This post comes to you from scenic suburbia. For my 6-week rotation in psychiatry, I have temporarily relocated and I’m living in a sublet at a friend’s apartment, about 10 minutes away from the psych hospital.
The psych hospital is a separate building from the main hospital. It has its own ER, and 3 floors with 1-2 units each (for a total of 5 units). Since each adult unit can hold about 22 people, and each child & adolescent unit can hold about 16 people, that means the capacity of the hospital is approximately 98 people (not counting the ER, where people can supposedly languish for up to 3 days while waiting for a bed). That’s a pretty impressive number of people.
I am on unit B2, which is an adult unit. For good or bad, we do not rotate through different floors or units during our 6 weeks. Instead, the unit you get assigned to is the unit you stay with the entire team. Similarly, the two attending physicians you get at the beginning are the same ones for all 6 weeks. One of my attending physicians is Dr. D, the same person who ran the Behavioral Science course from my first year, and he’s now the clerkship director for the psychiatry rotation. This is… a mixed bag. On the one hand, I specifically chose this hospital to do my rotation because I’d learned so much during my first year. On the other hand, I really didn’t want to actually be on Dr. D’s unit — he expects a lot from his students. I didn’t want to directly work on his team — I just wanted to be adjacent to the team, and reap the benefits by being at his lectures. I mean, on the first day, Dr. D asked us what the definitions of psychosis and delusion were! The nerve! I don’t remember things I learned over a year and a half ago! I barely remember Internal Medicine, and that was 3 weeks ago! And now he expects us to read and learn and answer questions, God, I am so put upon. (Ha, now you all are hoping I don’t become your doctor in the future.)
So, obviously, the bad parts of being on Dr. D’s team have to do with being forced to learn and work, which is anathema to other students’ experiences on other psychiatry teams. The good part is that I will learn a lot of psychiatry. Dr. D truly loves his job, and basically spends those 6 weeks trying to convert people to psychiatry. Dr. D himself started out at an obstetrician/gynecologist, and then realized that he’d rather do psychiatry.
One point in favor of psychiatry? On Friday morning, we went to court! We had some patients who took us to court, to petition for release because they were being held involuntarily in the psych ward. Not to be mean, but some of the best times come from when patients prepare statements or speak out of turn, because then the judge gets to see just how RIDICULOUSLY CRAZY they are. For real, one of our patients prepared a long statement that started off with, “I am with the Israeli government. I am also with the CIA. I am a lawyer, and I taught special education for [redacted] County for 7 years.” The judge interrupted and said, “Wait a minute… the Israeli government and the CIA?” The patient said, “Yes.” And the judge, bless his heart, replied, “Okay.” The patient’s request to be released was, thankfully, not granted. Court was really, really interesting. It’s not so much that I love lawyers or confusing law-speak (sorry, Erika, but I do not), but rather that this specialty of health care interacts so much with other parts of the world. You have judges and lawyers and social workers and doctors and patients and their families and the police who maybe were called to the scene, all working together to try to help the patient. It’s enormously gratifying to be part of this overall plan, and not just work in a vacuum of the hospital, where we release our patients after they are mostly better and hope they continue to heal. I suspect, though, that the recidivism (is that even the right term? probably not) of our sicker patients is very high, and that this chronicity of mental illness would start to bring me down over the years.
