Week 1: May 25, 2010
I will give you a basic idea of what I do first. I started my internship with Allegheny General Hospital in Pittsburgh, Pennsylvania. I work in the Neuropsychology Department. Everyday I report to the office, which is in a separate building from the hospital, and we have a morning meeting where we discuss the patients that need to be seen that day. There is a wide variety of patients but the majority have been in a motor vehicle accident (MVA) or have fallen. We then divide the patients among the interns and walk over to the hospital to complete the inpatient neuropsychology testing. We perform the standard C & L Battery that has the Galveston Orientation and Amnesia Test (GOAT), Logical Memory I & II with delay, Brief Visuospatial Memory Test-Revised (BVMT-R) with delay, Hopkins Verbal Learning Test-Revised (HVLT-R) with delay, Digit Span, Mental Control, Controlled Oral Word Association Test (COWAT), a Judgment testand Wisconsin Card Sort (WCS). After we administer the test we have to go back to the office and score it. We then give it to our supervisor, Dr. Glen Getz to dictate.
My first week was a lot of procedural things. First thing I had to do was complete two basic tests, compliance and office policies. We then went over to the hospital to get our ID badges. Throughout the week I studied the tests and observed a few patients. They are all so interesting. First I observed a woman who was in a MVA then a man who crashed his motorcycle and was not wearing a helmet. He had a lot of stitches on his head but surprisingly I was able to deal with it. During the testing of the man I learned how difficult it can be to complete the testing accurately because of the distractions and variability of bedside testing. While we were in the middle of a test about 10 nurses and doctors came in the patients room to ask him and his roommate questions. I could tell the patient was annoyed because prior to their arrival he was very compliant but afterwards he was extremely frustrated and had difficulty focusing. Then our final patient for the day was never actually tested. He crashed his car trying to evade the police so he was handcuffed to the bed with an officer in the room at all times. He kept delaying the testing because he thought that would delay his incarceration but he was wrong. They took him to jail later that afternoon before we were able to test him.
Each week we have Grand Rounds where we listen to a lecture. This week it was called “Growing Up or Growing Pain?” It was about the DSM-V. It discussed the risk of changes, why make changes, what changes are going to be made, and new diagnosis.
Week 2: June 1, 2010
It was a long weekend because of Memorial Day and because of that we had a lot of patients. I tested out on Tuesday and was observed so now I am able to administer the C & L Battery by myself. My first patient was oral only because she had a C-collar on. My supervisor, Dr. Getz observed me administer my first test. The woman was very nice and compliant so it went well. My first patient that I tested by myself was a male who turned 21 two weeks prior to his accident in which he flipped his BMW Z4 Convertible. He was pretty beat up and did not perform very well on the testing. It was a pretty slow week even though it was a long weekend. Grand Rounds was cancelled this week.
Week 3: June 7, 2010
On Monday, we set a new record for total number of inpatients tested in one day. We tested 16 patients. I tested a patient who was diagnosed with encephalitis when he was a child so he was not very good at the delay tests and had a difficult time with all of the memory tests. We had a fire drill this week. It was not a big deal at all though. All we did was gather by the elevator and sign our name. It didn’t seem like very good practice to me but oh well.
On slower days we try to do different things so one day I was helping another intern prepare for her first outpatient testing by being a 5-year-old. I liked it because I was also able to see and learn the child tests. I talked to Dr. Getz about observing outpatient child/adolescent testing. I also looked into getting certified to do research but I’m not sure if I want to spend my time on that yet. I was also able to supervise a 7-year-old complete a computerized test. I noticed he had a tic while he was completing the test but afterwards we went into a different room to color and he didn’t seem to tic at all, it was weird.
I learned how to administer and score the geriatric battery this week. I administered my first one on Thursday. My patient was very nice and cooperative at first but as the test progressed she became more difficult. She was not very good at the math parts and when I asked her to do some addition she said to me, “I only count my money!” So I skipped that test and moved on. She because very resistant towards the end and said we were just insulting her intelligence but I explained to her the importance of the testing and she eventually complied and I was able to complete the test.
Finally, Grand Rounds this week was about how to properly treat patients who are deaf or hard of hearing.
Week 4: June 14, 2010
We have a new undergrad intern this week. I took her to get her ID badge and showed her our office in the hospital and showed her around our office too. She observed me while I tested a man who was trampled by horses. I was only able to give the oral tests because his arms were all bandaged. He did very well on the test though. After we returned to the office I showed Jess how to score the tests.
On Monday I had the opportunity to observe a child inpatient test. The girl we tested was in an ATV accident and was very cooperative. We then went to test a 14-year-old boy but he was asleep and his dad advised us not to wake him so we just went back to the office and were going to try later when we was hopefully more rested.
