Rotation 3: Psychiatry

I had intentionally placed Psychiatry as my 3rd rotation. As you may (or may not) have known, I was seriously considering pursuing Psychiatry when I started medical school. The usual advice is to place what you are considering 4th or 5th in your schedule so that you are not a newbie 3rd year and can impress, but are not so far along your year that you are burned out. I wasn't keen on placing it 4th because I thought I might get burned out since it was around the holidays and I also didn't want to have too many inpatient rotations back to back. I didn't want it 5th because I feared it might be a little late in the year just in case I changed my mind. I wanted to really have a sense of what I wanted to do before Christmas. And so 3rd rotation it was.

I was nervous going in. I really wanted to like it, to validate that this was what I was meant to do. I didn't want to have a panic attack, thinking all my future plans would be unraveling if I decided this wasn't what I wanted to. I had 1 month of inpatient and 1 month of outpatient to get a good idea of the field.

I started on inpatient at the county treatment center. Brutal honesty here: I was so so anxious that first week there. It's a locked unit and I was nervous for so many reasons. 1) Most of the patients are psychotic. 2) I didn't want to drop my key at any point and have it picked up by someone else. 3) I didn't want to get hurt - we actually had to take a mini self-defense class the day before we started just in case. And they gave us lanyards that break apart if someone tries to choke you. All of this was making for a very jumpy T. Which wasn't a feeling I was liking. It was definitely a difficult environment and so unlike my previous rotations. People don't just get better over the course of a few days in the hospital. Some patients had been there for months or even years! The hero complex in me wanted to fix everyone quickly, but that would not apply here. However, I slowly adapted to my surroundings and everyday became easier and easier. There were some moments that were certainly scary - such as when a patient got attacked by another patient right in front of me, or when a patient I didn't know kept approaching me and I yelled for staff because I wasn't sure what they wanted, or when a patient I had been taking care of suddenly yelled that he didn't want to see me again and refused to talk to me anymore. It was quite an experience, and I'm grateful that I did it, but I wasn't sure if this was something I wanted to do for the rest of my life.

Lunch at the treatment center! I got a meal card and everything. Only $2 for this whole thing.

But before I started on my outpatient month, med school friend F and I attended a Psychiatry conference in SoCal. It was a really great weekend and I learned a lot, especially about delirium tremens and new treatment strategies for that. The place wasn't too shabby, either. What do you think?

Eggs benedict aka my favorite breakfast ever.

I told myself I wouldn't make any decisions until my outpatient month was over. But looking back, I think I enjoyed inpatient more than outpatient. In general, I think I thrive much more in the inpatient setting. I like the structure, and the acuity of the patients. Something was missing for me in outpatient psychiatry. I think I wanted to have the role of the psychologist or case worker rather than the psychiatrist in that setting.

In my heart, I knew that the decision had already been made for me. I didn't think this was the right career path for me. I didn't love even though I really really really wanted to. I felt guilty for so many reasons. I had told people this was what I was going to do. I had been the president of the Psychiatry club at school! I had mentors who had taken the time to talk to me, guide me, give me advice over the last 2+ years. I felt like I would be letting them down, that they would somehow be disappointed with me for diverging from this path. I also wasn't sure whether I liked Pediatrics so much because it was right after Surgery or whether I truly truly liked it. I was so concerned I even scheduled a meeting with one of our deans who also dispenses career advice. I think I just needed someone to hear out my thoughts even though I knew what I wanted. It was nice that he validated my concerns and offered his thoughts that I was making the right decision, especially given that I was still thinking about Peds months after that rotation had ended. That felt nice to hear and eased my worries a bit.

So that's that. Sorry Psychiatry. I really really wanted to like you. I leave you with this: one interesting assignment we had for the rotation was to attend a local AA or NA meeting and then write a reflection about it. Here are a few excerpts from my piece:

My first thought while perusing the Internet, looking for a meeting to attend, was: Wow! I had no idea there were so many meetings that occur on a weekly basis just here. There were so many to choose from, I figured they would be small, intimate sessions – perhaps 15 or 20 people at a time. My second surprise was when I walked into one and there were at least 50, if not more, people there. There were professionally-dressed people, people who brought along their kids or spouses, people who had never attended a meeting before, and people who had been attending for longer than I’ve been alive. Some had been sober for years, others for days. Some had relapsed. It’s humbling to think that there are so many people who struggle with this and we would not even know it when passing them by on the street or working by them side-by-side. It was immediately clear to me that this was a safe place for them to come to, not only to maintain their sobriety, but also be able to check-in about things and gain and give support to others who have walked a similar path.

....

Many of the attendees who spoke and shared their experiences relayed that they do not think it is possible to overcome this addiction without a sponsor, and that sponsor is preferably someone who is in recovery themselves. I completely understood this statement and it resonated with me for many reasons, not least of all because of being in medical student. Most of the time, I find it difficult to share some of my experiences and feelings regarding school with friends or family who are not in the healthcare field. Somewhere along the line, things get “lost in translation.” While it’s helpful and wonderful to have supportive people around, it’s truly significant when that person can also serve as a “mentor” figure, one who has already gone through similar experiences and can provide advice, share coping strategies, and offer encouragement.   

Rotation 2: Pediatrics

After my Surgery shelf exam, I had 2 whole days off before starting my second rotation. I didn't really know what to expect as I've heard really great things about Peds and some not-so-great experiences others have had. Overall, I was happy with my schedule and sites so figured it would be an interesting couple of months and definitely a respite from the OR!

