Quote of the Week

Me: Mary*, you seem happier today. How are you?

Mary (smiling toothlessly) : Oh, I am better. I see the devil on your body.

Me: Excuse me? You see the devil on me?

Mary: Oh yes. I see the devil on your body.

[Pause]

Me: I like your new sweater.

Mary: Oh thank you!

*Patient name changed.
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If you're going to be crazy, you have to get paid for it or else you're going to be locked up.
Hunter S. Thompson

Revolutionary Papa

1, 2, 3

My roommate and I watched Part 1 of the epically long Che this weekend.
I know he's an extremely polarizing character and has ironically become the most commercialized photo in history.
But this film will stir up some revolutionary longings in your heart, man.
It will make you scoff at yourself for being politically correct instead of listening to that child voice inside your head that screams against injustice.
It might even make you step back from your cubicle and remember that there are ideals worth fighting for.

But the real thing that captured my imagination was,
how do you manage love,
how do you have a family,
how do you give enough to your children
and still give all your passion to your cause?

It's a hard question for men,
but I think it's an even harder question for women.

I don't have an answer,
but I liked these photos of Che and his family.

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"Above all, try always to be able to feel deeply any injustice committed against any person in any part of the world. It is the most beautiful quality of a revolutionary."

-Che, in his final letter to his children

The South

I miss the South when I'm gone from it for too long.

Best Billboards on my drive from Atlanta to Florida:

• "HELL IS REAL. Sponsored by JT Construction Co."
• "Would you give $200,000 to Liberals?? Roy Barnes did!!"
• "Homosexuality is an abomination. Sponsored by Bluegrass Church of God."
• "Where's the Birth Certificate??"

I know these thoughts exist in the South, but you need to put them on BILLBOARDS, people? For realzies?

I also passed not one but 2, HUGE Confederate flags flying along the side of the road.

It's good to be back in the Southland for a while.
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"The South's got a lot wrong with it. But it's permanent press and it doesn't wash out."
-Pat Conroy, Beach Music

Know Thyself

In doing this psychiatry rotation with various extreme personalities and behaviors, I think Socrates had some serious advice there, man.

The other day I took an online version of a Myers-Briggs test
because I couldn't remember the results I got when our college counselor had us take it in high school.

INFJ
Introverted Intuitive Feeling Judging

Here's what it says:

INFJs focus on possibilities, think in terms of values and come easily to decisions. The small number of this type (1 percent) is regrettable, since INFJs have unusually strong drive to contribute to the welfare of others and genuinely enjoy helping their fellow men. This type has great depth of personality; they are themselves complicated, and can understand and deal with complex issues and people.

It is an INFJ who is likely to have visions of human events past, present, or future. If a person
demonstrates an ability to understand psychic phenomena better than most others, this person is apt to be an INFJ. Characteristically, INFJs have strong empathic abilities and can be aware of another’s emotions or intents even before that person is conscious of these. This can take the form of feeling the distress of illnesses of others to an extent, which is difficult for other types. INFJs can intuit good and evil in others, although they seldom can tell how they came to know. Subsequent events tend to bear them out, however.

INFJs are usually good students, achievers who exhibit an unostentatious creativity. They take their work seriously and enjoy academic activity. They can exhibit qualities of overperfectionism and put more into a task than perhaps is justified by the nature of the task. They generally will not be visible leaders, but will quietly exert influence behind the scenes.

INFJs are hard to get to know. They have an unusually rich inner life, but they are reserved and tend not to share their reactions except with those they trust. Because of their vulnerability through a strong facility to interject, INFJs can be hurt rather easily by others, which, perhaps, is at least one reason they tend to be private people. People who have known an INFJ for years may find sides emerging which come as a surprise. Not that INFJs are inconsistent; they are very consist and value integrity. But they have convoluted, complex personalities, which sometimes puzzle even them.

INFJs like to please others and tend to contribute their own best efforts in all situations. They prefer and enjoy agreeing with others, and find conflict disagreeable and destructive. What is known, as ESP is likely found in an INFJ more than in any other types, although other types are capable of such phenomena. INFJs have vivid imaginations exercised both as memory and intuition, and this can amount to genius, resulting at time in an INFJ’s being seen as mystical. This unfettered imagination often will enable this person to compose complex and often aesthetic works of art such as music, mathematical systems, poems, plays, and novels. In a sense, the INFJ is the most poetic of all the types. Just as the ENTJ cannot not lead, so must an INFJ intuit; this capability extends to people, things, and often events,
taking the form of visions, episodes of foreknowledge, premonitions, auditory and visual images of things to come. INFJs can have uncanny communications with certain individuals at a distance.

(Bold is my doing.)
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What do you think?
Want to take it?
Here
Tell me what you get!

