Archive for August, 2011

It is the third year of my medical school and I am in a psychiatric ER, against my will, and on the phone with my course director who states the dean promises that they will treat this incident just like any other acute illness requiring hospitalization.

How did I get there? I think it was a perfect storm. Sure, almost every month I have times where I am actively planning every little detail of my death, but this time was different. It was Ramadan thus I was fasting from food/liquid and because of this I had not taken my Ritalin for 2 weeks or so. At first it wasn’t going so bad but suddenly, or so it seems to me, I started crying at the slightest thing. People would make tiny criticisms and I’d just fall apart.

It was also the anniversary of my grandmothers death, who you know was very close to me. I could feel the fear and apprehension of actually having to face it start to mount.

My wife was also pregnant and in her last weeks. I did not feel prepared, I did not feel like I should be a father.

Ritalin my enemy

Posted: August 18, 2011 in depression
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My heart is pounding against my chest, I feel the tremendous force of its impact against me and it’s uncomfortable. My mouth is dry and tacky reminding me of when I fast from liquids. My eyes are darting around and it’s hard to focus on anything for too long.

My mind follows this pattern, skipping thoughts and subjects at a rapid pace. I barely can keep with the speed of my thoughts, I wonder If this is what mania or ADHD feels like? It’s hard for me to talk to people as my mind wants to go faster and faster.

I have a deep pit in the bottom of my stomach. My body and mind are telling me I did something really horrible, like run someone over, and I’ll be caught. I try to review my life, and I can’t find a real event that causes this.

This is why I have a love/hate relationship with Ritalin. Whereas it helps reduce my suicidal thoughts and helps give me emotional stability it comes at a cost.

I also hate how it works. I hate how I can be planning my “end”, take the medication, and an hour later I am hopping all over the place. But of course it works, it’s based on amphetamine. Wouldn’t even a normal happy person feel better with such a stimulant? SSRIs, like prozac, take 4-6 weeks to take effect, so isn’t it wrong to have my mood elevated in 30 minutes?

It feels dirty, like an illegal high. Like I am doing something wrong that I shouldn’t be doing.

Can’t I get thru this by my intelligence alone? I have gotten in and completed an ivy league education and medical school with moderate effort, so can’t I overcome this problem with my mind alone? If I am so smart why can’t I apply it to this situation and overcome it?

“Compare it to a diabetic who needs insulin, are they weak for needing medicine?” is what I’d tell a patient who thinks antidepressants are for the weak. But this is different. Ritalin is an instant up with a noticeable downslope. It comes out of the system in hours. It’s abused so that people will feel better. No one takes Prozac without prescription for fun!

Saving a life?

Posted: August 11, 2011 in medicine
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This story begins with me in a rotation in the medical ICU as an intern, which is the first year of residency. I feel more prepared than others because I have experience as an EMT on a 911 ambulance service and I also have had quite a few rotations before this one, including pediatrics, 2 family medicine hospital rotations, and a rotation in the cardiac ICU.

As settle myself in I see the fast paced action going around and I decide in about the second week to tell the senior residents that I want to “run” the next code. Running a code basically means you tell when to give the drugs, when to stop CPR to check the EKG rhythm, and when to stop the “rescue effort” all together. As fate would have it, the next patient who “coded”, aka whose heart stops mechanically pumping, is one of the patients I have been managing.

She is an african american in her 50s who looks like she’s in her 80s because of her severe blood infection (sepsis). I have never interacted with her when she was awake, as all my visits have been while she was in this coma like state. Despite our efforts to save her, including tons of IV fluids, which are making her swell like a marshmallow, and 10 drugs hanging from IV poles, she is still dying. Even though everyone sees what is happening, her health care proxy, her son, wants us to do everything possible.

