22 May 2011

AA Meeting

Humid air, spun around by a rickety old fan that provides the only hint of refuge because there is no air conditioning unit. The atmosphere creates an illusion of stepping back in time to a building that has seen better years. Ceiling tiles sag, paint is peeling, the AA posters on the wall are faded; clearly this place has seen better days.

The people seam friendly enough, but just like the room, they appear well worn, tired, the look in their eyes saying they've seen better days too.

I walk in timidly. Do I belong here? Is it too late to turn around and pretend like I just realized I'm at the wrong place?

Then, just like they show in the movies, the guy in charge said, "hello, my name is _____, and I'm an alcoholic." What do I say? I introduced myself as a student observer, and they cheerfully said, "Hi Shannon," just like they greeted everyone else.

Introductions were followed by a moment of silence, serenity prayer, 12 steps, and 12 traditions.

After introductions, they introduced the discussion topic from the big book. A list of blessings. And people started sharing their stories about things they count as blessings, and the way their outlook has changed as far as blessings are concerned.

Many of them remarked at how they have so many blessings they can't even begin to list them. They would sometimes tell a story, sharing how much they have lost, but they still have their life, and they have so much to be thankful for. It was humbling to see people share about how much they've lost. It never occurred to me that by the time people finally turn to AA, they've lost ties with family, they've lost their house, jobs, the will to live, everything.

And suddenly, the patients I've had at parkland now have faces, have stories, They're more than "that drunk/high guy that's been in the psych ER 14 times in the past 3 years." They became real people with real problems. People who actually needed the social workers to find them a place to stay. People who really were planning to kill themselves. Crying for attention because they had nothing left to do. Literally, no one else to turn to.

Making me think? What are the blessings in MY life? I really do have more than I can count.

People continued sharing stories about how messed up their life was, how close they came to death, and how AA saved them. Taught them how to find the strength to stay sober, and gave them people they could turn to.

As we closed by holding hands and saying the Lord's prayer, my mind was open to an incredible resource I can use for patients of mine struggling with alcohol and drug addictions. I think it is a great place to send people who feel ready to conquer their problems, but are unable to.

I have seen the social workers in the Psych ER send people to halfway houses, boarding houses, the salvation army, as well as numerous inpatient facilities. Below are some of the websites for resources.

http://www.aa.org has information for healthcare professionals (including pamphlets and a section on "how to refer a problem drinker) at http://aa.org/lang/en/catalog.cfm?origpage=223&product=11

http://www.na.org/ has information for specifically narcotic programs. (although several people at the AA meeting identified themselves as alcoholics and drug addicts)

Many churches, including my church have programs for all kinds of recovery. Our church's website is http://www.celebraterecoverynorthwest.com/

05 May 2011

Infectious Reflections

My very first patient had malaria.  It turns out, he went on a mission trip to Africa, forgot to take his malaria prophylaxis, and subsequently got malaria.  It was so interesting to see what his disease course looked like in contrast to the children I have seen in orphanages in Africa with the same disease.   What a great way to start the rotation!

I was excited to learn about HIV/AIDS.  I told the fellow this, and he gave me a patient about half way through our first week that I followed pretty much the whole rotation.  I got to learn more about what his specific HAART drugs were, and watch what we ended up switching the drugs to and why.  I also got to research more about what we diagnosed him with, and how the treatment differs for someone with AIDS.  We were very involved in his care. Watching him ender respiratory failure, get moved to the ICU, lose all ability to communicate with the outside world, and then recover helped me see a little more about the deep struggles and immense hope you have to think about when you deal with an illness like AIDS.  I also learned a lot more about tailoring drugs for renal failure and drug side effects.

I learned more about antibiotics (the best drugs for specific diseases) and how to look up new guidelines in the Sanford guide.  I used that book a lot!  I also got to listen to an ID conference on the growing amount of antibiotic resistance, which was fascinating!  I think in the future we’ll have to worry about that a lot more than people do now, so it was great to see that there is research about what works, what doesn’t, and what we can try next.

I was surprised at how good I got at thinking like someone in ID.  I got great at creating a plan and making recommendations to the teams, especially about things we talked about a lot: narrowing drug spectrums and picking a reasonable treatment length.

I liked being on a consult service and being the person primary teams came to with questions.  We were much more involved in care than I thought we would be!

I honestly wish we had gotten to see more diverse cases and gotten more teaching from our attending doctors.  The service was set up so that we had a new attending all the time, and I feel like that made each attending feel less responsible for teaching us.  It took me a long time to get comfortable with antibiotics and antiretrovirals, most of my learning was on my own which I don’t think is as effective as learning by caring for a patient.  I think the rotation was good because everyone will be exposed to infectious diseases no matter what practice they are in, but I wish it was set up differently.  It would have been neat to spend time at the Dallas County Health Department to see TB treatment or STD treatment, or to be at Amelia Court to see more AIDS treatment and care. 

Overall, I learned a lot, but I don’t think  I’ll want a job working on an ID consult team at a hospital!