We're being seriously recruited. It's time to start thinking about where I'm going to apply for jobs and what kind of jobs those are going to be. Of course, my first choice of job would be to work on the BMT floor at OHSU. Since that is unlikely to mesh with my graduate school plans, I need to expand my search a little. Like, to the BMT floor at Strong Memorial Hospital in Rochester. Which, by the way, offers full tuition reimbursement for any classes at UofR for anyone that has a) worked at SMH for a year or b) worked in a university setting for a year. I believe I fall into category b. Pretty sweet deal, huh?
Then again, if I get into the MSN/PhD program, tuition is covered anyway. But, this would be a good backup in case I don't get accepted and end up doing just the MSN or something. Speaking of MSN/PhD programs, I've requested more information about the program at University of Pennsylvania (Ivy League, on my!) in Philadelphia. I hear good things about Philly from my housemates (they've both lived there) and Sarah and Ronen might consider following me there if I go, since they have an exceptional nurse midwifery program as well. Haven't discussed the whole moving thing much with Paul yet, I need to have a talk with him soon though.
I've been missing Portland a lot this week. Maybe because the weather has been so quintessentially Portland-like. About 65 degrees and misting rain. I love it, but it makes me homesick. Rochester is an okay place, but I would never choose to stay here because of the city itself, it would take something like getting into a fully-funded dual degree program to keep me here. I don't know if I would like Philadelphia any better, but I could at least visit there before moving. One definite perk of Philadelphia would be more access to the things I love to do, like cycling and dancing. There is no such thing as a women's cycling team in Rochester, the city is just too small to support it. And dancing is extremely limited and doesn't seem worth the effort to get out on a weeknight. Then again, if none of my friends came with me to Philadelphia, I'd have to start all over again.
Basically, I'm back to the waiting game, not sure if I'm hoping for my decision to be made for me by admissions committees or if I'd rather have all my options open and have to choose myself. So far my decision to come out here has proven to be a good one, but right now I"m really unsure if I want to stay for 5 more years.
Tuesday, September 30, 2008
Saturday, September 27, 2008
A little more about the psychiatric hospital
People have asked me why I hate my psych rotation so much. It's not because I'm not interested in psychiatry, or because I don't get to be involved in patient care, although those would be reasons enough. It's because I come home angry and depressed every single day. So, here's a quick summary of the things that I have seen that make me so angry. I honestly hope it makes you angry too, because unless a whole lot of people get very upset about it, nothing is going to change.
First, there is one nurse for every 30 patients. That is simply not enough. The nurse spends his/her day filling out paperwork, not even giving medications (an LPN does that). Zero patient contact, unless a patient becomes disruptive or dangerous.
Second, the unit feels like a prison. There are locks on all the doors, and I understand that is out of necessity and cannot be changed. What could be changed are the institutional rooms, fluorescent lights, warnings posted on the walls, and complete lack of individualization of patient rooms. Several patients have said that they feel much happier and more stable when they're at the regular hospital or doing outpatient treatment, just because that place makes them depressed. Honestly, I would probably become suicidal after being locked in that unit for a month.
Third, there is nothing for the patients to do. The nurse is too busy to interact with them. The mental health techs don't seem to give a damn. The LPN just does medications. Who's left? Other patients. And they do okay together, but any time you put a group of 30 people together with no available form of distraction besides the one television there will be problems. Then do it with 30 mentally ill people, many of whom have impulse control problems or histories of violence, and you've just got a ticking bomb.
Fourth, the patients get medication, not treatment. Medication is not the same as treatment. The doctors don't seem to realize this, and the nurse and social workers are either too busy or too jaded to do anything about it. Medications help. They calm symptoms, like command hallucinations and extreme depression or mania, and make it possible for various types of therapy to be successful. There are several kinds of therapies available, and many of them are effective. But, they need to be implemented with consistency and expertise. One group therapy session each week is not going to make a difference in these patients' lives. So, instead of getting treatment, they get medicated to the point where they are "safe" (read: unable to feel or think straight) and then medicated some more to deal with the side effects of the original meds.
Fifth, the patients believe that nobody cares about them, with the possible exception of the social workers. And who can blame them, I've seen very little evidence to prove the patients wrong. Almost all of the staff are unapproachable and impatient. I don't blame them either, they are overworked, underpaid, and buried in paperwork.