And here are some links for descriptions:
Here, here, and here.

We are the Storykeepers

Photo credit: Mayo Fujji, my classmate, on her trip to Montana

I don't think I knew how much of medicine was storytelling.

The majority of time is spent gathering people's stories,
"taking a history".
And people tell you everything.
They will tell you about the aches in their little toe, their great aunt's hernia repair, the time of their last bowel movement, that they're having sex with someone who isn't their wife, all the drugs they've done, and they'll tell you their fears.
Fears about cancer, about heart attacks, about death.

Then we keep these stories.

We can't share them with many people,
only those involved in their care.

But we write them down in H&P's (History & Physical)
or we present the story to our attending physician.
And we keep them inside of us.

When we see that patient again,
this time for high blood pressure,
the history of their divorce and their family history of diabetes
comes tumbling out of our story chest also,
like a pulling a piece of tangled string and realizing that it's connected to everything.

And these stories become a part of us.
We know someone who is a recovering heroin addict.
We grieve the loss of people with stage 4 lung cancer.
We struggle with the knowledge that COPD (emphysema) patients are out there still smoking slowly causing themselves to drown in their own lungs.

Today I started my psychiatry rotation.
I have a feeling that the stories are about to get more harrowing,
and that they may haunt me.
But I feel like these might be the most important stories to hear,
because there are no dressings to be changed,
no stitches needed,
listening might just be one of the best medicines we have.
And there are no side effects for the patient,
only the care giver.

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Eventually, all things merge into one, and a river runs through it. The river was cut by the world's great flood and runs over rocks from the basement of time. On some of those rocks are timeless raindrops. Under the rocks are the words, and some of the words are theirs. I am haunted by waters.
-Norman Maclean, A River Runs Through It

Questionable

This is a practice question I did the other day.

A 19-year-old man is evaluated for depression of 6 weeks duration. He enrolled in college as a freshman 5 months ago and began participating in intramural basketball, football, and soccer in addition to carrying a full academic load and having a part-time job. He smokes cigarettes and marijuana and consumes more than 12 alcoholic drinks on the weekends at parties. He is sexually active with four different partners. However, during the last 6 weeks he has seldom left his room and has stopped attending classes because he cannot concentrate; he is in danger of failing all of his classes. He feels restless, cannot sleep, has a poor appetite, and feels depressed. He can identify no precipitating event related to his change in mood, although he had a similar episode once before at age 16 years. There is no family history of mood disorders.

Which of the following is the most likely diagnosis?

(a) Bipolar disorder
(b) Dysthymia
(c) Major depressive disorder
(d) Seasonal affective disorder
(e) Situational adjustment reaction with depressed mood

(Question from MKSAP for students 4, American College of Physicians)

The answer I gave: Major Depressive Disorder
The one they said was right: Bipolar Disorder

They thought his behavior when starting college was "hypomanic".
Seriously??
I would just label that at "college freshman". No??

Interesting how much depends on your perspective.

So I've been studying lately, and sweating, and packing up my car wearing a dress, and sweating through the dress, and planning stuff for this weekend.
Fun things to post about coming up ...
a 30th birthday, a wedding, time in Vermont, and Buckfest.
And that's just the next 4 days!

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"A question that sometimes drives me hazy: am I or are the others crazy? "
-Albert Einstein

Summer Reading

Sorry for my absence. I've been sucked into my absolute favorite summer activity:
Summer reading.

As a kid I definitely always read more than the required 3 books.
I wasn't as good as my friend Abby who always read the ENTIRE list,
but I did my fair share.

So now that I'm doing a much milder outpatient rotation (Praise Jesus!),
I have the luxury on the weekend of staying up late reading,
sleeping in,
and first thing in the morning grabbing the book off my nightstand to start again.

Of getting so sucked into a different world that the characters start to feel like long lost friends.

Of daydreaming about reading, wondering what will happen next, whenever I'm stuck at work or in traffic.

Of, as the International Man o' Mystery found out last weekend, preferring reading to swimming in the lake, hanging out, or pretty much anything.

Here's what I've been reading:

Recommended by my friend Erica.
An engrossing story of a Dominican family that moves to NJ.
Tons of heartbreaking Dominican history, which I did not know.
It helps to have a working knowledge of Spanish to read it, especially swear words.
And a dash of magical realism as any self respecting Hispanic book should have.

Pat Conroy books make me feel as wrapped up in a warm, cozy blanket of Southern culture as if I had just had crawdads, biscuits, and boiled peanuts while sipping sweet iced tea on the veranda of my plantation home.
He spins the Southern culture into the beautifully golden but crooked web that it is.
And he's a beautiful writer to boot.

This one is up next. I want to read it before the movie comes out.

What are you reading??
What should I read next?
The summer is still young.