psychiatry

Differential Diagnosis: A Meaningful Life?

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What does it mean to live a meaningful life, I muse as I sit at my desk on a sullen Tuesday evening, listening to Seven Lions and shovelling lemon slice into my mouth. It’s a question that has popped into my head from time to time over the years, until I get distracted by more pertinent issues such as licking the icing off my fingers and checking Facebook.

It’s a question that has done a little more popping than usual in recent months, maybe because of the nature of my work. I see a lot of people who feel their lives are meaningless; or, sometimes, we look at them and judge them to have meaningless lives.

I see a lot of people who don’t leave the house. People who find it a challenge and a personal success to go out for a fifteen-minute walk, who struggle to get dressed and take a shower and do their chores. I see others who have no motivation or desire to do anything. They wallow, unwashed, largely unseen by the rest of society, in their bedrooms, playing video games (X-Boxes are particularly popular). They survive on unemployment benefits.

They are not productive members of society. We treat them and we try to improve their “social functioning”, try to improve their connectedness and train them in “job skills” and get them involved with “activities”. We try to gift them with “meaning”.

Is productivity, then, a measure of a meaningful life? If you contribute to society in some way. If you give back to your community, if you make money and pay taxes and fuel the economy, if you have big projects and do things that change the world. Is the cardiothoracic surgeon, then, or the human rights ambassador, living a more meaningful life than the stay-at-home parent or the post-man? What sort of contribution to society should we aspire to?

When I went to church, this was a huge question. What is the meaning of being alive? As teenagers, we talked about it with each other all the time, shiny-eyed and eager to discover our callings and our place in the big wide world. We decided that a meaningful life was simply one where you did what God had called you for. I have no doubt that many people still follow this path today and derive a lot of fulfilment from it.

What about creativity? Creating something, whether it be a work of art, a piece of writing, a design, a recipe, a precedent, a building or road, and leaving it in the world to be a legacy after you are gone. Is that meaningful?

Still others talk about finding meaning in pursuing your own goals and seeking your own happiness. After all, you only get one life, and your life is entirely your own, and no one else’s. Why not seek to put yourself first?

And still others talk about finding meaning in touching other people’s lives. A life cannot be meaningless if you have done something to better another person’s experience, if you have left your fingerprint in someone else’s book. That, they say, is how you will know you have lived a good one.

I’ve run out of lemon slice. Time to get another piece and check Facebook.

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My Guest Post on Dr M’s Notes: Empathy for the mad man

Originally posted on May 14, 2014 at Dr M’s Notes (www.thehealthquotient.com)


 

It’s easy to dismiss the patient with mental health issues.

When they pop up in our Emergency Departments, on our wards or in our clinics, there’s a common urge to handball responsibility to another party. They’re not my problem. They’re already sick. What help can I be to them, anyway?

The very practice of psychiatry is full of labels and names. Schizophrenia. Manic depression. Borderline. Dependent. Schizotypal. Involuntary. When one of these terms pops up on the admission notes, it’s easy to let the person fade behind the jargon. Especially when we’ve got fifteen other patients to look after; patients who are more relatable, more help-able.

Since February of this year I’ve been working in a community psychiatry clinic. It’s an experience I’m thoroughly enjoying. The diversity of patients constantly astounds me. There are people from families like mine, and families completely removed from anything I know. There are people from rural Victoria. There are middle-aged women living alone in boarding houses, young men on the streets, older men in their family homes. There are refugees from Vietnam, Somalia, India, Cambodia. I’ve used interpreters for many different languages.

Sometimes, when you meet a person who is suffering from a mental illness, you look into their eyes and you’re not sure if you’re reaching anything there. Sometimes they feel as vacant as an abandoned house. You wonder, how did they ever get to this stage? What happened to them to bring them to this point?

Over time I’ve seen some patients improve and others deteriorate. But what I’ve noticed this job growing in me is an ability to empathise with people from various walks of life. And I’m delighted that I’m becoming more genuine, rather than more jaded.

I’m learning to pause, to really listen. I’m trying not to simply search for the answers I’m expecting, but to absorb the sense of who a person was before they became unwell. And some of the best moments with my patients are when they crack a joke—usually a wry, half-true joke, but a joke nonetheless—and they look over at me to see if we’re on the same page. And for a split second, the interview transforms, and we’re just two people sharing a laugh.

It’s funny how simple and effective a joke can be. It’s prompted me to realise that we’re all made from the same dust. We’re not really different from the people we treat, at all, and we shouldn’t go down the path of thinking we are. If not for a different set of life circumstances—a different set of genes, a different childhood—you or I could so easily be the one with the label.

via Empathy for the mad man | Dr M’s notes.

