The Inpatient Neurology service is slow.
Consult life. Five patients. The PA brought a book to read during the long downtime.
We finished seeing patients on the consult list around 10a. Wait until 3p to see if any new consults pop on the list. If none show up, then the 5hr waiting game ends and I go home.
I went to the YMCA for a quick sauna trip, during my extended lunch break.
That night, I went to bed feeling a bit off and more snotty than I would expect from even the worst allergies I’ve experienced.
I didn’t sleep very well overnight. Alternating between sweats and chills. Couldn’t figure out if I wanted the extra blanket on top or not. Mouth breathing all night because of nasal congestion. Low grade headache simmering through the morning.
Called out of clinic because of this head cold. I figure a virus, and one that is likely transmissible to patients. I know residents rarely call out when ill, unless flu positive, and this always struck me as odd.
Wouldn’t you expect the physicians, PAs, and nurses to be among the healthiest folks in the hospital? Rarely so. Like the oddball psychiatrist treating fellow oddballs in the psych wards, medicine residents are in their own way often as sick as the patients.
Mackenzi had something similar over the weekend. In retrospect, perhaps so did Joonsu. He was a bit more irritable than usual, even considering his teething pains. I figure they gave me something and I was more wrecked by it than they.
Took some Tylenol, Joonsu’s primary medicine over the past few weeks since his teething pain ramped up. Felt nice for his appa to take the same medicine. Headache resolved and I enjoyed a day at home with my son and my mother, Joonsu’s halmoni. She made me so much delicious Korean food throughout the day.
A nice reminder of how wonderful it is to have your mother around when you are sick.
Went to bed feeling pretty gross. Still mouth breathing all night: moving around and bouncing the baby kept the congestion at bay, however, as soon as I laid down and attempted to relax, the fluid built up and prevented any meaningful airflow.
I awoke on Wednesday feeling still quite gross. Less gross than Tuesday, however, not much better. I called out again, knowing that the attending neurologist wasn’t too pleased to have two medical students on the consult service to begin with. The third year covered well for me.
Joonsu had his 4mo well-baby visit scheduled for 3p. I figured calling out would give me the emotional reserve to attend the visit and support both him and Mackenzi during whatever post-vaccination reaction he may have. Last time around, at the 2mo visit, he was quite fussy and upset the evening following the shots. Tylenol relieved that fussiness, and the next day he was still not feeling 100%. I expected the same, but quietly hoped for better.
We were told about the Buzzy by a friend going into pediatrics. A small, but powerful, vibrating unit painted to look like a little, friendly bee. Detachable wings which serve as reusable cold packs. Apply the cold packs to the injection site prior to sterilization for local analgesia, then press the vibrating unit nearby to distract the little one from the shot.
Worked like a charm. Joonsu didn’t really react to the first shot, and he got a little upset by the second one, but I attribute that more to my imprecision with the cold pack than anything else. That night, he was his usual self without much fussiness.
All-in-all, a very successful check-up!
I had a weird week. One day on, two days off, then another two days on before the weekend off. I honestly don’t remember much about this day, except for one patient. Some consults and the list wasn’t too busy. I enjoyed another long, long lunch with accompanying trip to the gym.
Both the attending and the PA had clinic in the afternoon and we got a late consult right before quitting time, so I decided to put my big-boy medical student pants on and see the patient without much grumbling.
A patient with non-epileptic seizures: spastic motor activity without the characteristic electrical brain activity which would denote a true neurological disorder. In the past, this phenomena has been called pseudo-seizures, but both psychiatry and neurology has changed the title of the diagnosis to accurately describe the complex without dismissing those afflicted.
These patients usually ride the line between psych and neurology: the episodes can be stress-induced or come out of the blue, usually have some psychiatric co-morbidities like anxiety or depression, and neither field can treat the condition well. Anti-seizure medications don’t touch the motor disturbances and neurologists generally groan when they are consulted on these cases or have a patient come into clinic with this as the primary problem. ‘It’s a psych problem!’ they exclaim.
Benzos are usually the only thing that touches the symptoms, leading many of the patients to appear as drug-seeking for these controlled substances. Psych usually takes these patients, to both prescribe benzos with a long-term plan of weaning them off and adjunct psychotherapy to address any underlying stress or trauma.
I say this all to describe the funny interaction of an exasperated neurologist and a soon-to-be psych resident seeing a patient with non-epileptic seizures on the neurology service.
The attending wanted to be out of the room as fast as possible and I didn’t blame him. This patient had quite an anxious vibe about her, and I honestly wanted to leave quickly, too. However, one day soon I’ll be asked to be the primary treating provider for these types of patients and I had better build up a thicker skin.
I will not always get the patients that I want, but I will figure out how to help them.
Mackenzi stayed home. Not because of an illness, but because of a scheduling lull for her rotation. She worked from home on some emails and enjoyed the start of a three day weekend.
My day in the hospital was much like yesterday. Morning rounds with an early afternoon lull. Some later consults. A good and educational day.
A long day. No sleeping in, since Joonsu decided everyone should wake up at 445a. Luckily, we took a long nap at about 8a, replenishing our reserves.
2hr interview for the podcast in the morning, followed by a 2hr call with a friend whose spouse is expecting a child in the coming months. Then, another call with a friend to check-up on his life and see how things are going.
5hrs of time either in front of the computer or on speaker phone while juggling Joon. I imagine this is what my future psychedelic practice will resemble, at least at first. Lots of time on my ‘off-days’ checking in on folks and engaging in deep, thoughtful conversation.
All I wanted to do was hang outside either in my hammock or bounce around on the slackline. The PA weather has turned into a wonderful spring: the sun is powerful, the grasses are pushing out of the ground, and the trees are budding. It is challenging to stay focused on what is important to me, in the long-term, when the short-term fun is so alluring.
I am glad, then, that I find the long-term work rewarding.
Today, we slept in a bit. Joonsu didn’t wake us up at 445a, instead the sun slowly stirred us into movement at 730a. I left the window open overnight, listening to the frogs in our backyard. As we awoke, so did the birds.
After I finish writing, we’ll head to a local state park and walk about with friends. Then perhaps enjoy some ice cream. It should be a warm and sunny spring day.
As night falls, we’ll head over to our new home to visit our landlords and determine some new colors for the rooms. They’ve offered to repaint the home according to our tastes. Yesterday, Mackenzi picked up a bundle of color swatches to have a full palette of options available.
This week has been long. Both of us returning to rotations at the same time challenged us, however the life added on top of clinical responsibilities are what truly weighed me down.
- Lease signing on Tuesday with awkward parent mingling
- Head cold on Tuesday and Wednesday
- 4mo well-baby visit with associated vaccinations on Wednesday
- 5hrs of in-depth virtual conversations on my ‘off-day’ Saturday
- Possible sinus infection brewing as I type this on Sunday
Honestly, the time in the hospital has been the easiest part of this week. Life doesn’t stop. Life won’t slow down for me. As a parent, as a resident, or as a partner.
The load of life won’t get lighter anytime soon. The responsibilities and duties and commitments will slowly pile up, increasing the burden over time with fewer and fewer respites.
Instead of a lighter load, I will ask for a stronger back.
Long Form Sundays
- On an eventful week off (or Match/Epilogue: a post-mortem)
- On Epilogue Week
- On revisiting a placeholder