I started off on Newborn Nursery. I basically got to play with babies all day, so I know you are all incredibly jealous. At first, I was very very very careful when examining the babies. After all, they were like 2 HOURS OLD. I would put my stethoscope on them extremely gingerly, so much so that my attending would watch me with a bemused expression on her face. She later assured me that I wouldn't break the babies and I could be a little more confident with the way I was conducting the exams. Ha!

I then had 3 weeks of outpatient. The hours on outpatient are glorious. It's basically 9-5 and I had to be in clinic 3 days out the week! It was such a change from the 13-hour-6-days-a-week schedule I had gotten so used to. It was nice to have the chance to catch up on some life things, like going to the optometrist, taking my car to get serviced, getting my laptop fixed, etc. I really enjoyed outpatient too, which was a little surprising to me. I've always known that I like the inpatient setting more than outpatient - I find the time constraint of appointments a little difficult to manage and I worry after the appointment if I did all that I could for the patient. At least on inpatient services, you can always check in on the patient whenever you want to, get more information, etc. Inpatient cases tend to be more acute as well, which I find exciting. It's like a puzzle you have to solve. And (at least in academic centers) you work in a team, so you feel less isolated and it's more of a learning environment where it's easy to call consults and bounce ideas off others. So when I found myself really enjoying the outpatient part of Peds, I figured it must be because of Peds itself. I told myself I would wait and see how my month of inpatient peds went and then figure out if this is something I want to consider pursuing as a career.

The preceptors I worked with in clinics were also really great about letting me take the reigns and seeing patients on my own rather than simply shadowing. I don't think all of my classmates had the same experience and that's really unfortunate. There's a huge educational benefit to being active participants in patient care so I'm grateful the pediatricians I worked with were willing to do that for me. I also felt I learned a great deal in just a few short weeks. Even though it was summertime, I still saw plenty of sore throat cases, rashes, ear pain, and of course sports physicals. Although some cases were tough and I couldn't get more than one-word answers even though I was trying really hard, other times it was just so easy to build rapport. One kid even gave me his sticker!

After that, I had 4 weeks of inpatient service on the Wards team. Initially, I had requested either the Heme/Onc service (blood disorders and cancer) or Nephrology (kidneys), so I was a little bummed that I had gotten my third choice pick. But it turned out to be the greatest thing ever. I absolutely loved wards so very much. It's the general service so I got to see what you call the "bread and butter" of pediatrics - the typical cases that you manage. Each of my patients had a different issue so I got to experience a variety of things and it turned out to be great not just educationally but also as validation that this might just be the field for me. I loved learning about pediatric conditions, loved interacting with kids and their families, loved working with the various interns, residents, and attendings, and just always felt a sense of happiness. I was happy when I woke up in the morning, exciting to go in to the hospital and experience my day. And I was happy when I came home in the evening, excited about the things I had seen or learned about. Studying pediatrics also did not feel like a chore. At the risk of sounding like a nerd (but we all know I am one, not ashamed to admit so), I would read for hours and not realize how much time had elapsed. From meningitis to botulism to irritable bowel to rashes to cystic fibrosis, I took it all in as a starry-eyed third year student is apt to do.

On our last day of service, the pharmacist brought over samples of the medications we give kids so that we can taste them and experience what it's like. (Before anyone gets bothered, we used the syringes so we were only taking in a few drops.) Let me tell you, most of these are just nasty. I felt bad thinking back on all the times I had to prescribe some of these. I'm sorry, kids! It was for your own good and I'm so glad you got better!

PharmBar.

Shelf day. Peds students have a dress code. 

What a wonderful rotation this was! I'm sad to leave but also excited to see what other surprises third year has in store for me. Check back in 8 months time to see if Peds is the winner.

Lottery

3rd year is right around the corner! Pretty soon, we will be done with our pre-clinical curriculum, go off to study for and take Step 1 of our boards, and then we will officially be in the clinical half of the med school years. Third year is reserved for the core clinical rotations. Since everyone can't obviously be on the same rotation at the same time, schools have various ways of scheduling students. Some schools simply hand students schedules. Other schools have a few set schedules they have students rank and then assign accordingly. Our school is a little different. ;)

We have a Lottery system of choosing your clerkship schedule. Everyone gets to pick a number out of a hat and then based on your number, you choose one rotation at a time. The starting point changes with each round, of course. Anyway, you don't have to go in any particular order (e.g. you can schedule your third rotation before your first) and are free to choose any order you like, so long as there is an open spot. Now, see where it gets stressful? What if what you want isn't open, you ask? Well, you can't take it and have to figure something else out!

Over winter break, I came up with like 17 permutations for schedules I would be okay with. Which was a complete waste of time, haha. You really end up making decisions on the fly, because your strategy needs to change based on how other people are choosing their rotations. If it looks like one of the rotations is filling up, you choose it that particular round to avoid losing it. Regardless, about 1/4 of the class will end up getting locked out of their last rotation pick just because the spaces have filled up. There might be spaces open for other rotations, but they are not the one you need.

Of course, I figured with my luck, I was bound to get locked out. And I did! Good thing I'm consistent. I had picked every rotation except Pediatrics for my second rotation. What happens when you get locked out is, each person has to go through their schedule and adjust accordingly to fill in whatever is open. This might mean that you have to tear apart your entire schedule. Luckily, the person before me dropped Pediatrics as her second rotation when she was adjusting her schedule, and I swooped right in. Didn't need to adjust my schedule after all!

Behold, my 3rd year schedule (8 weeks each):

Surgery
Pediatrics
Psychiatry
Medicine
Ob/Gyn
Family

It isn't what I originally wanted, but it's close enough. I'm excited and terrified.

Prepping the night before.

The school decorated our room as Super Heroes! 

My lottery number.

Won a Starbucks gift card as well! 

Post-lottery celebrations.