The End of an Era

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Today I officially finished my internship.

In Australia, after you finish a medical degree, you have to work for a year in a public hospital under probational registration before you are granted full registration as a doctor. I spent my internship year at Monash Health, which I truly enjoyed, and completed five x 10-week rotations: Inpatient Psychiatry (Youth and Young Adult), Acute Assessment Unit, General Medicine, Upper Gastro-Intestinal Surgery (Hepatobiliary) and Emergency Medicine.

I won’t deny that it has been a tough year. At times, the days have dragged. At other times I marvel at how quickly the time seems to be flying by. You enter a new department, lost and clueless, trying to learn all the nurses’ names, keep track of room numbers and figure out where the damn radiology request forms are kept. Just when you settle in, you’re shuttled off to your next rotation. There will be moments when you are bombarded with so many jobs that you just want to hurl you pager onto the ground and bawl. Disasters will happen in bunches: one afternoon, a patient began to die of bowel obstruction while another, simultaneously, had a heart attack.

The wonderful thing about internship is that you work, and you earn money, and you don’t often have to work too much more than what you’ve been rostered for. And outside of work, you have a freedom that is different from being a student. I played soccer, ate out, bummed around with friends, watched movies, read books and travelled without worrying about having to go home and hit the books. It was great, and I treasured it, because I know it’s a rare period in life to have so few obligations.

My first year of working life has also taught me that I am not invincible. I do not have endless reserves of energy, and my health may not be perfect if I do not put some small daily effort into looking after my basic needs. In fact, I am definitely someone who needs more than an average amount of sleep. During my general medical rotation, when I got 6-7 hours of sleep per night on weeknights, I struggled to make it to the end of the shift each day. Running around doing jobs kept me awake, but any time I sat down to do paperwork, I’d be yawning my head off. During my surgical rotation, where the roster was more irregular, a 5:30am wake-up would completely knock me out for the next few days. And when I went into my last rotation, Emergency, where I was swinging back and forth between morning shifts, evening shifts and overnight shifts…my body clock pretty much started waving a white flag. I got headachey, exhausted, and had abdominal pain and pretty horrible IBS.

It probably didn’t help that during this year I really wanted to keep up my social obligations. I played in up to three futsal games per week, went to dinners and parties, and even dabbled in Dungeons and Dragons for a good few months ;P (Yes, that counts as a social obligation…) I suppose this year has taught me the challenges of establishing a work-life balance. Everyone talks about it, and it always seemed so straightforward–just make sure you do heaps of fun stuff outside of work, no? But it’s a little bit more complex than that. You will have to make small sacrifices on both sides to get the balance right. Sometimes you will choose to uphold commitments and you will be very tired. Other times you will have to learn to say no, and put your own welfare first.

So I now have three weeks of leave (YAY, YAY, YAY!) and on February 3rd I’ll start work as a resident in psychiatry. Last week I did feel a little scared. I had a moment of profound realisation: I may never look after a patient ‘medically,’ ever again, if I keep going down this road. I may never put in another IV drip, or ponder the cause of a patient’s low blood pressure, or perform basic life support. My general medical knowledge will dwindle and fade, despite my best efforts not to forget. And I will become a pseudo-doctor, a part of the system that the other doctors don’t really regard as real doctors. Will I love it or hate it? I don’t know.

Ramble.

I am a doctor. Yes, I am.

A doctor with provisional registration, at the very least, who must still run most of her decisions past a superior, and whose main areas of expertise are, summarily: inserting drips, writing discharge letters, and looking for folders. If, by the time the end of this year rolls around, we haven’t accidentally prescribed someone 100 units of insulin, or ignored a head injury after a fall, we are rewarded with a full registration. (Which, of course, we need to fork out several hundred dollars for.)

The way things work in Australia is that junior doctors must re-apply to hospitals every year; we are employed as “temporary full time” workers, on a contract that only lasts for 12 months. It’s a bit sucky. You spend a couple of months celebrating the fact that you survived interviews and got a job, only to realise that you have to do the whole thing over again. And again.

I recently submitted an application to do a six-month job next year, hopefully as a psychiatry resident. I’m planning to take six months off to do something totally silly and wonderful: write. I’m really excited. And a bit scared. (A little of becoming poor, but more of failure.)

This is how the rest of my year is looking:

– a couple more interviews, maybe

– hepatobiliary surgical rotation

– emergency department rotation

– trip to China and Hong Kong, yayz!

– three weeks break in January 2014

– work, if I have a job

:)

I think I’m feeling optimistic.