So, who's to blame? Everybody. Why? Because none of us care enough to fix these problems. What's the fix, you ask? Easy, money. Mental health funding has been cut significantly in the past 10 years. They are now so broke at this place that they don't even have snacks or drinks other than water available between meal times. They have a full kitchen and used to bake cookies with patients. Now they can't afford the ingredients, so the appliances have been disconnected and the kitchen is locked. They used to get $200/month for the entire hospital (less than $1 per patient) for recreational therapy. That is going to disappear by the end of this year. They won't even be allowed to buy a deck of cards or a soccer ball, unless it comes out of the pocket of a staff member. This isn't a unique situation, this is standard for psychiatric hospitals around the country.
Where does the small amount of money that they do get end up? Paying staff to do paperwork. The amount of paperwork they have to do is beyond belief. Double, if not triple, anything I've seen at a regular hospital. That's why the nurses can't spend time with their patients, and the therapists don't have time to do more than one session per week. The intense overregulation of mental health care is preventing any actual care from being given.
So that's why I hate psych, because it's a broken system and there is nothing I can do about it, except be angry and try to care.
First, there is one nurse for every 30 patients. That is simply not enough. The nurse spends his/her day filling out paperwork, not even giving medications (an LPN does that). Zero patient contact, unless a patient becomes disruptive or dangerous.
Second, the unit feels like a prison. There are locks on all the doors, and I understand that is out of necessity and cannot be changed. What could be changed are the institutional rooms, fluorescent lights, warnings posted on the walls, and complete lack of individualization of patient rooms. Several patients have said that they feel much happier and more stable when they're at the regular hospital or doing outpatient treatment, just because that place makes them depressed. Honestly, I would probably become suicidal after being locked in that unit for a month.
Third, there is nothing for the patients to do. The nurse is too busy to interact with them. The mental health techs don't seem to give a damn. The LPN just does medications. Who's left? Other patients. And they do okay together, but any time you put a group of 30 people together with no available form of distraction besides the one television there will be problems. Then do it with 30 mentally ill people, many of whom have impulse control problems or histories of violence, and you've just got a ticking bomb.
Fourth, the patients get medication, not treatment. Medication is not the same as treatment. The doctors don't seem to realize this, and the nurse and social workers are either too busy or too jaded to do anything about it. Medications help. They calm symptoms, like command hallucinations and extreme depression or mania, and make it possible for various types of therapy to be successful. There are several kinds of therapies available, and many of them are effective. But, they need to be implemented with consistency and expertise. One group therapy session each week is not going to make a difference in these patients' lives. So, instead of getting treatment, they get medicated to the point where they are "safe" (read: unable to feel or think straight) and then medicated some more to deal with the side effects of the original meds.
Fifth, the patients believe that nobody cares about them, with the possible exception of the social workers. And who can blame them, I've seen very little evidence to prove the patients wrong. Almost all of the staff are unapproachable and impatient. I don't blame them either, they are overworked, underpaid, and buried in paperwork.
So, who's to blame? Everybody. Why? Because none of us care enough to fix these problems. What's the fix, you ask? Easy, money. Mental health funding has been cut significantly in the past 10 years. They are now so broke at this place that they don't even have snacks or drinks other than water available between meal times. They have a full kitchen and used to bake cookies with patients. Now they can't afford the ingredients, so the appliances have been disconnected and the kitchen is locked. They used to get $200/month for the entire hospital (less than $1 per patient) for recreational therapy. That is going to disappear by the end of this year. They won't even be allowed to buy a deck of cards or a soccer ball, unless it comes out of the pocket of a staff member. This isn't a unique situation, this is standard for psychiatric hospitals around the country.
Where does the small amount of money that they do get end up? Paying staff to do paperwork. The amount of paperwork they have to do is beyond belief. Double, if not triple, anything I've seen at a regular hospital. That's why the nurses can't spend time with their patients, and the therapists don't have time to do more than one session per week. The intense overregulation of mental health care is preventing any actual care from being given.
So that's why I hate psych, because it's a broken system and there is nothing I can do about it, except be angry and try to care.
