I’ve spent three weeks on the psychiatry clerkship and it’s been an interesting experience so far. I’ve had inpatient, outpatient, and crisis experiences and they’ve all had a certain charm.
For my inpatient experience, I’m working on the inpatient crisis unit of a psychiatric hospital. This is where patients come for short hospital stays when they are having difficulties in the community or at their residential treatment facilities. Patients come in when their medications need adjustments or they’re feeling suicidal or if they had a relapse of their substance abuse. It is rewarding to see patients improve over the course of their hospital stay. Oftentimes they come in scared, disheveled, or frankly psychotic. As their increased medication dosages take effect, they gradually come to the team meeting in better shape each day – with cleaner bodies and clearer minds.
My outpatient experience is with a psychiatrist in the community. So far I’ve seen many cases of substance abuse, primarily heroin but also prescription pain medications and benzodiazepines. Some patients seem to be making decent progress in their recovery, but others are still engaging in illegal activities like buying their medications on the street. It has been frustrating to watch patients continue to struggle with addiction. I relate more strongly to some patients than others. Some of them I’m fairly content to just sit by and watch. Others, I feel this urge to take them by the collar and tell them to make better choices! I know this isn’t necessarily the best approach, but even the psychiatrist agrees with me that some patients are not doing as much as they could to get better. Some of them need more routine in their lives: they need to get up early, to work at a tiring job all day and come home ready for bed. They need to spend time away from home and fill their days so they have less time available to use drugs. Sometimes it seems like the drug use is not the only problem. The feeling of helplessness and inability to change are also powerful forces in the patient’s life. Despite these frustrations, I have enjoyed outpatient psychiatry the most so far.
My experiences on crisis call have been short but memorable. My favorite experience thus far has been meeting a patient with mania. It was evening and it had been a long day. I was wishing to go home when we were called to evaluate a new patient. The patient was talking a mile a minute, spelling words, going off on tangents, and giving us compliments. The patient was funny and engaging and a real hoot. It was as if the patient had rubbed off on us a bit – after speaking with the patient the whole team was joking and laughing and having a much better time at work. It was a pleasant change of pace from some of the darker parts of psychiatry.
Three weeks left of psychiatry – who knows what they’ll bring! Wish me luck!