My day is looking not too shoddy either. I’ve got work 4-10pm, which is manageable, but I’ll be grumpy because I’ve got a cold. In the meantime, I have plenty to occupy myself with. For the past year I have been struggling to finish the Bitterbynde Trilogy by Cecilia Dart-Thornton–an Australian fantasy author, with wonderful writing ability, but LORDY. There came a point in the third book where I felt like I was just being constantly slapped in the face by purple prose. Her turns of phrase are lovely, but really, does she need to spend three lines describing how beautiful the inside of a strawberry is? We all know what a strawberry looks like.

Paragraph about strawberry.

Paragraph about strawberry.

Normally I have a rule that I give up on a book if it’s really struggling to hold my attention, but the Bitterbynde Trilogy admittedly is very beautiful. It’s sweeping and bursting with Celtic mythology and it’s got Faeran folk in it. It’s well planned out and elegant. I’ve just had enough of fantasy tropes, Mary Sue characters and dizzying descriptions of heartbreakingly handsome Faeran heroes. I’m sure the trilogy could have been one book shorter. Anyway, I’ve only got about 80 pages to go so I may as well skim through it.

Ten dolla! I picked up this trilogy from an amazing little bookstore in Morwell, Victoria called "The Nook and Cranny". If you're ever in Gippsland and you're a book nerd, you have to step inside this place. It's so unpretentiously rad.

Ten dolla! I picked up this trilogy from an amazing little bookstore in Morwell, Victoria called “The Nook and Cranny”. If you’re ever in Gippsland and you’re a book nerd, you have to step inside this place. It’s so unpretentiously rad.

I recently also read The Mind of a Mnemonist, by the Russian neuropsychologist Alexander Luria, who lived and worked in the early-mid 1900s. I heard about Luria whilst listening to a podcast featuring Oliver Sacks (Sacks cites Luria as one of his key inspirations). Mnemonist is a detailed case study about a dude who can remember everything. He also has intense five-sense synaesthesia, which is bizarre and fascinating to explore. Luria really delves into the guy’s mind, how his thought processes work, how his gift affects his personality, and what his weaknesses are.

In the TV world, I’ve just finished the season 2 finale of Battlestar Galactica–several years too late, I know–which, as usual, keeps blowing my mind. I can’t believe I didn’t listen sooner to my friends (looking at you, Mookxi!) who told me to watch this. Spaceships plus Greek mythology plus intense character study. HOW COULD ANYTHING BE MORE AWESOME?

bsg

Speaking of ancient Greek myth, I highly recommend the Greek and Roman Mythology course over at Coursera.org for anyone looking for an intro into ancient mythology. The readings can be a bit intensive on top of full time work or study but I found it totally worthwhile. It’s a very well taught course and a great starting point for beginners like me!

Oh no, work looms in four hours. Time to work on my novel. Wish me luck! Have an excellent week, readers. Don’t forget to smile unexpectedly and creepily at someone to brighten up their day.

x

Grace

PS. Can’t help it, but toaster Cylons just remind me of Cybermen. I think they used the same sound effects :P

cylon cybermen

A Mind of its Own – Cordelia Fine

Books about the brain tickle me. They fascinate me. They’re like thrillers about myself, with twists on how I trick myself and how I don’t actually think the way I think that I think. Are you confused yet?

Cordelia Fine, apart from having a name like something out of a Neil Gaiman children’s book, is cool because she lives in Melbourne, Australia. Hey, maybe we passed each other in the street. How awesome. She’s an academic psychologist who’s studied at Oxford, Cambridge and University College of London. Good grief, lady…now why did you come to Melbourne again?

Maybe for the coffee and suburban backyards :)

A Mind of Its Own is an intriguing little book about how our brains deceive us. Each chapter explains a different way in which we delude ourselves into thinking that we’re more moral, clever, rational, special and in control than our neighbours and friends. (Can you hear your own brain now? “Surely not! I can see some of my acquaintances falling prey to that flaw, but never me! I’m too sensible for that!”)

Fine tells it in an approachable, conversational style. She talks through battery after battery of psychological experiments, going as far back as the infamous Milgram obedience tests first conducted in 1961. (This disturbing test, conducted after WWII, was designed to explore if ordinary American citizens would perform horrible acts of torture when under pressure from an authority figure. The results are astonishing and have been repeated consistently in multiple subsequent experiments.)

The content is fascinating. Within the first chapter, I was informed that my brain is vain, conniving and falsely optimistic about my abilities and chances for future success. And yet, even when we are told that we delude ourselves, we still can’t help but continue in the same manner. Fine explains that we are wired this way for our own sake–otherwise, would we bother to get up in the morning? Would life be endurable? There are a subset of people who view the world more realistically, she says. These people are clinically depressed.