What's wrong with this picture?
There's a young man on my unit, let's call him Jim, who's a paranoid schizophrenic. He's in his early twenties and has a past history of violence, badly beating several patients, but nothing recently. Jim believes that people are trying to kill him, have already killed his father, and that he should be in the witness protection program. He is afraid of leaving the hospital because there will be an attempt on his life. He has constant and persistent hallucinations and delusions, despite the medication he is on. He's also one of the most thoughtful, soft-spoken, and caring gentlemen that I have ever met.
Today Jim came to the staff and told them that there was a wire in his leg and he had to go to the hospital. They explained to him that he is in the hospital already, he responded by turning around and punching the wall. Based on his history, staff called a "Camelot," meaning security came running and Jim was medicated and then isolated for the rest of the day. Had Jim punched a staff member instead, it says in his treatment plan that he would immediately be taken back to prison.
Compare Jim's story with another young man on my unit, let's call him Tom. Tom is also a schizophrenic and hears voices frequently, probably command hallucinations. He has attacked three people in the past four weeks, twice stating that he was trying to kill them. First he tried to choke another patient with headphone cables, then he tried to break someone's neck, finally he punched a lawyer in the face. Tom also has a history of imprisonment, and has been moved off of every regular unit at my hospital because he was a danger to the other patients. My unit was the last option, and so he's stuck there. After each incident, he was medicated and isolated, arrested briefly, and then returned to the unit because his actions did not qualify as severe enough to actually imprison him. Note that there is a forensic unit at this hospital specifically for criminals that have been found guilty by reason of insanity.
So, to sum up: Tom has a history of attempted murders. Jim gets frustrated and punches a wall. They both get the same treatment, except now if Tom punches somebody nothing different will happen. If Jim punches a person, he'll get taken to jail, setting back all the progress that has been made.
Anyone else have a problem with this?
Today Jim came to the staff and told them that there was a wire in his leg and he had to go to the hospital. They explained to him that he is in the hospital already, he responded by turning around and punching the wall. Based on his history, staff called a "Camelot," meaning security came running and Jim was medicated and then isolated for the rest of the day. Had Jim punched a staff member instead, it says in his treatment plan that he would immediately be taken back to prison.
Compare Jim's story with another young man on my unit, let's call him Tom. Tom is also a schizophrenic and hears voices frequently, probably command hallucinations. He has attacked three people in the past four weeks, twice stating that he was trying to kill them. First he tried to choke another patient with headphone cables, then he tried to break someone's neck, finally he punched a lawyer in the face. Tom also has a history of imprisonment, and has been moved off of every regular unit at my hospital because he was a danger to the other patients. My unit was the last option, and so he's stuck there. After each incident, he was medicated and isolated, arrested briefly, and then returned to the unit because his actions did not qualify as severe enough to actually imprison him. Note that there is a forensic unit at this hospital specifically for criminals that have been found guilty by reason of insanity.
So, to sum up: Tom has a history of attempted murders. Jim gets frustrated and punches a wall. They both get the same treatment, except now if Tom punches somebody nothing different will happen. If Jim punches a person, he'll get taken to jail, setting back all the progress that has been made.
Anyone else have a problem with this?
Thursday, September 18, 2008
Simulation Lab
Today was my first experience in the Sim Lab. I think I've mentioned it before... basically there's a room set up just like a hospital room with a dummy lying on the bed. The dummy has pulses, a bood pressure, breath and heart sounds, a peripheral IV, it can bleed, and the professor running the simulation can talk through it. SimLab is going to be really good, because in there we can do all the things that aren't allowed on real patients, like hang blood products, insert IV lines, etc.
This simulation was for Psych, so the situation we were given was of a woman going through alcohol withdrawal. It was based on the movie 28 Days about Sandra Bullock going through rehab. I have to admit, at first I thought it was the zombie movie, and was kind of wondering what sort of simulation we were going to be subjected to. We got to work in a group of three, which did help make things easier.
