Residency 1.5: Teen Clinic

I finished up my month of Adolescent Medicine. Rather than try to think back and summarize the whole month in one post, I thought I would share some of what we learned at a training seminar that the department got to do while I was there, because I think it's an intriguing idea for anyone who tries to motivate change in others.

They brought in a consultant to talk about risky behavior in teenagers and how to talk to them about it. One activity had us come up with scenarios of risky behavior we would like to change in our patients (drug use, unprotected sex, unhealthy eating, etc), but then to think about what we were asking the teenager to risk by giving it up. For example, one patient that we used as an example was a heavy marijuana user, who also happened to have suffered a fair amount of loss in her life. We typically say, "Smoking pot is a risky behavior; you could end up doing a lot of stupid and dangerous things when you're high, plus it's a gateway drug, so just stop." But asking her to stop is risky too. If she stops smoking pot, she risks not only the loss of her current social support, but also part of her identity, and maybe most importantly, her mechanism for coping with grief. When you look at it from her standpoint, it's not so easy to say "Just stop smoking pot; it's dangerous" because for her, it may feel more dangerous to quit. It doesn't justify risky behavior, but if we look at what we're asking our patients to risk by following our advice, we may be able to help them find alternatives that are acceptable.

If only we had the time to go through this with all of our patients. That's one thing that I continue to find frustrating about being in the clinic, whether it's Teen Clinic or my regular continuity clinic: the lack of time to cover everything I want to with my patients and their families. How do you find the time to talk about diet, exercise, school, safety, discipline, sleep, drugs, depression; not to mention things like stomach pain, headaches, back pain, and other vague chronic symptoms that could be anything. There's not enough time in the day, let alone in one appointment slot. I always leave feeling like I've let my patients down. It's super frustrating, and the alternative is to just not care and stop mentioning all those things. If anyone has the magic answer, let me know.

So now I'm off to Owl Team (aka Night Shift). It will be hard on my psyche and my social life to be working nights, but it's supposed to be a fun month. I'll let you know how it goes.

E-S-A-R-I-N...

It's 4 in the morning..."the phone on the wall is ringing so loudly, I'm sick of it all" never mind all you non-Will Hoge fans...

Anyways, sidetracked. It's 4 in the morning. I'm starting nights tonight, so this is my attempt to stay up and then sleep the day away. A nap and a latte and so far so good. I'm trying to motivate myself to brave the 29 degrees to run over to the gym and work out. So not working. Instead, I'm watching "The Diving Bell and the Butterfly," a book I read not too long ago and wondered how they would turn it into a full-length film. It's amazing how with such a simple story, and no true dialogue with the main character, they can still make you feel the despair of locked-in syndrome. I started thinking about what it would be like to communicate one letter at a time. To be completely paralyzed except the ability to blink, and only one eye at that (his other was stitched shut because he was unable to keep it moist enough after the stroke). How painfully slow it would be to get out a complete thought; how horribly impatient I would be. What would I want to say? What would you want to say? Makes blogging seem a bit superfluous, doesn't it?

A big girl bed

Last night as I was getting into bed, I decided I was done. Finito. I'd had it. My back hurt too much to keep sleeping on this stupid mattress. I'm getting a new one. And there just so happens to be a Mattress Firm across the street having a big sale. Well, I'm feeling all consumer savvy because I am in the Bargain section and being very firm about not wanting to try the floor models or buy a new boxspring cause I don't need it. So the salesman is being very nice and obliging my comparing Mattress A and Mattress B while I roll from back to side to other side. And with one question, my sails deflate: "Who is this bed for? You? Or...a child?" Ugh. I am SO not a grown-up. I have my own car, my own apartment, a medical degree, and my very own Bananagrams, but I am STILL sleeping in a CHILD'S BED! I felt about 12 years old (does NOT help that said salesman is young and attractive). Upshot? I got a new mattress. Hopefully goodbye, back pain and hello, REM sleep. But leave the night light on.

Down for the count

Are you looking for a way to tell 100% if it's time for you to throw in the towel and just go home sick from work? You're in luck. I have it. If you find yourself gripping the wall in the hallway while the world turns black, then checking out a patient to the attending while lying on the workroom floor with your feet elevated to keep enough blood flow to your brain to keep from passing out...it's time to go home. (Though, admittedly, not as bad as: If you find yourself being the patient in a Code Blue while seeing a consult...true story, not me, my fellow 'tern.) Not sure what I was thinking even going in to work, since the hour before work had me dry-heaving into my trash can and lying on the floor curled up in a ball with my hands spasming and my body wracked with chills, but sure, I can make it through a full day of work seeing sick patients, no problem. Yeah, just give up. Admit defeat. Go home, sleep on the couch for 5 hours, eat a whole bag of Goldfish Saltine crackers, go back to sleep. And maybe by the weekend, you'll be up for playing in the football tourney, even though you haven't worked out all week and only today made it through work without feeling nauseated. We'll see how that works out.

Really need it, gotta have it, to survive...

Today was Birthday Cake Day at Housestaff--first Housestaff of every month means a giant half-white, half-chocolate cake celebrating all birthdays that month, and since I can never decide which to get, I get...both. Turns out I'm not the only one using someone else's momentous day for my sugar high. I caught a fellow resident "edging" the cake after Housestaff--you know exactly what that is, you've all done it, using the knife to just "even out" the end of a row, just to clean it up a little--and it just looked so tempting that I had to have a second piece (except since I'd already had one of each, I guess it was a third piece, except I still wanted both flavors, so it was really third AND fourth. But small pieces). Then I went off to do something else and come back and now the chiefs are using the spatula and a fork to scrape all the scraps and crumbs (and some more edges) together onto a plate. They called it "cleaning up." Like I'm fooled. Oh, missed a dab of icing--get it! So, of course, I joined them. Was the fact that we were nauseated from sugar going to stop us? NO! Eat through it! Well, now I'm coming down from the sugar high and definitely feel sick. Maybe not the best exercise in self-control.

Oh well!