21 August 2011

The Mental Status Exam and obsolete ethernet cables

I’ve written the neuro exam, the respiratory exam, the cardiac exam? (not yet) – what else. Pelvic exam will certainly deserve something. Anything that intimate. Eye exam (except I’m not good at it/we don’t really learn a good one, in med school). Musculoskeletal could be interesting.
Dermatologic, again, we don’t really learn, but that sort of scrutiny to the outside might be the most similar to psychiatry’s scrutiny of outside-to-inside-to-outside.

It’s applicable to anything. In psychiatry, actually, I did a presentation on the mental status exam and interpreting poetry – poetry I blurred on the projector screen so that you couldn’t read the words.

Mental status includes action, includes movement and speech and anything that indicates internal state in externalization.

I spend a lot of time, lately, searching for wi-fi.

Crossing into Chad

We haven’t installed it at home yet (new apartment, new city, new life as a writer-med student rather than med student-writer), and so we’re stealing – pirating – where we can. There’s one network that’s usually close enough for us to get onto (have they realized? How much slower has it become for the mysterious Them?)
It’s available at different points in different parts of the house. If that makes any sense – but there is a distance from the invisible (waves I don’t understand) that makes it easier and harder – and the distance is about 20 feet. There is, most of the time, a cloak or shield around my room. I don’t have it. And rather than take that as a sign that I should be doing other things, I should be reading, or I should be writing other-than-emails.
Instead, I search. I go look for it. I move around.

I’ve been back too long.

My frame of reference for frustration in Cameroon:
The summer prior to leaving, I was frustrated when our wireless internet wasn’t working and I had to go downstairs to plug in my computer.
A few months later I didn’t care if there was power, I’d rather it stayed off than dimming the bulbs (yes, there, it can be cut by what seems like half) and flashing in and out.

I’ve been back too long.

(I’ve said this, I know). But there is cell service in the village, now. In Mvangan. I’ve gotten calls in the middle of the hospital from friends in village – things I can’t explain about how I can’t talk at work, I’m with a patient, I’m in the hallway, and I can run into the stairwell but I can’t stay for too long and I can’t really shout and if I’m heading into the elevator I’ll lose connection. Or have to cut it off.

I wonder how frustrated they get with me. And because I have to Skype I have to count the hours, be at home, and remember. And my excuse now for not answering the phone calls upon phone calls (it’s biping, for the most part – call and hang up so the other person sees the number and calls you back).
Because there isn’t always internet.

In Cameroon, they can call me. For me to call – money less of an issue on this side – there are many, many other factors.

It’s the logistics here that are more complicated, and that’s what I have the most difficulty with. Logistics. Dealing with such. And having intermittent internet. Being in a large city in the United States, naturally, it’s easy enough to wander to a nearby café with free internet. Sit for hours with a table and a mug in the style (is it really first from Friends?) And even from there, it wouldn’t be couth to have a loud (necessarily, it’s both Skype and a phone call across sometimes-hesitant network to Africa).
I’m pirating and it’s more difficult to communicate. Or that’s an excuse.

In psychiatry, everything is relevant.

(Even this)

Cacao drying, Mvangan

One of the interesting – and difficult – things to learn, in the beginning, was that in an hour you can speak with two patients who are very anxious. One is afraid of a recurrent heart attack, a recurrent theft, an attack, a nightmare.
The other can’t access wireless internet and feels disconnected from the entire world* (yes, without ‘smart’ phone or 2/3/4 G).

*Not actually the case. Though, anyone who knows me does know that I don’t have an internet-capable phone.*

Another (perhaps relevant) point is that, when too tied to internet/devices and searching for internet/devices, you forget to pay attention. Attention to detail. To listen to everything around you – we block things out with headphones and ear buds (how much more intimately invasive can you get than actually blocking the ear canal directly?) Loud noises that drown out less loud ones. Right now, as I write, I’m periodically checking to see if I can access Wi-fi. If I could, would I be periodically checking email? Likely.
I had learned at one point to turn off the internet capability of the computer in order to really write. Editing poetry is generally long-hand, on paper, with red pens and a paper thesaurus. That helps with the concentration. And typing that is stream of thought, something moving forward, at any rate, so I’m less likely to multi-task in the middle. (And this, compared to any sort of essay or assignment, is stream-of-consciousness and directed thought. And yet. I’m still searching for internet. I’ve moved to the part of the apartment where I’m more likely to find it…are they onto us? Are we cut off???)

The mental status exam, like writing poetry, is about using every sense.


The patient might say he doesn’t drink, ever. Or hasn’t had a drink in two weeks. Your sense of smell gives you a different answer. Write it down .
We classify each other into subtypes – the ones most discussed in my life, currently, being hipster and hippie. High school was goth. Emo. Etc. These change, generationally. And they don’t at all. Incredible how people, even, are tropes. Would that be a shortcut to describing appearance? And how do you describe so that someone can listen to your presentation, someone can pick up your note and see the patient, exactly? A psychiatrist, any doctor, should be a writer. Is.


Who’s actually calm, these days? Behavior is being constantly connected. Behavior is what’s on your facebook status, gchat status (previously AIM – someone recently said I was betraying my age when I admitted to having an ICQ account, long ago). Behavior is having to tell people where you are, when you are, how to find you, your GPS coordinates, what you’re reading, where you’ve been, and who you know. I remember the Kevin Bacon game (preceding or co-existing with the advent of IMDB?) We do it to each other now, and not celebrities.
Behavior is voyeuristic. (Photos of people you haven’t spoken to in a decade? What, really, is the curiosity, and why is that what becomes part of the procrastination routine? (admitted)). Finding out how friends are connected to friends of yours, from other parts of your life – connections necessary to know for curiosity? This is how the world is real. There are few people who do not, to some degree, know each other. Whatever knowledge is, now. Behavior is having to be online to work and thus being online for everything else. What’s “productive” and what’s not.

And because I am in a coffee shop – and I spent at least 15 minutes trying to troubleshoot why the internet was, initially, not working, though I mostly don’t need it – and because this is procrastination from working on a research article – and because this sort of rambling, this sort of unedited diatribe, is common in the self-promoting, self-actualizing world of blogging and online conversations without punctuation other than key returns becomes unbearably long – I will continue the mental status exam later.

Attention to detail. Attention to length. Attention to the icon on the bottom of the screen that, moused over, declares both local and internet connection. The shiny blue circle over the superimposed monitors, on my computer, looks like a little world of oceans.


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