The simulation itself was nerve-wracking at first, but then just kind of fun. There is an assessment for patients suspected of going through alcohol withdrawal called the CIWA (Clinical Institute Withdrawal Assessment) and I was in charge of doing that, along with the CAGE questions to assess for alcohol addiction/dependence. (Have you ever wanted to Cut back on your alcohol intake? Do people seem Annoyed with you when you drink? Do you ever feel Guilty about drinking? Do you need an Eye-opener drink in the mornings?). She ended up scoring really high on the CIWA (hallucinations, dry heaves, sweating, loss of orientation) and got a nice valium drip going to calm her down. She was so happy about getting valium she even made up a little valium song for us (I think the instructor was having a little too much fun).
After the simulation was over we had to watch ourselves on video, which was by far the worst part. Then we were supposed to watch the rest of the movie, but we all just wanted to go home, including the instructor, so we left. In theory I could go check the DVD out from school and watch it any time. Not likely to happen.
I'm looking forward to future simulations, since they'll be done during our Adult Medical/Surgical course. They've already warned us that we'll be encountering a little bit of everything, so it should get very interesting.
This simulation was for Psych, so the situation we were given was of a woman going through alcohol withdrawal. It was based on the movie 28 Days about Sandra Bullock going through rehab. I have to admit, at first I thought it was the zombie movie, and was kind of wondering what sort of simulation we were going to be subjected to. We got to work in a group of three, which did help make things easier.
The simulation itself was nerve-wracking at first, but then just kind of fun. There is an assessment for patients suspected of going through alcohol withdrawal called the CIWA (Clinical Institute Withdrawal Assessment) and I was in charge of doing that, along with the CAGE questions to assess for alcohol addiction/dependence. (Have you ever wanted to Cut back on your alcohol intake? Do people seem Annoyed with you when you drink? Do you ever feel Guilty about drinking? Do you need an Eye-opener drink in the mornings?). She ended up scoring really high on the CIWA (hallucinations, dry heaves, sweating, loss of orientation) and got a nice valium drip going to calm her down. She was so happy about getting valium she even made up a little valium song for us (I think the instructor was having a little too much fun).
After the simulation was over we had to watch ourselves on video, which was by far the worst part. Then we were supposed to watch the rest of the movie, but we all just wanted to go home, including the instructor, so we left. In theory I could go check the DVD out from school and watch it any time. Not likely to happen.
I'm looking forward to future simulations, since they'll be done during our Adult Medical/Surgical course. They've already warned us that we'll be encountering a little bit of everything, so it should get very interesting.
Wednesday, September 17, 2008
Child psych unit
I had an "Alternate Site Visit" today. This is an attempt on the professors to show us more than one side of psychiatric nursing. So, I was assigned to go to the child psychiatric floor at the hospital. It was very, very hard, but not for the reasons that I expected. I expected to see kids that were completely out of control and/or medicated so heavily that they were partially sedated. Instead, I met a few kids that seemed pretty okay and a couple of autistic boys.
One of the autistic boys ran up and hugged me as soon as I walked in the room. He would then grab my hand and pull me around the floor every time he got excited about something because he wanted to share it with me.
The hard part started when I was helping a little girl clean her room after breakfast. She started talking about her family and showed me a picture of her dad. Then she told me a little about her mom and her grandparents. And finally she said, "My uncle isn't nice. He threw me down the stairs and gave me two black eyes. Then he beat up my mom." She said this in the same matter of fact voice that she had used to talk about her grandparents. I was at a complete loss for words. Later on, I got the chance to look at some of the kids charts. It turns out that this little girl had been brought into the hospital when she started trying to stab her grandmother with a steak knife. She was discharged this afternoon.
Another one of the kids had been brought in because of repeated attempts to run away from home. He even tried to jump out of a 12-story building in order to get away. Last winter he was found by a snowplow driver walking along the side of the road without a jacket or shoes on. Sounds crazy, huh? Until you keep reading and see that his father beat his mom and he witnessed it. He and his mother went to live with other relatives a couple of times, but his father always found them. His mom is currently living in a battered women's shelter, which this kid has also tried to run away from.
I was only on this floor for 4 hours, but I still got to spend enough time with the kids to see that they were all capable of being very smart and very sweet. They just didn't have the chance at home and all they had been exposed to was violence and abuse. I would have been running away or stabbing people too.
One of the autistic boys ran up and hugged me as soon as I walked in the room. He would then grab my hand and pull me around the floor every time he got excited about something because he wanted to share it with me.