Tuesday morning was not busy at all. We were not able to test a single patient. In the afternoon I tested a woman who was extremely hard of hearing and I had to yell to her for the entire test. After we finally finished I was so dizzy and lightheaded I wasn’t able to do anything for the rest of the day. And to make things worse, as soon as I walked out of the room her daughter came to visit and the first thing she said was, “Hi mom. I brought your hearing aid.”
Wednesday we had team building. We played the Wii during our morning meeting and during lunch but we were not able to finish the tournament so we have to do it tomorrow too. I also tested one patient. She was in a MVA and was also in one in February so she told me this was it, she was going to sell her car. She also had not worked a day in her life. She quit high school early to help her mom take care of her family and has been a housewife ever since. She, like most of the patients, was very nice to start the testing but as it progressed she became tired and frustrated.
Thursday was a good day. We completed the team building and I won the championship! Then I made some copies and did a little filing and I signed up to observe ECT at Forbes Regional Hospital next Wednesday. I’m excited for the opportunity but also a little nervous. I was able to observe a 13 year-old who was being tested for ADHD. She was extremely meticulous with the first test so we did a shortened battery. After the interview and the tests it looks like it might be an anxiety disorder rather than ADHD.
There are no more Grand Rounds this summer but we are going to have Journal Club in the office once a week. Overall it was a good, busy week. I like always having things to do and I am learning a lot. I really like the internship so far.
Week 5: June 21, 2010
While there are a lot of patients from the weekend on Mondays, they are usually pretty slow for me because there are a lot of graduate students and people in the office on Mondays the work is usually split pretty thin. I tried to test one patient who was on contact precautions so I had to wear a gown and gloves when testing her. We were testing her in order to assess her decision making ability. She was asleep so I was unable to test her. So I just studied the WISC-IV test. Then I scored a test from earlier in the day.
On Tuesday I went back to her with just a simple yes/no test but was unable to administer the test. She could understand that I was in the room and was talking to her but all she would do was make eye contact with me without any sort of response. I asked her to blink, tap her finger, or nod her head but she was unable to respond at all. In the afternoon I tested a patient who was waiting to be discharged. He slipped his motorcycle on gravel and didn’t have a helmet on but seemed okay. I like to test patients when they are ready to be discharged because they are always the easiest patients to test as opposed to them when they are first admitted.
Wednesday I went to Forbes Regional Hospital to observe ECT. I followed a doctor around the whole time. Before each patient received the treatment they had to interview with the doctor so she was able to assess their progress. The first patient was a man with schizophrenia. When he was admitted to the hospital he was having both visual and auditory hallucinations. After a few weeks of treatment he has no more positive symptoms but is still depressed. The next patient was a very nice elderly man who was just receiving maintenance treatments. His last treatment was 4 weeks ago and his next one will not be for 5 more weeks. The next man was only on his third treatment but the doctor said that he was already smiling more so that is noticeable improvement. There was a younger woman who is a new mother and seemed very happy but it just shows how different depression can present with different people. Finally there was a woman who would not let the nurses prep her for the treatment until she spoke with the doctor. She kept talking about how difficult it was to come to the hospital to receive the treatment. She said the nurses always have a difficult time getting the IV started and she want to get a pic line but the doctor would not allow it because she has a history of suicidal thoughts and has borderline personality disorder and it is too dangerous. Her situation was a little difficult because her ex-husband who moved to New York took a leave of absence from work to come back to Pittsburgh to drive her to and from the treatments and it was adding more stress to her situation. The doctor continued to tell the patient that the treatment would help with biological factors causing depression but not the social factors. She eventually ended up receiving the treatment. Once the patients complete their interview they are taken to the OR to receive the treatment. They give the patient anesthesia and muscle relaxant then the seizure is induced. However, the muscle relaxant did not work for the first few patients so it was a little difficult to watch. The last few patients did go smoothly. When it is administered correctly there is just a slight twitch in the right foot. They like to make sure the seizure spreads all the way to the left hemisphere. It was very interesting to observer but also very invasive. It is very appealing because it is 80-90% effective for treating depression but it is intense treatment.
Thursday was a pretty busy day. I stayed in the office for the morning to learn and practice some outpatient tests. I was able to administer the STROOP, COWAT, Trails, and gave the 13 year-old some self-reports to complete. Then I had to test another patient in the afternoon that was waiting to be discharged. It went pretty quickly and he did pretty well.
Week 6: June 28, 2010
This was a short week. I worked until Wednesday and took off next week for vacation.
