Friday Factoids Catch-Up: Being with A Life Until The End

I am experiencing the impending death of an elderly family member, our matriarch, my Granny. Thankfully, she will be able to pass on in peace. Our family knew what she wanted the end of her life to look like. We had very much agreed with her wishes.

 

Despite whatever differences our family may have on other fronts, we are a unified front for her now. We are sure about our decisions for her. When a doctor had come in and suggested she be transferred to a large medical center for very aggressive treatment we were able to smile and nod in understanding. Her kidneys have failed as a part of the dying process and her doctor wants to help by “fixing” this. Most of the people in the small community my Granny lived in knew her well and this doctor is no exception. He wants to do everything his training in the healing arts has given him to stop death. It is his imperative. When we were able to talk with him and describe what we knew were her wishes, he understood, but seemed defeated somehow.

 

I have worked in intensive care unit settings as a respiratory therapist prior to becoming a doctoral intern in psychology. I have assisted in brain death determinations on patients a day old to 104 years old. I have been a part of ethics committees questioning the continuation of aggressive treatment via life support. I have been in situations where a very few medical staff, usually three of us, an MD, RN, and RT, remove life support alone because a dying person’s family has fractured and no one can emotionally or physically attend the death.  I have seen and heard reactions to death by medical staff despite the denial that they are affected. Broken professionals are leading broken families at times and creating poor outcomes for dying patients.

 

What is a “poor outcome” in death? The medical community most certainly identifies death itself as a “poor outcome.” Aggressive treatment is used too often with dying patients and this is something I personally identify as a poor outcome. The message that there is still hope is easier to deliver than there is no hope. I disagree with the idea that there is no hope in the dying process itself, if it is recognized. There have been great strides made in awareness of death and dying, but too many still die in pain and with modern medicine trying valiantly to “save” them. Why? Most medical staff in intensive care units know they do not want the same measure of treatment they provide to others every day. This should provide a better guide in the care administered in these settings. The more I practiced in medical settings initiating and maintaining life support, the more times I administered care I would personally never want. This happened to most all I worked alongside regardless of religion, culture, or creed.

 

I hope at some point to be able to help other families and medical teams in providing a death like my Granny’s for others–where there is a sense of calm and not a flurry of anxious activity meant to avoid what cannot be avoided. Our family and her medical team are sitting with her calmly. There is no push to “save” a life when the proper course is to simply be with a life until its end.

 

Rain Blohm, MS
WKPIC Doctoral Intern

 

Surviving Match: Personal Stories

Like many students, I found the APPIC process daunting, but worth it in the end. I experienced an early elation at receiving interviews. I am a returning adult pursuing a second career, and I was unsure how that might play out in the eyes of those reviewing my applications. I am quite sure there have been older graduate students, but I encountered only younger applicants during my interviews. I have more life and work experience than my younger counterparts, but this does not always seem to compete with the solid accomplishments that many of my counterparts had already made very early in their careers.

 

I found that the APPIC process caused me to look at the lingering doubt I had in myself being able to finish my doctoral program. I was excited that I received the interviews, but also dismayed by fellow students in my program who I felt were just as qualified as myself receiving none. I felt like I knew even less about what to expect on interviews if students who I thought were well qualified had not received interviews.

 

The logistics of what I was about to embark on quickly became a reality. I found a phone app that helped me organize travel itineraries and hoped for the best with the January weather. There were several hitches along the way, but the worst actually happened traveling to my WKPIC interview. I was delayed in Chicago due to poor weather conditions and had missed an interview. I was placed on another flight and thought I was underway until there was a loud thump as the plane backed up. The plane began moving back toward the gate and that was when the entire plane of delayed and tired passengers let out a collective groan. We soon found out that our plane had backed up into a truck, and once it was determined that no one was hurt, jokes and laughter abounded. The accident was actually considered a plane crash and we all remained on the flight until an investigator dismissed us. I pretty much stepped off my flight from Chicago to Nashville, into my rental car and drove to Hopkinsville (thank you GPS). I had already called WKPIC while sitting on my “crashed” plane to alert the interviewers I might be running a bit late.