The hard part started when I was helping a little girl clean her room after breakfast. She started talking about her family and showed me a picture of her dad. Then she told me a little about her mom and her grandparents. And finally she said, "My uncle isn't nice. He threw me down the stairs and gave me two black eyes. Then he beat up my mom." She said this in the same matter of fact voice that she had used to talk about her grandparents. I was at a complete loss for words. Later on, I got the chance to look at some of the kids charts. It turns out that this little girl had been brought into the hospital when she started trying to stab her grandmother with a steak knife. She was discharged this afternoon.
Another one of the kids had been brought in because of repeated attempts to run away from home. He even tried to jump out of a 12-story building in order to get away. Last winter he was found by a snowplow driver walking along the side of the road without a jacket or shoes on. Sounds crazy, huh? Until you keep reading and see that his father beat his mom and he witnessed it. He and his mother went to live with other relatives a couple of times, but his father always found them. His mom is currently living in a battered women's shelter, which this kid has also tried to run away from.
I was only on this floor for 4 hours, but I still got to spend enough time with the kids to see that they were all capable of being very smart and very sweet. They just didn't have the chance at home and all they had been exposed to was violence and abuse. I would have been running away or stabbing people too.
Monday, September 15, 2008
Quick update
I met with the director of the Ms/PhD program here last week. She talked me through the whole program, and how to pay for it, and how to apply. It was extremely helpful, and I've now decided that I will be applying. The program lasts 4-5 years and they only take 2-3 students each year, so I'm not sure if I'll get in but I can at least apply. I'm also looking at schools in Boston, Philadelphia, and San Fransisco. And I contacted OHSU to see if I could do their Master's and PhD programs simultaneously. Unfortunately, it sounds like I'll need to get an Adult Nurse Practitioner license, which OHSU does not offer.
In other news, I've been having a great time with my housemates. Jess continues to bake cookies every night (coincidentally, I started going to the gym again) and Jordan is rarely around but when he is we generally geek out together about health stuff or gadgets like my new iPod. I've settled in well and I really love living here.
Things are still going well with Paul and I. His parents will be in town for a little while at the end of the week, so I'll probably be meeting them. Since my schedule is completely wacky and his is completely normal we have difficulty getting a lot of time together, but that'll be changing as soon as I'm done with Psych.
Speaking of psych, I hate it. I don't really feel the need to elaborate, except to say that mental health care is an oxymoron and I'm spending my clinical time angry and frustrated. I will be very glad when it's over.
We had the tail end of Hurricane Ike come through Rochester last night. Wind was gusting up to 60mph and blew down many trees and knocked our power out for about 18 hours (midnight until I got home this evening). Luckily I was in class almost all day, so it didn't really affect me too much, still very annoying and by far the longest power outage I can remember. The only casualty was our ice cream.
Sarah and I have a plan to go to the gym together three times every week starting on Monday. We'll see if it works, but I think it'll help me a lot to be responsible to someone. Ideally I'd like to be 15-20 pounds lighter by the beginning of the collegiate cycling season next spring. That should be doable, as long as I work hard at it and Jess's cookie production slows down.
In other news, I've been having a great time with my housemates. Jess continues to bake cookies every night (coincidentally, I started going to the gym again) and Jordan is rarely around but when he is we generally geek out together about health stuff or gadgets like my new iPod. I've settled in well and I really love living here.
Things are still going well with Paul and I. His parents will be in town for a little while at the end of the week, so I'll probably be meeting them. Since my schedule is completely wacky and his is completely normal we have difficulty getting a lot of time together, but that'll be changing as soon as I'm done with Psych.
Speaking of psych, I hate it. I don't really feel the need to elaborate, except to say that mental health care is an oxymoron and I'm spending my clinical time angry and frustrated. I will be very glad when it's over.
We had the tail end of Hurricane Ike come through Rochester last night. Wind was gusting up to 60mph and blew down many trees and knocked our power out for about 18 hours (midnight until I got home this evening). Luckily I was in class almost all day, so it didn't really affect me too much, still very annoying and by far the longest power outage I can remember. The only casualty was our ice cream.
