Now onto my exciting recap... as I've mentioned, I'm in my psychiatric nursing rotation right now, focusing most on learning about therapeutic communication and the importance of developing and maintaining a trusting relationship with patients. Not only that, but I've also assessed how to recognize my own areas of "expertise" as well as limitations and what I need to improve upon as I work through the upcoming rotations. Having to sit with patients and process with them through their issues is quite challenging - the one thing I've been struggling with is how to keep my mouth shut and let them work through their problems as they talk to me. My first instinct is to provide a solution - to offer my opinion on how they should solve their problems... and while in some situations it may be important to offer ideas and alternatives, in most cases it will benefit the patients if they come up with their own answers to their lives' problems. For one, this gives them responsibility and accountability to themselves, but also it doesn't allow the patient to blame us if things don't work out exactly as planned. It's an interesting balance, and I'm still figuring out how to best help those that I interact with. Last week, my patient was diagnosed with severe depression (Major Depression Disorder, or MDD) and after a month of outpatient therapy, it was quite obvious he was getting worse. He was an older man, and he was slowly starving himself... and then his wife admitted him to the ER one evening because she found out that he hadn't been taking his medications. He is the sweetest man, and it was so difficult to try to figure out a main underlying issue behind his depression. We then learned in rounds with the physicians that they had suggested the idea of ECT as an alternative form of treatment - Electroconvulsive Therapy. Many people are more familiar with the term "Shock Treatment" and, in effect, this is what it is... but most people associate this term with an archaic, underground "torture" and I am here to dispel any misunderstandings of what is a very effective form of treatment for depression. It was initially developed as a treatment for schizophrenia, but doctors learned after many clinical trials that it was not helping as much as they had hoped... and then, on accident, they discovered its potential with severely depressed patients who are not responding to drugs. In short, the brain does not produce enough serotonin or norepinephrine (neurotransmitters responsible for feelings of euphoria) in those people with depression. Antidepressants work to stimulate further release of these NTs or work on receptors to keep what NTs they do have in the synapse longer in order to increase the time of activation and response in the neurons (I hope that makes sense). Although doctors don't quite understand every working biological detail behind ECT, the general understanding is that it induces a grand mal seizure which stimulates the release of serotonin and norepinephrine in large amounts into the brain, thereby acting as a "natural" antidepressant as it is the body's own "natural" response to produce larger amounts of these NTs. It's fascinating, I think... and I had the opportunity to go with my patient down to his third ECT treatment (they usually have 6-12 treatments in total). I had time to talk with him before and did my best to reduce some of his anxiety prior to his procedure. The treatment itself lasted only a few minutes, and was completely controlled - they administer a muscle relaxant in order to prevent the body from full convulsions. The most incredible part of the entire experience was my interaction with him after the procedure - I had the opportunity to help him reorient, and I talked to him about some of the things we had discussed prior to the procedure (his interests and life at home). He had been very despondent and withdrawn from our conversation, and although very respectful as he responded to my questions, it was obvious that he was not engaged. Afterwards, he actually smiled as he asked me a couple questions about my background! I was caught off-guard... but so pleasantly surprised by the immediacy of the improvement in his affect and mood, however slight it was. Since that, I have followed-up with him as he has undergone additional treatments and he is making steady progression forward. We were so excited to hear him talk about how hungry he was as he finished off his entire plate of french toast :] This is why I love medicine - seeing first-hand how our efforts, no matter the methods, can truly change the lives of our patients.
I'll try not to go into much detail about the next experience... I don't want to keep you here all day! This past Wednesday in my Faith & Health class we were fortunate to have 3 guests come in to speak with us - Dr. Laura Taylor, a professor at JHUSON who is doing research on how spirituality plays a role in transplantation, a nurse transplant coordinator at JHH, and a recent kidney transplant recipient. I'm not sure if many of you watch Grey's Anatomy, but I will admit that it is one of my favorite shows, and when they started talking about this specific transplant story I immediately thought of an episode last season on Grey's - only to learn that the writers took this story and rewrote it for the show! Hopkins really does make headlines... and here are a couple about the story, to give you better background:
Wow. The sheer logistics behind this comprehensive scenario just sends my head spinning. But it was a success, and all patients are doing well! The man that came in to talk to us, Mr. Imes, works for the facilities department at the hospital. His part of the story was touching - the Director of Human Resources, Pamela Paulk, asked him one day in passing if he needed anything, and he jokingly responded "A kidney!" He had been undergoing dialysis 3x each week for 3 years and it was taking its toll... a few months later she informed him that she had undergone testing and was interested in donating her kidney to him! Unfortunately, she was not a suitable match, so they were thrown into this huge mix of "domino donations." He ended up receiving his kidney from an anonymous donor in Oklahoma, and her kidney went to another woman. He was such a humble man, and our class was very appreciative of the chance to ask him questions about his experience. The transplant coordinator was also very forthcoming with her perspectives surrounding organ donation, expressing that she has developed a greater sense of spirituality after becoming involved with this process. Her experiences, watching a kidney removed from one person and transplanted into another to see it start up and work immediately, have more or less proven the existence of some higher being. And it's true - looking inside the human body, it's hard for me to understand how it just "happened" - it works too perfectly to have merely evolved. But that's my opinion :] Live kidney transplants have a much higher success rate, but not many people are so willing to give up one of their working organs... even though our body can work just as well with only one! So to have 8 simultaneous healthy donors come forward in this giant mix, no matter their reasons (whether for a family member or a friend), is just amazing. Organ donation is an amazing blessing that we are able to utilize, giving a new lease on life for many who have no other options. I am an advocate for the importance of organ donation, and encourage all to look into the benefits and, most importantly, to discuss it with your families. The statistics are staggering surrounding organ donation... the list of those needing organs grows each day, but unfortunately many viable organs are unable to be used because people are confronted with the questions of donation in their darkest hours. These topics of conversation will never be easy to have, but if decisions are understood and made as families, it will be easier to answer those questions if need be. And that's my soap box moment for the day!
I can't wait for my upcoming clinical rotations... Labor & Delivery starts in a few weeks, and then next semester is Med/Surg and Pediatrics. I can only imagine the experiences I will undoubtedly have! I feel like a kid in a candy store... I want to be involved with everything, to experience these incredible stories and witness medical miracles as they happen. I am excited for the chance to see different aspects of the hospital before I make the decision as to which direction I want to head after I graduate. Only 10 more months...! Well, I've definitely flooded you with much to read today, so I'll leave you now! I'm off to enjoy the rest of September, I hope you do the same!
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