 

I of course made it to my interview and was even on time within 5 minutes. I had taken the idea of finding a good fit to heart, and at this point tried to interview sites as well as having them interview me. I feel like one of my stronger interviews was at WKPIC because in part, I was literally too tired to be anxious. I was drawn to WKPIC because they treated applicants so well during the interview process. One of the psychologists complimented me on an answer to an interview question. I actually still carry that compliment with me. Current interns smile and laugh that WKPIC definitely fed us better than other sites. I noticed a group of psychologists who seemed to enjoy being with one another. I saw a culture of acknowledgement, dignity and respect during my interview. My thought during ranking was that if I was acknowledged and respected in an interview, this was likely part of the culture at WKPIC. I have certainly found that culture to hold true as an intern.

 

Rain Blohm, MS
WKPIC Doctoral Intern

 

 

Surviving Match: Personal Stories

 

 

While reflecting back on the internship match process, a lot of mixed emotions surfaced like anger, anxiety, sadness, acceptance, and elation. Sounds a lot like the five stages of grief because that is exactly what it felt like, being rejected the first time.

 

Not getting matched is the worst imaginable outcome for any psychology student. “The Match” is a horrible process to go through once and the idea of going through it twice is daunting. So much time is spent planning, writing, reviewing, redrafting, and rewriting essays. Then after spending weeks or months of selecting the ultimate internship list you have enough hope to charge your credit card over and over and over again. Hoping and waiting to hear back from the sites you are really interested in for internship. But one by one they slip through your fingers. Self-doubt and negativity begin to set in. You start to question your competency and think about what you could have done differently. Unfortunately, after going through all the rounds of the match process it began to set in that I will have to reapply for next year.

 

Goodness of fit was my most important factor for selecting the right internship. It was difficult to imagine selecting an internship that would cause me misery for one year. There were some sites I interviewed at the first time and did not even rank them because I knew it was not a good fit for my style of learning or career goals. The idea of waiting another year was devastating. It felt like I was being left behind while friends moved on with their careers and I was just stuck. It was embarrassing to tell people that I did not match and I wanted to forget it even happened.  Then it hit me that in only a few months the process begins again. There was little time to sulk and mentally process what just happened. My advice for all future applicants is to be prepared and feel confident to not rank less than ideal sites even if that means waiting another year. It was worth the wait for me!

 

To prepare for attempt No. 2, I asked my friends’ internship directors to review my essays and CV for feedback. I examined clinical areas to improve and gain further experience.  A lot of time was spent talking with my previous practicum supervisors for emotional support and keep them updated with my progress of reapplying for internship. Not only was I relying on others for support but I was also engaging in a lot of positive self-talk. Time was spent reminding myself that students go through this process two or even three times and they still become successful psychologists. I had to keep pushing myself forward and have a positive outlook on my future. It took me a while, but I realized waiting one more year was not the end of the world.

 

Before I knew it, the next round of coordinating flights, hotels, car rentals, and hoping to avoid disastrous weather began. When scheduling flights I made sure to avoid certain airports that are notorious for delays during bad winter weather (I’m looking at you Chicago). Due to scheduling conflicts, I had to decide which internship sites to decline their invitation to interview. Luckily some of the interviews were in December or spaced a week apart in January. However, during my most busy week, I had three interviews in four days.

