard but they party harder.

18. Recognize that each consultant thinks his/her word is gospel. Like all gospels, they will frequently contradict themselves.

Academic Tips

19. You will never get asked about the topic you read the night before. You will always get asked about the topic you said you were going to read later.

20. So read. Read all the time. Read everything.

21.  Prepare for your tutorials. You will actually be able to follow the discussion.

22. Dress appropriately. This is a hospital – there are gross things everywhere. The less skin you show, the harder it is for the microbes to get you. And you don’t want to be the student in the consultant’s anecdote about wardrobe malfunctions.

23. Common things are common. Don’t be the med student who hears hoofbeats and thinks “Zebra!” (But if you are, don’t worry. We’ve all been there).

24. Practice your clinical examinations. All the time, everywhere, on anybody who will let you. You can graduate without knowing how to site an IV, but you will fail third year if you can’t competently examine an abdomen. (You won’t, but everyone will think you’re an idiot anyway).

25. Hold on to that sample case note from Introduction to Medical Practice. It will come in handy for your multiple graded case notes in third year.

To all the third years about to start their junior clinical rotations on Monday, good luck and Godspeed.

Edited to add: Oh my goodness, the abdomen station was removed from this year’s junior exams and that makes me hopping mad! (It is also probably way harder to catch the bad students now).

Answering your questions: UWI Clinical Rotations in the U.S.

can you do clinical rotations for uwi med school in the us?

is a Google search that gets people here. (Also ‘Romain Virgo pictures’ and ‘Junior Residency UHWI’. Really, junior residency? Impressive). Out of gratitude for the spike in site visits I’ve had this week from people searching for information about medical school at U.W.I Mona, I’m going to give an answer. (Whether or not this results in me getting even more site visits is totally irrelevant).

Short Answer: Yes.

You spend your first clinical year, third year, doing junior clinical rotations at UWI Mona teaching hospitals. In the fourth year of the MBBS programme – your second clinical year – you start rotating through a variety of medical specialities. During this time, you also have a three-five week elective block which can be completed at any teaching hospital of your choice. Travel expenses/visa not included. Boo, UWI.

In addition, students from the Bahamas also have the option of returning home after completing their Pathology/Microbiology rotation to do all the other rotations. I am pretty sure this applies to any country, as long as the rotations are offered at a teaching hospital and the curriculum is similar to UWI’s.

Fourth year rotations:

  • Emergency Medicine; Radiology; Medicine and the Humanities (Ethics in Medicine; History of Medicine)
  • Community Health
  • Elective
  • Otolaryngology; Dermatology
  • Pathology and Microbiology
  • Obstetrics and Gynaecology; Psychiatry
  • Anaesthesiology; Ophthalmology
  • Orthopaedics

Most foreign students are given preference to register for Path and MicroB as the first rotation of the year so it’s easier for them to spend the rest of the year abroad.

On a final note, these rotations are really great at facilitating clinical exposure as long as you’re not stationed at UHWI. Off-cite clinical experiences (at recognized teaching hospitals) will trump UHWI every time, but UHWI retains the academic edge. Perhaps UHWI consultants are better academicians that clinicians. The MBBS programme gives you a pretty good balance of academics and clinicals overall.

Image from whatshouldwecallmedschool.tumblr
Reading a new article about medical students losing their empathy during third year clinicals.

I am not the absolute authority.

The end of an age

As of last week Friday, third year is officially over.

We completed our last junior clinical rotation last week and even though some of us had assignments to hand in on Monday (or Tuesday, or today, depending on their outlook on deadlines) we were no longer third years. Nor are we fourth years. Not yet in any case. We are in limbo, such as it were.

Looking back, my first three years in medical school passed in the blink of an eye. Hindsight is like that. But while I was slaving away in preclinical years, I remember thinking clinical rotations couldn’t come fast enough. Oh how they did. I went from studying anatomy/physiology/pathology in a vaccuum to having to apply those principles on my feet, in the ward, out of the recesses of my brain where they’d been kicked post-exam 1-2 years ago in front of the expectant consultant whose favourite line will always be “Didn’t you guys do this just this other day? I haven’t studied that in 20 years.”

I went from swotting with no idea how to connect the ideas to learning. Legit learning, where you can apply and critique and not just regurgitate. Preclin was really just an introduction to a foreign language. Clinicals are moving to the country and diving head first into the culture.

And this culture is being demystified more and more every day. I have to say that the closer I get to actually being a doctor, the more I realize how much the same we all are. Well, except for the weird perfect students.

When I just started medical school, 5th years were akin to consultants (aka gods), 4th years some kind of demigod (aka residents) and 3rd years represented the height of my aspirations at the time. Having gone through third year with the scars to prove it, and now standing on the other side of the abyss as it were, everyone has a much more human appearance. Consultants make dirty jokes, all the time. They’re not always right. 5th years don’t know everything. 4th years are little more than overly ambitious 3rd years. And as for 3rd years? Ha. We were the bottom of the clinical food chain.