After getting off to such a cheery start, the rest of the book doesn’t disappoint. It’s about 200 pages, a relatively cruisey read, and Fine writes in eloquent, engaging language. She uses very little technical jargon, and I felt this was almost to her detriment–the personal anecdotes and obvious attempts to enlarge her vocabulary with awkward twists of phrasing devalued the experience somewhat in my eyes. It would have been better if she stuck to simple, straightforward, succinct language.

All in all, Fine really knows her stuff and backs it up with the evidence (ie. 30 pages of references). It’s a very accessible glimpse into the world of neuropsychology and a great read even for those who don’t have any interest in the neurosciences.

And that’s not the last we’ve heard from her. Cordelia’s second book, Delusions of Gender, came out in 2010. It sounds even more intriguing. In it, she postulates that male and female brains do not possess an innate biological difference, but that the perceived differences are shaped by society and culture. To me, that sounds near impossible. But I guess I’ll have to read the book and find out.

So, it’s been a while

Hello, world!

I’m back and ready to roll! I haven’t put up a post for almost two months now, and that last entry was really a cop-out ‘cos I just copy-pasted an image that was created by someone much more inspiring.

What kept me away for so long? Did I escape to some secluded tropical haven where I danced barefoot on scattered petals amongst pygmy natives, and dozed off each night basking in the reflexive waves of a foot massage? No, I did not (surprise). I’m not sure what exactly has distracted me for the last few weeks. First there were exams, and then there were holidays, and then I began my nine-week rotation in paediatrics, which involved getting up at 6am on Mondays and spending the rest of the week in a happy stupor. I got to know a lovely new group of fellow students, comforted wailing babies and felt all mushy about it, and met a whole spectrum of parents, from Totally Chilled to Terrifying. I’m pretty sure that paediatrics isn’t for me, but it was an interesting rotation nevertheless =)

Other than that, someone special has gone overseas for six weeks. This has left me a little mope-y and in need of lots of distractions. Fortunately, there are only 14 days until he returns. That’s 336 hours. Or 20,160 minutes. Or 1,209,600 seconds. It has been a slooooow month.

Onto business!

What I’ve been reading lately…

The Mind’s Eye – Oliver Sacks

Where I got this book: Dymocks, Collins Street, Melbourne

I discovered Oliver Sacks three years ago when I read The Man Who Mistook His Wife For a Hat. How could I resist such a book? It had a quirky title, and it was about neurology. The Mind’s Eye is Sacks’s latest publication, and continues in much the same format. He describes, in fascinating detail and with compassion, several of his own patients with intriguing neurological dilemmas: a concert pianist who loses her ability to read music and eventually to recognise objects; a novelist who has a stroke and loses his ability to read but not to write; a woman who becomes unable to speak; a scientist who has never seen in 3D but suddenly acquires this ability in mid-life.

A large part of the book focuses on vision, particularly stereoscopy, or 3D vision, and how we develop it. For the first time, Sacks’s also talks about his own journey: firstly, his prosopagnosia or inability to recognise faces, and then his experience of being diagnosed with eye cancer and the loss of visual faculties that followed.

The Mind’s Eye is both moving and intellectually fascinating. He explains neural mechanisms with clarity and without overcomplicating the story. His writing is consistently articulate, compassionate and stimulating. For those who are intrigued by the brain.

The Boy Who Was Raised As a Dog – Bruce D. Perry

Where I got this book: The Book Depository, online.

This is an amazing book. It was recommended to me by my dear friend J. “Dong” Chae, who told me it was in fact discovered by his girlfriend, Linda. I love how good books get passed along on an irrepressible wave of…goodness.

 Bruce D. Perry is a child psychiatrist who has worked for many years with victims of trauma and abuse. In this book he tells the stories of a number of children who have changed and shaped the way he practises. Some of these stories are horrific: murder witnesses, sexual abuse victims, severely neglected children, genocide survivors. Perry tells their tales with immense insight and compassion. Not only that, he explains what happens to the brain when it is put under extreme stress and the vital importance of nurture–touch, language, care, affection–in the first few years of life. So crucial is this nurture that it can mean the difference between a humane member of society, and a psychopathic killer. I think this book would be a moving and insightful read for parents, future parents and anyone who works with children.

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That’s all for today, folks! Fiction reviews to come in the next couple of posts. Enjoy your weekends, eat that extra slice of pie, dance like a madman to the radio, and tell everyone you love that you love them!

x,

Grace