medical-records-llc

Fuck me sideways, if this doesn’t clear up tonight I might have to go back to the hospital. There’s shit in my lungs and I have a fever. Pains so bad my entire sides numb it feels like ice if I touch it. Gonna watch the fever tonight and bleeding. Gonna use the spirometer when I can… shit man I was so good this morning what happened

That Fleeting Feeling

My intern year has progressed in distinct phases. For the first three months I lived in a state of perpetual fear. Each time a nurse would call about something, like Tylenol, I would rewind in my head every possible contraindication. Did I know this patient’s liver enzymes? How much had they already had today? Could they have an unknown allergy? I would freeze up with the constant worry I might unintentionally injure someone.

This uncertainty trickled into everything I did. My admit notes were many paragraphs long, just in case the fact that a patient had a rabbit as a pet in first grade might be useful to the diagnosis of their community acquired pneumonia (#alwaysruleouttularemia?). My exams were extensive and thorough, but I worried about documenting findings or exam signs others had not. I would look at consultant notes and worry that perhaps the boiler plate “regular rate and rhythm without murmurs, rubs, or gallops” meant that the murmur I heard wasn’t actually there.  

Slowly I learned that patients were much more resilient than I had been led to believe by standardized tests. In the coming months I gained some confidence in making decisions, making my own diagnostic judgements, and note writing. My admissions got smoother as I figured out what to ask and how to document it. My orders became less complex as I figured out to properly do a med reconciliation. I began to see complex patients as an entire entity rather than the sum of each problem on the problem list. Perhaps most important for my patients, I began to gain a better understanding of pain medications and my fear of them began to abate.

As we passed the new year, I began to feel like a well-oiled machine. I could knock out admit notes and progress notes without issue. I called all my own consults. I began to have enough procedures logged to be signed off. I was beginning to peak as an intern. Wards became something that was fun instead of frightening. I had time to read about my patients and do some teaching for the medical students. As the weather warmed for spring we began to get off work earlier and earlier.

Then April hit and attendings began to make seemingly innocuous comments like, “I think you are ready to be a senior,” or “you are really operating at a senior level.” Slowly the terror drifted back.

Originally posted by collegerunningprobs

Holy shit, I have to be a senior resident soon.

In just two months I will be responsible for twice as many patients. I will have 24-hour call. I will have two clueless and terrified interns who can’t even prescribe acetaminophen. I will have to stay late for them to finish their 4 page long admit notes. And I will have to answer for their mistakes.

I feel like another intern year might be beneficial. I was just getting the hang of being an intern and I want to hold on a little longer to this feeling of competence.

It is interesting how medical training always works like that. Just as you get comfortable in one setting you are whisked away into another and put back into a situation where you are uncomfortable. Whether there is much intention in that, I am not sure. But that is what seemingly makes medicine such a difficult profession. There really is no such thing as mastery. You just progress up the chain and hope that each year you get better.

An attending recently told me that there will never be a time you can rest and stop studying. If you are practicing right, you will always face new challenges that force you out of your comfort zone.

Dang. I really like this fleeting feeling of competence.  

Meds n Stuff

first of all, everyone responds to meds differently so this is just my experience with these medications, but I thought it may be helpful.

Zyprexa- worked very well for my hallucinations and mood stability, however I gained over 50 pounds while on it without changing my eating routine.

Prozac- my best buddy. sometimes makes me a bit manic if the dosage is too high, but overall has “cured” my OCD symptoms and helps with anxiety a ton.

Latuda- I was only on it for about a week and a half and I was constantly throwing up and felt even more depressed than before.

Klonopin- mildly helps with anxiety and sleep but I have such a high tolerance to the stuff that I’d only really notice a difference if you didn’t give it to me.

Xanax- similar to Klonopin, much faster acting, but less long lasting.

Abilify- I know a lot of people hate it, but for me it works to a degree and I’m on the maximum dosage. It doesn’t stop all of my hallucinations, but it’s so much less severe than before that I’d say t’s doing a good job. As for mood stability, I can’t say it does much for that.

Restoril- good for sleep and panic attacks.

Minipress- amazing for nightmares (especially trauma related), if you have nightmares please tell your psych and ask for minipress. Only downside is it lowers your blood pressure so it makes you kinda dizzy, but ideally you’ll be asleep during this time so that doesn’t really matter.

Lithium- I have a love/hate relationship with lithium. It sure as hell stabilized my mood, but at what cost? I was flat and emotionless and just wanted to feel something. That was why I stopped taking it. 

I hope that helped somebody, please discuss your experiences with these and other medications that I didn’t mention! 

[EDIT] as requested, my diagnosis is schizoaffective bipolar type, borderline personality disorder, OCD, PTSD, and other various anxiety disorders.

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I’m starting to think this is a serious medical condition, or Deku’s true quirk he never knew he inherited from his mother…