The higher I climb in this medical field (it’s a sheer cliff face, there’s no safety rope and I’m using my bare hands) the more I understand and the less I trust absolutely. Old facts and unlearned, relearned, ridiculed and tossed out the window only to be recycled the next day. One truth remains: I’m not a junior any more.

Notes from the Edge of a Social Life

I wrote this more than a week ago. Clearly I am psychic. You may have it, unedited, because I am still chin-deep in post-call duties, ward rounds and general madness. 

I begin my Junior Medicine rotation on Monday, November 19. That’s also my mother’s birthday. I will be stationed at the University Hospital of the West Indies in Kingston. My mother will be at her job in Montego Bay. This will probably be the first time in my entire life that I don’t see my mother on her birthday.

I only hear terrible things about this rotation. Whenever you ask one of the other students how it is, you’re rewarded with a blank stare followed by a big sigh, “prepare to die” warning optional. This is because as the consultants put it, “medicine is the most important rotation of your entire med school career”. This is what doctors do. Well, internists, at least. Internal medicine has the most patients and the longest hours. On these wards, patients are chronically and terminally ill. Surgical patients come in, get cut up a bit then go home. Medical patients are long-term residents.

I will be on call no less than three times during this rotation. Staying at the hospital clerking patients until 10pm is a pretty daunting prospect. I am terrified but determined. We get Christmas break halfway through, so that will ease the pressure somewhat.

I suppose this is a suicide note, of sorts. If I don’t show up when I’m supposed to you’ll know that I’ve died of shame from my ineptitude on ward rounds. And lack of sleep.

I really want to survive, though.

The week from hell: it’s only Wednesday

It’s the final week of my Community Health Rotation and that means exams, exams, exams. We’re graded by way of oral presentations and multiple choice papers. I have four such presentations to prepare and deliver between Monday and today. On Thursday and Friday I have to sit two papers  for Paediatrics and Comm Health.

What all this boils down to is a remarkable lack of time to scratch my butt. I like scratching my butt. It’s a welcome distraction from the gargantuan piles of work looming over me. My one saving grace so far is that I apparently haven’t failed my Paediatric OSCE (read: practical) since I wasn’t asked to contact the course coordinator like some truant schoolchild.

Regardless, I still have to study my socks off for what is allegedly the hardest exam to get good marks in. Not that I’m overly concerned with good marks. I’m more interested in hanging on by my fingernails to this sham of a medical education. Which is why at 11:11pm on a school night I was in someone else’s dorm having a group study session instead of catching up on my well-needed beauty sleep. (Yesterday I woke up with dark circles under my eyes. Dark circles, you guys.)

The other people I was studying with are A students. Well, at least one of them is. If I was a self-motivated student capable of studying effectively on my own, I would definitely not not have subjected myself to that kind of sleep deprivation.

Why must I always be surrounded by over-achievers?

Paediatric Medicine

I am holding down a screaming baby – boy – while the goodly intern (who can’t stand children) tries gently to insert a catheter.  I say baby but the child is in fact older than two (hence the catheter) and he puts up a good fight. We try to get it in before he relieves himself all over the makeshift sterile field.

Alternately, I am holding down a screaming baby – girl – while the capable intern (who isn’t terribly good at these procedures) tries unsuccessfully to do a lumbar puncture. The sterilizing Betadine (traitorously) seeps into the fabric of my white jacket as I attempt to pin her wriggling hips with my shoulder. For my efforts and hers, I am rewarded with a brown stain the size of a cheeseburger while she is rewarded with a firmer grip and a few more needle sticks.

Again, I am holding the hand of a boy who screams bloody murder before the needle goes in, but quiets down once we’re taking the sample. “He’s a good boy,” his father tells us. “He’ll carry on, but he’ll settle down in the end.” Thanks, kid.

Or, I’m stroking the arm of a girl whose veins the intern can’t seem to find, but who covers her mouth so politely when she coughs unlike every other patient who’s traipsed through this treatment room spreading aerosol droplets of infection from pharyngeal aspirations. I’m sorry, darling, but we’ll have to stick you again.

There I am collecting blood from a calmly quiescent eleven year old while an intern guides my shaking hand.

There I am listening to the scariest murmur I’ve ever heard from the heart of my favourite nine year old ward resident with chronic kidney disease. (I only have one wish for him – to live longer, and happier, than me).

There, poring over dockets thick as Bibles. There, running behind the Consultant peepeecluckcluck. There, stumped trying to answer a question. There, bumbling through an X-ray.

Also, learning. All over the place learning. Learning more in four weeks than (dare I say it) I have in the last two and a half years.

It’s official: I love clinic.