It was a pretty simple week with inpatient testing so we were able to discuss more opportunities within the office. I learned how to completely administer the WISC-IV and I am going to be working with a doctor in the office that is only going to be testing children starting July 1st. I also spoke with her about doing research with her and another doctor in the office. I am going to be starting the research went I return after vacation. We are going to be doing a factor analysis with Conner’s Continuous Performance Test (CPT). I will just be helping enter the data into the database and finding article for the literature review. I am excited about all of these new opportunities because I am pretty comfortable with the inpatient testing. I am also looking forward to interacting more with children.
Week 7: July 12, 2010
There were a lot of inpatients on Monday but since we have so many interns on Mondays I helped with outpatient. I had watched a little boy for Dr. Getz earlier in the summer while he did the second part of the intake and he was coming back today for testing. Last time I saw him he had a little tic but he I did not know that he also has been known to squeeze goldfish until their eyes pop out. The family dog also has to be isolated from him. For these reasons, I stayed to help test him. Surprisingly, there were no behavioral issues during all of the testing. He was getting a little tired towards the end, but that’s to be expected of a 7-year-old. He struggled to find words but other than that there were no serious deficits. He was obese and came to testing with an unusually large bag of snacks for a child. He had a large bag of Reese’s Pieces, banana, and juice for breakfast. Then after his break for lunch he came back with a family size bag of potato chips. This shows that the parents are very permissive towards him. After I tested him I went over to test two patients in the hospital but they were both in the OR so I came back to the office and scored two other tests that were left in the office.
Tuesday was very slow. I was the only person to test a patient in the hospital. So we all started to learn the Wechsler Memory Scale (WMS).
Wednesday was an interesting day. I tested my first outpatient. She was 7-years-old and was extremely energetic, she was almost euphoric. Throughout the testing she continually grabbed for things on the table and would push the table and she somehow managed to even push the panic button. She was wearing a dress and kept putting her feet on the table and sitting inappropriately. She had crackers for her snack and was a very sloppy eater. There were crumbs all over the testing supplies, herself, the chair, floor, and table. She also thought she heard Freddy Krueger’s voice in the hallway and talked about how she watched the some of his movies. All of this behavior would lead someone to believe that she does not come from a very good home. Her concrete perception and reasoning scores were not very high. She did respond very well when corrected but would eventually get worked up again and need to be told to calm down. After the testing was complete we had Journal Club were we discussed the Rey-Osterrieth Complex Figure. We looked at two patients who struggled significantly with the task. Then I went over the WMS again so hopefully next week I can test out. Then I would be able to test adults as well as children.
Thursday was another slow day. I stayed in the office all day again. I went over the WMS again. Then I helped another inter that I’m working with on the research project go through the files to find patients who are in our database. We needed to randomly select 1% of the people in our study to check the data. Then in the afternoon I watched a little boy on the CPT. He did not want to sit still but he was able to complete it so that was good. Then I tested out on the first 6 tests of the WMS.
Week 8: July 19, 2010
First thing Monday morning I finished testing out on the WMS. Then I finished checking the data for our research project. Now all I have to do is the lit review. I worked on that for the rest of the morning. Then in the afternoon we had two new patients. One was a full geri and it took forever to complete. I felt really bad giving the tests because it is so long and the patient didn’t even have a head injury. He was attacked by a pit bull but never hit his head. Dr. Getz was not even sure why we were doing the testing. The patient kept asking us if his wife put us up to it so maybe she wanted it to be done. Then we had a woman who fell down a flight of stairs and her face was pretty hard to look at. She could not see very well because her face was so swollen so we were only able to do the oral tests.
Tuesday was pretty normal. I went to do a geri but they were not responsive so I observed 2 other inpatients. One patient fell and the other was in a car accident. They were both very nice and cooperative. We went back to the office and scored the tests. Then I learned how to score the WISC on the computer. There was a new patient in the afternoon but by the time I went over there she was already discharged. So I don’t really understand why they order the consult if they are going to discharge them without it and not require any sort of outpatient evaluation. So when I got back to the office I started to look at the Delis-Kaplan Executive Function System (D-KEFS) while we were waiting for someone to come interview for an internship. She was lost over at the hospital though so we had to walk over there and find her and bring her back to the office for her interview. We talked to her on the walk and told her what we do but I hope she didn’t really have any questions for us cause we left while she was still in the interview.
Wednesday morning I had two patients but one was transferred to UPMC so I did not have to do that one. The other was a 60-year-old man who drank alcohol and did heroin then hung out with his friends and somehow fell and hit his head on the concrete. We do not know any more details of the fall. He has a history of depression and addiction. Then in the afternoon I had two more patients but, luckily, the one was in the OR. The one woman I tested was 83-years-old and took forever to complete the tests. She was very nice but loved to talk so I spent most of the afternoon over there. She told me she fell on her way to check her email. She did not do very well on the WCS or the COWAT but seemed okay other than that.