 

For the first interview, I flew into a major city then drove three hours to a very small town during an ice storm. After the interview was over I hopped in the car and drove across the state to my second interview for the next day. As a note, while you fly and drive to interviews the only food you really eat is unhealthy fast food especially if you are in small towns. It was nice that this second interview site took the applicants out to a restaurant for lunch. I made sure to order the healthiest item on the menu and man was that not the best tasting broccoli I have ever had! After the second interview, I had to wake up the next morning at 3:00am to catch a flight because my next interview was in the afternoon that same day. I needed to walk off the plane and be prepared for the interview because there was no time to check into a hotel and get ready. If my flight was delayed or if there was an accident on the highway then I would have likely been late for the interview. Everything had to be timed perfectly. When I reached my final interview I was actually in a lot of physical pain. The back of my legs were sore from sitting in Planes, Interviews, and Automobiles. It was painful to sit so I stood and stretched while waiting to be interviewed. After a physically and emotionally draining week it was finally over.

 

Some consider ranking the sites to be the most stressful aspect of The Match. It is almost like a mind game of guessing where each site will rank you and trying to be strategic with each site. There is a big deal made about being accepted to an APA-Accredited site versus Non-APA. In a perfect world the only things that should matter are our clinical, personal, and professional skills. It is a ridiculous process but in the end everything will work itself out. Personally, I was more concerned about ranking sites based on goodness of fit rather than accreditation status. Leave the mind games out of the equation! Ask yourself if you can work at a site for one year or even longer. Would you be able to build a positive and effective relationship with the supervisors? Will an internship provide new experiences? Will you feel a part of a supportive and collaborative team or will you be a work horse?

 

During this whole process, it is important to stay calm and not allow distractions spill into the interview. Everyone will have some sort of “horror story” about their travels and interviews. While you are interviewing, the outside world does not exist and you should not worry about the next adventure. It is not only important to mentally and emotionally prepare yourself for interviews but also physically, as I had learned. Be sure to exercise, stretch, and find time for healthier food options. You will spend countless hours reviewing each interview site trying to come up with the best answers for potential questions you may be asked. Try to relax, enjoy the process, and be yourself.

 

This is the nature of the beast that is called The Match.

 

Jonathan Torres, M.S.
WKPIC Doctoral Intern

 

 

*Director’s note:  We’re pretty sure Jon picked us because we fed him a healthy lunch… Kidding! Mostly… 🙂 We are very proud to have him, and all of our interns. Our message is as always–you will get through this, and we have faith that you, our young clinicians, will not only survive but thrive in the field. Good luck to all of you!

 

 

Friday Factoids: Sydenham’s Chorea

The link between mental illness and viral/bacterial/parasitic infections is proving to be greater than we ever imagined. Many neurological disorders are now known to be caused by infections in addition to already known genetic and other factors. Sydenham’s chorea (SD) is a neurological disorder that is produced by the bacterium that causes rheumatic fever. It is an acute symptom of rheumatic fever and in some cases the only sign that a patient is ill. SD mostly occurs in children ages 5 to 15. However, it can arise in pregnant women. It is a gender selective disorder that presents in prepubescent females more often than males.

 

SD is characterized by uncoordinated movements, muscular weakness, stumbling, falling, slurring of speech, difficulties with writing, trouble concentrating and emotional instability which can include loss of emotional control, periods of inappropriate laughing or crying and obsessive compulsive disorder. There is usually a history of the patient having a sore throat for several weeks before the onset of SD. Onset is usually rapid, however, it can be insidious meaning that symptoms can gradually develop. In these cases of slow onset, the symptoms can be present for up to five weeks before they become troublesome enough to seek medical attention. However, in some children, symptoms might not arise for 6 month after the infection and/or fever has been treated and cleared.

 

Blood testing is currently used to identify specific proteins associated with the disorder. They can also be used to detect markers that indicate an erythrocyte sedimentation rate (ERS) of rheumatic fever which is another good indication of SD.  ERS is a test that indirectly checks the level of inflammation in one’s body.