The blue light begins flashing, “CODE BLUE MICU, CODE BLUE MICU”, indicating a patient in cardiac arrest. I run to my patients room knowing that it is probably her. I am one of the first ones there and begin assuming command of the code. As I am keeping track of time and the drugs that have been given, I am disgusted as I watch the medical staff slip off her chest as they do CPR. Sadly, she is so far into sepsis that any contact with her is literally tearing off her skin. The area where chest compressions are done is just bare raw flesh, even her wrist where the nurse is checking for a pulse has turned into red flesh absent of any skin. The staff put a towel on her chest so their hands stop sliding while doing CPR. We continue the code….5 minutes…10 minutes… I call out “2 more minutes and I am calling the end of the code!” 1 minute passes… Then a nurse yells out “I have a pulse!”, I reply in a monotone voice “Confirm”, which another nurse does.  We end the code and I have “saved” a person. A person who is twice their normal weight from all the fluids that are needed to keep her blood pressure up, a body that’s skin falls off at the slightest of touch, a person who has no interactions with the outside world.

At the end of the code, when everyone else has left , I straightly stand over the “living” person. I stare down at her corpse-like body thinking “What have I done?” Have I really “saved” a person to experience more suffering and hardship? Tears begin forming in my eyes as I am having trouble accepting if I have done as what Hippocrates said, “Do no harm”.

I go off to lunch for about 10 minutes, when I come back a bedsheet is over her body. Her heart stopped again during the short period I was gone and the staff made the son watch the resuscitation process. He last only few minutes before he pleaded for the workers to stop and let his mother go.

Thus ended one of the most horrible experiences I have had when I did what is medically right, but felt so wrong inside.

 

When we touch

Posted: August 7, 2011 in autism, medicine
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One of the aspects of autism is a problem with personal space and affection. Either the person avoids touch and has a large personal space or the complete opposite, guess which one defines me?

I hate being touched, hugged, tapped on the shoulder, or having someone put their hand on me. It brings up a feeling of anxiety and a need to escape that overwhelms my consciousness. For example, if someone is talking to me and puts their hand on my shoulder I can’t think straight. I lose track of the conversation and all I can think about that feeling of something foreign invading my sense of comfort.

The closest I can describe the feeling is “pain like”. Bolts of electricity are sent to my brain as the physical contact continues. It’s like a molten red piece of metal pressing on my skin. The feeling demands to be acknowledged and requires to be on the forefront. It does not fade but instead stays present.

I have learned on some level how to lessen my visible repulsion to touch. The reason neurotypicals do this came to me as a teenager. I realized that they are actually comforted by such motions and are hurt/offended when I do not seem to return the same response. This is why I started to limit my response and I have come a long way.

When I was a teenager and people hugged me I stood straight like a piece of lumber. I kept my arms and hands flat against my sides and did not move them during the interaction. I could tell by the way people reacted that they found my response very uncomfortable. Then in my early twenties I started moving my hands, giving the other personal taps on the back in a very mechanical way.

Now as a physician I have advanced even further. I will initiate contact such as a touch on the shoulder or even in certain situations a hug. They seem more fluid and almost natural but they are still painful for me and overwhelm my senses. To help deal with this I count to 5 and release, this helps me deflect some of the pain and gives me and endpoint to look to.

In the end physical contact still brings on that burning feeling but I have learned to push thru it to achieve the objective, comforting the other.

The abyss

Posted: August 6, 2011 in depression
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I sit on the couch, all of my muscles feel exhausted even though I have over slept by 4 hours. My thoughts form slowly, my mind working at sluggish speeds. Even though it is just the beginning of the day I feel like I have run a marathon and then had to take a 2 hours calculus test. It is almost like I am drugged, dragging myself thru a fog.

In addition to this exhaustion I am have no interest in common things. I can’t find myself caring about anything, I am not drawn to music or hobbies. Thinking about playing guitar, or even going outside seem like unobtainable goals.

But worst of all is the feeling of being alone. I feel unattached to anyone. No connections to the outside world. I float along thru the mass of humans with no attachment to the masses. It feels like a dark abyss, large and empty. Surrounded by a gulf of darkness. My body remains untouched, my skin isolated from the electricity of humanity.

My mind tells me to escape. To do anything possible to leave my current situation. I am like an animal who is caught in a cage, my vision is narrow and I can only think of the immediate present. I am unable to visualize the future and the consequences.