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The Unclear LJ Future, ACGME Update


So, I've been off of livejournal for a while now, mostly because I kind of forgot about it... oops. I've been considering get another blog, but I'm not sure if I have the motivation to do that, either. Part of me thinks that now that q5day call is over I will post more on LiveJournal, but I'm not even sure exactly who is reading this anymore, and I'm not sure what I would post about; part of me wants to post about experiences at work / thoughts about psychiatry and medicine, but I think that would be better served on a new blog. Some of the more minor / personal things I have been posting on Facebook instead, which is attached to my name (thus friends-only) and at least somewhat* secure. This is open to the public and not attached to my name, but it is also not followed by people anymore due to a somewhat mass exodus from LJ and due to myself not posted frequently.

Thus, I'm not sure where that leaves the LJ. I'm not saying that I am quitting it just yet, but I'm not sure what the future has in store for it.

In unrelated news, PGY-2 year is starting soon. Woo! Also, apparently newly proposed ACGME rules would limit work time to 24 hours, which I have been advocating for some time (post-call work is terrible patient care and torture for residents); it also, however, suggests a 16 hour limit for PGY-1s, which I don't support because it would either completely eliminate them from call or make them miss both call and post-call clinical duties. I personally believe that the best call arrangement is to have the most frequent calls as PGY-1s so that things get better as the years go on, and I think that eliminating PGY-1 call just delays the crappiness that is call until later. I'm kind of hoping that this part doesn't become a rule and just the 24hour rule happens; either way, surgery is going have fits if this happens.

Rock, rock on.

California Checking In

Hallo, haven't posted in a long time.

I've been on inpatient psychiatry; it's a lot of work, but overall it is good. The call frequency kind of kicks own's ass, but I don't better.

Now I'm on vacation in California, and will tend return to the last 13.5 weeks of PGY-1 year; then a one week break, then shazzam, PGY-2 begins, which means more patients and work when I am there but much better call schedule.

Otherwise, I've been playing a lot of Plants vs. Zombies.

Finally, good luck for matching M4s on this black Monday!

This entry was awesome!

True, True


Otherwise, I've just been having an awesome time on my current rotation, reading psych, and reading random manga. Because that's how gangsta I am.

Entering VA Psychiatry


So, my vacation is over, and starting tomorrow I will be rotating through the VA psychiatry ER / intake clinic. I rotated through there as a medical student and had a good time, so I have high hopes. One potential problem, however, is that there is apparently a resident from another program there, plus two medical students, which will probably lead to some issues with having enough space / patients to see. Also, apparently the secretary can be really crazy.

VA psychiatry, at least at the VA medical center that I work at, is very "special." That is, it can be very rewarding, and you get to see pretty much everything, but it can also be kind of frustrating at times. Usually, the aspect of psychiatry that I am seeing (intakes, with occasional ER patient) is pretty good; the inpatient aspect can be frustrating, as my VAMC is not a "formal voluntary" unit and thus patients can request to leave at any time and will have to be allowed to leave with 1 business day of said request or else be admitted involuntarily to another unit (as this unit rarely allows involuntary patients.) This is different from a "formal voluntary" system, where patients that want to be voluntarily admitted to the inpatient unit have the option of signing a "5-day", which means that the treating team has five days to finish up and discharge the patient or else legally make them involuntary patients. Why is this important? Because certain VA patients enter the current system and then decide to cut out before they can receive any treatment, usually for drugs / alcohol or simply because they don't have insight to their condition / want to be manipulative. A formal system at least allows the treating team some time to assess and treat the patient, prevents hotel-like checking in and out of the unit / allows the patient to chill and consider their reasons for leaving early, and makes sure that entering the inpatient unit is considered something important for treatment. They are considering changing the status to formal volunteer, which would be nice.

Anyway, enough of that rant; I'm hoping to have less dealing with that kind of manipulative stuff and more dealing with the awesomeness that our VAMC's veteran population is. So, let's hope.

As for the overloading of residents + medical students, I've been considering getting a netbook, but with looming rumors of upcoming improved tablets, changes in phone plans, and the possibility of eventual iPhone tethering (eliminating the financial benefit of the cheap-netbooks-with-two-year-internet-contract bullshit), I think I might hold off just a little bit longer. I guess I'll have to bring a book or something.

That's pretty much it, for now...

Post-Call New Years Post

Happy New Years, peeps.

I'm post-call. My 24 hours at the hospital were OK, but there was a lot of bullshit to put up with, including liars at community hospitals, people acting out, and patient surfing between local ERs.

I'm basically checking in, not really too much to say; I'm on vacation starting Wednesday afternoon until returning to work the Wednesday after. During my vacation, I will be taking care of some things, including cleaning up a little, initiating my Step 3 studying, buying some shit, and hopefully spending some more time with some neglected hobbies, especially martial arts, mysticism / religion, and Japanese.

Um, I guess that is pretty much it. Not too much else to report at this time...

Oh, except to mention about the previous post - turns out that PGY-2 had a great night after that. So, I guess she didn't have a black cloud on that call after all...

Black Cloud; Perennial LJ Future Notes


Still on psych ER, taking crisis calls, seeing ER patients, accepting transfers, you know, the good shit.