Sarah and I have a plan to go to the gym together three times every week starting on Monday. We'll see if it works, but I think it'll help me a lot to be responsible to someone. Ideally I'd like to be 15-20 pounds lighter by the beginning of the collegiate cycling season next spring. That should be doable, as long as I work hard at it and Jess's cookie production slows down.
Thursday, September 4, 2008
School stuff
Classes started on Tuesday. I'm currently taking Psych/Mental Health, Research, and Therapeutic Interventions 2 (aka "The Tubes and Tests Course"). On Tuesday I picked up my shiny new toy, which came with a drug guide and lab tests guide. Not that I've used those yet, but they're available. I also had my first lab, where we "learned" how to take stool and urine samples (The trick is to catch the pee in the cup!), and my first psych lecture. We didn't really learn anything in psych except about the dress code.
Now, that doesn't sound so bad, except I don't wear any of that stuff. I wear tank tops, t-shirts, capris, and cargo pants. Other than that, everything I own is really formal. So, I had to go shopping yesterday. I spent way too much money, but managed to get a couple of nice tops, some dress pants, and a pair of appropriate shoes. I also got myself a pair of jeans, ordered a bridesmaid dress for Matthew and Leah's wedding, did some grocery shopping and forgot to take my passport application to the post office. Still, not bad for one afternoon with a zipcar.
Today was my orientation to Rochester Psychiatric Center, which will be my clinical site for the next 5 weeks. It's going to be interesting, but I don't think I'm going to enjoy it. Because these patients can pretty much take care of all their basic needs independently, and we're not going to be allowed to pass meds there, we'll mostly be observing. But who knows, I might surprise myself. We did get to have a very interesting discussion with three recovering/recovered patients that are now "patient advocates". They come in and talk to current patients and help them get their lives figured out. Hearing about their experiences dealing with their mental illnesses was quite amazing, especially when compared with how stable they all are now. Two of them had been homeless, one had stolen a car without realizing it, all three had spent time in prison for various charges, but now they all have jobs, apartments, and are rebuilding their relationships with friends and family. It was really fascinating, and a good way to help us remember that the patients we meet will most likely recover, even if it takes years.
Acceptable professional attire includes tasteful (business style) skirts, slacks, jumpers, dress blouses, tailored shirts, turtlenecks, sweaters, jackets or blazers. Please do not wear denim, jean-like, or khaki material. Lab coats should not be worn. Footwear may be any conventional color except white. No white socks, sneakers, athletic shoes, open-toed shoes, sandals or high heels. When boots are needed for inclement weather, students will need to change to appropriate shoes for their clinical work. Book bags and coats should be placed in lockers because they are not permitted in clinical sites. Minimal jewelry is recommended (for example, a wedding band, watch with second hand, plain stud earrings). Please do not wear large earrings or hoops. If you wear make-up, please wear it tastefully. Please do not wear perfume or after shave lotion. No nail polish and length of natural nails is no longer than 1/4 inch from the finger tip.
Now, that doesn't sound so bad, except I don't wear any of that stuff. I wear tank tops, t-shirts, capris, and cargo pants. Other than that, everything I own is really formal. So, I had to go shopping yesterday. I spent way too much money, but managed to get a couple of nice tops, some dress pants, and a pair of appropriate shoes. I also got myself a pair of jeans, ordered a bridesmaid dress for Matthew and Leah's wedding, did some grocery shopping and forgot to take my passport application to the post office. Still, not bad for one afternoon with a zipcar.
Today was my orientation to Rochester Psychiatric Center, which will be my clinical site for the next 5 weeks. It's going to be interesting, but I don't think I'm going to enjoy it. Because these patients can pretty much take care of all their basic needs independently, and we're not going to be allowed to pass meds there, we'll mostly be observing. But who knows, I might surprise myself. We did get to have a very interesting discussion with three recovering/recovered patients that are now "patient advocates". They come in and talk to current patients and help them get their lives figured out. Hearing about their experiences dealing with their mental illnesses was quite amazing, especially when compared with how stable they all are now. Two of them had been homeless, one had stolen a car without realizing it, all three had spent time in prison for various charges, but now they all have jobs, apartments, and are rebuilding their relationships with friends and family. It was really fascinating, and a good way to help us remember that the patients we meet will most likely recover, even if it takes years.
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