 

Treatment is fairly basic. Those who only have a mild case will be prescribed several days of bed rest. Those with more severe cases will need a medical professional to prescribe antibiotics to kill the bacterium that caused rheumatic fever. SD symptoms usually lessen and clear in several months. However, for those with severe cases, future antibiotics are usually prescribed as well. There is currently a debate as to if those who had SD should be treated with antibiotics until age 18 or for the duration of their life to prevent the return of symptoms. Additionally, in some cases, psychopharmacological drugs are prescribed with the antibiotics to help control the severity of involuntary movements, emotional outbursts and OCD behaviors.  These too, however, usually clear in several months for most cases.

 

References

Frey, R., Polsdorfer, J., “Sydenham’s chorea.” A Dictionary of Nursing. 2008, & “Sydenham’s chorea.” The Columbia Encyclopedia, 6th ed.. 2015. (2005). Sydenham’s Chorea. Retrieved December 3, 2015, from  http://www.encyclopedia.com/topic/Sydenhams_Chorea.aspx

 

NINDS Sydenham Chorea Information Page. (n.d.). Retrieved December 3, 2015, from  http://www.ninds.nih.gov/disorders/sydenham/sydenham.htm

 

Washington, H. (2015, November 3). Catching Madness. Retrieved November 29, 2015, from  https://www.psychologytoday.com/articles/201511/catching-madness?collection=1081138

 

Crystal K. Bray
WKPIC Doctoral Intern

 

 

Friday Factoid: Toxoplasma Gindii

 

 

An interesting tidbit of information that recently caught this writer’s attention is the possibility that we are susceptible to psychiatric disorders stemming from parasites. That is not to say that all or even the majority of those diagnosed contracted a parasite but according to several studies it is a probability that a few may have. Toxoplasma gondii (T. gondii) is one of the more studied parasites that has already been linked to intellectual deficiencies, prenatal brain damage, retinal damage, abnormal head size, deafness, cerebral palsy and seizures. However, many doctors, scientist and researchers believe that it can also cause schizophrenia.

 

T. gondii is a one-celled, protozoan parasite that infects most warm-blooded animals including humans. All members of the cat family are currently the only known definitive host and they can shed the “eggs” for up to two weeks. Birds and mice can be secondary carriers of the parasite, however. Many humans who carry the parasite suffer no symptoms or ill effect due the body’s immune system keeping the parasite at bay. However, for a select few, the parasite can lead to toxoplasmosis. (Toxoplasma infection, 2013, January 10).

 

Several studies, including one by Dr. E. Fuller Torrey, have shown that mothers who became infected with T. gondii and essentially toxoplasmosis while they were pregnant had children with higher rates of schizophrenia in adulthood versus children of uninfected mothers. However, the most notable find discovered by Dr. Torrey was a correlation between those who were diagnosed with schizophrenia and were infected with T. gondii as children or teens. Essentially, what he identified was a link between increased incidences of schizophrenia in locations that had parks or community play areas that also had sandboxes. His explaination was that on average, 4-24 cats had been shown to use the sandboxes as a litterbox, the T. gondii eggs were shed in the feces and the children’s hands were infected while playing. (Washington, H., 2015, November 31).

 

To help support his theory, Torrey looks to history. He points out that up until about the year 1808 schizophrenia was relatively rare. However, he notes that in 1808 the prevalence of schizophrenia increased dramatically. At the same time, he also brings notice to the fact that cat ownership became progressively more popular in the United States and other areas around the world. He believes this shared surge of occurrence is much more than coincidence and that indicated that additional research should be conducted. Whether you agree or not with his insight to the increase and one probably cause to schizophrenia, one has to note it should be further explored. (Toxoplasma infection, 2013, January 10; Washington, H., 2015, November 31).

 

Work Cited

Parasites – Toxoplasmosis (Toxoplasma infection). (2013, January 10). Retrieved from             http://www.cdc.gov/parasites/toxoplasmosis/

 

Washington, H. (2015, November 3). Catching Madness. Retrieved November 29, 2015, from  https://www.psychologytoday.com/articles/201511/catching-madness?collection=1081138

 

Crystal Bray
WKPIC Doctoral Intern