Saturday, September 22, 2007

What's next

A few have asked, "So...what's next?" Psychiatry is next. It is known for being easy, mostly because there is no weekend rounding and no call. They call it Psychation.

I'm a bit nervous about it, though, because I hate what I've seen of psychiatric medicine. I was in the psych ICU last week for a surgery consult. It was sort of dark, nothing on the walls, beds bolted to the middle of the floor. I led support groups in a women's prison last summer, and I would rather spend the night there than I would sleep in this psych ward.

When I was an aide in college, I used to occasionally have to work in that hospital's psych unit, and it was much the same. One night, I was a sitter for a young woman who made a half-hearted attempt at suicide. I was assigned to sit in her room and make sure she didn't try to hurt herself until a bed in the secured psych unit became available. When that bed did open up and I walked her to her new room, she looked at me in terror and said, "You can't leave me in here." The rest of the unit was full of men--crazy men--who wasted no time coming to check her out. It was a nightmare. Co-ed psych units--who the fuck thought that was a good idea?

So, inpatient psych scares the shit out of me because I can't help but think, What are we doing to these people?

I will be in a child and adolescent unit for three weeks and then at a separate psych hospital for three weeks. I'm going to try to keep an open mind and hope that the environment is a bit more therapeutic than what I've seen so far. I saw a few patients with a psych resident in the ER last month, and I really liked him. He had some great tips for how to best get a history from the mentally ill. He also reassured me that he, too, is uneasy about some of what passes for psychiatric medicine around here. I hope to meet many more like him.

On the bright side...I should have more time to blog.


Terroni said...

Again, these are just my experiences with psych. I don't mean to imply that this is how all of psychiatric medicine works. In fact, I hope to learn that most of it is nothing like this. If you have had better experiences as patient or caregiver, I would love to hear about them.

In the meantime, please forgive what I'm sure is my ignorance as I start this rotation.

.j.william. said...

wow. I'll be interested to hear your experiences over this rotation. My mom spent some months in a hospital psych ward and seeing her there was one of the hardest experiences of my life. It was a strange dichotomy of feelings: not liking the place, yet knowing she was safe there.

Maria said...

I'll be interested to see how this plays out.

So much depends on the physician. Try to look at it as a puzzle. When you are looking at presenting symptoms, try to think of it as a Where's Waldo? type experience.

But, yeah...sleeping on a ward is just plain spooky. And attendants can either be miracle workers or so seasoned and jaded that they forget to look for Waldo.

It can be harder because the blood and guts aren't hanging out, they're hiding, but once you find the culprit, it can be such an incredible experience.

Mme Benaut said...

Terroni, Maria is so wise and I love the metaphor that the blood and guts culprits are hiding.
I grew up with an older sister who is both bipolar and schizophrenic. That was a tough road and I think I was beaten up nearly every day and still have the scars where she cut me with anything she could lay her hands on from the tips on her shoes to scissors. She is now 53 and under a mental health order so she has antipsychotic injections fortnightly, in addition to a number of drugs. I can honestly say that since this routine started, it is the first time in my life I have every felt safe as for many years now I have been the one to call the police or the ambulance or the emergency psych unit to get her taken to hospital and committed. She has spent up to 5 months in a pysch hospital and the first month or so in the lock up ward. They are very scary places because of the unpredictable behaviour of some of the patients but they can also be rewarding; particularly for the help given to the badly clinically depressed. I guess that one of the big challenges these days is working with patients who take nasty drugs like "ice" and have psychotic episodes but may not necessarily be affected at the endogenous level. Anyway, little one, good luck. By the time you finish, you will perhaps have more respect for the "system" of psychiatric medicine - some illnesses are totally predictable and the drugs are used because they work - enabling the patients to have some semblance of what we might consider a "normal" life; that is eating and sleeping and not being pestered by terrifying voices or collapsing from physical and mental exhaustion.
PS My sister and I have a good relationship now.

Terroni said...

J, Maria, Madame... Thank you for sharing. I so appreciate it. I look forward to sharing my upcoming experiences with you, too.

Cheryl said...

Good luck with this rotation. It should be interesting, and, like you said, hopefully easier. Stories?