A friend of mine that is the PGY-2 on tonight is known to be a ridiculous black cloud. For any random people that are still reading this (nice dedication!), a "black cloud" is a term we use in the field of medicine for those that have bad luck on calls (sometimes for other things, but usually for calls), while a "white cloud" is someone that has happier calls. "Bring your white cloud" or "hope you have a white cloud tonight" are examples of usage, as well as "I'm a huge black cloud." Anyway, my friend came by the psych ER office (where I hide, write notes, stalk the ER list, take ridiculous phone calls, and receive faxes) for sign out.

Now, I had a pretty good day - a few crisis calls including a long phone call where I let a patient vent, one call for a transfer to our ER*, and then seeing that same patient when she was transferred. Thus, a slow morning and a steady afternoon with a good patient experience, and an amazing lack of the BS that I usually deal with.

However, as soon as she walks in the room and attempts to forward the on-call pager from me to her, the following happens:
- unit calls about some BS about modifying a patient's medical record
- transfer attempt from other institution that will likely be rejected
- call waiting page from woman... who is mother of patient mentioned above and didn't tell us that until 5 minutes into the conversation
- OB service consult

Holy crap, MW, you need to calm that black cloud down. I will never doubt you when you talk about it in the future.

That was just a random store, otherwise good day where I spent a lot of time with a patient that likely has major depression with psychotic features in a manner that could be considered nihilistic delusions or Cotard's delusions. Nice.

On another note, the commonly occurring "why am I still on LJ" post. I'm still on LJ because I like documenting what happens a la journal and I tend to not like writing it, and if I'm typing it I might as well have it be backed up on the web and open to random friends that may occasionally want to read it. However, I still consider ending LJ and instead either doing private journals, switching to another more official blog, or continuing LJ but doing it privately. Sometimes I also consider making two blogs, and unofficial one with little to no links to me the actual person (like this one) and one that is the public journal that has my name attached to it. That, however, sounds like too much work for me at this time in my life; maybe later.

I also sometimes think of searching out my people on LJ, but eh, that also takes effort. And screening.

That is all for now...

* - usually you can't transfer to the ER, but some hospitals are "psych only" and thus don't have full ERs for medical evaluation... which is kind of lame.

Psyching It

I'm finally on psychiatry. Thank the Lord.

Also, I had my first call on Saturday, which ended up being 24 hours of migraininess that luckily involved a lot more sleep than would be typical of call.

That's pretty much it, plus I'm getting ready for the holidays, and I'm doing martial arts again, which is awesome.

The Kool Keith Experience

Just so that you know what the Kool Keith concert is like (I have mentioned it in the past*, but only slightly and before I had experienced it myself), here is video of the one that I went to, with my group and I visible in the audience at times. This is during a small segment in the show in which Kool Keith decides to give the audience some of his personal porn collection. Not shown in this particular clip are to moments in which he gives some magazines to females in the audience because they look like the porn models. Epic.

Keep on rocking.

* - During the old, brief but awesome tradition of GIMPDay, here: http://manzoku.livejournal.com/170627.html. Maybe I should bring that GIMPDay thing back; nah, shitty stream-of-consciousness image-searching-and-editing not a priority right now.

Returning; Blogs / Bookmarks List

Yep. My time in Santa Barbara is nearly up, and I will be returning to Chicago tomorrow for a full day of rest followed by the beginning of my two weeks of 9-5 M-F internal medicine clinic, which should be pretty nice in terms of free time. I'm feeling pretty refreshed from my time in California and away from the apartment and hospitals where I spent almost all of my time the last 24 weeks, and I'm hoping the Tuesday off can be spent getting some things done while also getting reacquainted with the concept of being an intern. Hopefully, this time will also somehow make me feel better about the upcoming two weeks, because though they are easy hours I have little excitement about them.

One of my friends is getting creepily harassed by a former peer; it started in the first two years of medical school and has continued since then, usually with weird intermittent inappropriate text messages or emails. That it, about how they we briefly involved and how he wants to continue that yet also doesn't want to talk to her because he feels hurt and out of control; of course, this doesn't make much sense, and he is always the one contacting her and never vice versa. Adding to this creepiness is that he is now married and still continuing. Even though he isn't violent or showing any signs of being stalkerish, this is creepy as fuck. I just felt like venting about that, I don't really have any in-depth analysis or such.

Otherwise, I've mostly been wasting time at the following sites (in no particular order) and playing a lot of DoodleJump on my iPhone:

Hilarious: http://www.textsfromlastnight.com/
Google is hilariuous: http://autocompleteme.com/
Can't really describe this but it does have a lot of Wu-Tang references: http://www.marriedtothesea.com/
Fail: http://failblog.org/
This is probably one of my favorite but most disturbing: http://ugliesttattoos.com/
New one that I am following, it is alright: http://wedinator.com/
Really good: http://www.smbc-comics.com/
Not that great most of the time but quick and dirty: http://comixed.com/
The reading man's funny blog: http://emailsfromcrazypeople.com/
Freeman's Mind & Civil Protection: http://www.accursedfarms.com/News.php
Angry Video Game Nerds and movie reviews and such: http://www.cinemassacre.com/new/index.php
Kind of weird now: http://www.megatokyo.com/
The Onion: http://www.theonion.com/content/index

That's all, pendejos.

Future Compieness

Ideal computer: Mac Pro with second touchscreen monitor, running Mac, Linux with Windows emulation / parallel, with external back-up hard drives.

Cheaper version for now: Mac Mini with Dell flatscreen, touchscreen monitor, external hard drives.

That is all for now.