Thursday I was going to help with an inpatient but he was not cooperative. He refused to speak so we only did nonverbal tests. I went over to the hospital and tested an older man who was transferred from a different hospital. He was a nice patient but kept falling asleep towards the end so we were not able to complete the COWAT. I went back and scored the test then looked at the D-KEFS some more. Then Dr. Getz took the interns to Gus & YiaYia’s. It’s a Pittsburgh tradition he said. It’s just a little snow cone stand in the park that has been there since 1936 and they just have a block of ice that they shaved by hand. It was pretty good and a nice way to thank us for helping him this summer. He is a really nice doctor to work with.
Week 9: July 26, 2010
Monday I tested one woman in the morning who crashed her car while she was driving while intoxicated. She was very emotional. She was my first patient who cried during testing. She was more comfortable doing the visual tests so every time she became upset with an oral test I would follow with a visual test and she was able to complete the entire battery. After I scored her test we had three new patients so I took two. The first one was not testable because he was in the OR. The second was in the Emergency Department and his doctor did not want to admit him so I had to do the testing there. The man was very disoriented to the day, time, and his location so I paged Dr. Getz and he told me to tell his doctor that he should be admitted. I had to add a note in his chart and I learned how to stamp the patient’s information on the paper.
Tuesday was another busy day. I tested three patients in the morning- one was oral only, one was a shortened battery, and one was just an effort test. I got back to the office pretty early so I was able to observe an intake interview with a woman who had surgery on her brain stem to remove a tumor. It was very interesting. She was doing remarkably well for such an intense surgery. I think her biggest problem was adjusting to her new lifestyle. She did not like how she is now so dependant on others to help her with things that used to be simple for her. After lunch I scored three more tests for another intern who had to leave at noon. Then I typed the patient list up for Monday and Tuesday. Then the interns talked to Dr. Getz for about an hour before we left about graduate schools.
We tested 20 patients on Monday and Tuesday. I stayed in the office all day Wednesday. In the morning I worked on research. I have to go through about 1000 files and write down the diagnosis. I had to help test a child in the afternoon. I administered the Stroop, Purdue Peg Board, and the Wide Range Achievement Test (WRAT). Then we had Journal Club and discussed articles about different types of medications and their effects on cognition.
Thursday morning I tested my first adult outpatient. I administered the WMS, COWAT, Trails, CPT, and WCST. She was assaulted by her neighbor and was having some symptoms of PTSD. After we finished all the tests I scored them. Then I work on more research.
Week 10: August 3, 2010
There are only two undergraduate interns left. First thing in the morning I scored the Personality Assessment Inventory (PAI) for Dr. Franzen. Then I saw three patients today but I was only able to test two of them. The one was way to lethargic to test. On my way out of the hospital I recognized a nurse that had approached my earlier in the summer when I finished administering the Mood Assessment in the NICU. She asked my about the questions that I was asking the patient and told me that she felt very depressed and that she wished that her doctor would ask her those questions. I was not sure what to say to her so I told her to talk to her doctor about the mood assessment. When I got back to the office I asked Dr. Franzen what I should have done and he told me to give her his number. So when I ran into her again today I made sure to give her his extension. I was very happy that I was able to find her again because I felt very bad about not giving her his number the first time I met her. I hope he is able to help her though. After I spoke with her I came back and scored the tests then worked on more research. I finally finished it all after lunch.
Wednesday was very busy. I tested two patients in the hospital in the morning and came back and scored them. Then I started to get the things I needed to test a child at 1:00. But at around 10:30 Dr. Franzen told me that she was there already. So I hurried and got everything together and I went out into the waiting room to get her. We did the WISC, CPT, WCST, CVLT, COWAT, Trails, and the Berry Visual-Motor Integration. I was going to have someone else sit with her while she the tests on the computer but she started to cry and was very upset when I told her that. She said that she had to go see her mom right then. I told here that was fine and she was working really hard so it was no problem if she needed a little break. I walked her out to the waiting room but her mom was not there. The other people in the waiting room said that she just left to go to the bathroom. I was so nervous I thought she was going to be even more upset but she was not. She wiped her tears and said that she was fine she could go back and sit with me and finish. I told her it was no problem we could wait and she could take a break but she insisted she was okay. I took her back and just sat with her through the computer tests rather than asking someone else because I didn’t want to upset her anymore. She was a very well behaved patient so that was very nice. Once I completed everything I met with Dr. Getz for my evaluation/exit interview.
On my last day I tested three inpatients in the morning. Two of them were full batteries and the other was oral only. I scored the inpatient tests before lunch then after lunch I scored all the tests from yesterday. After I finished everything I cleaned out m mailbox and said goodbye to everyone.
