I meant to write more last month when I was on my psychiatry rotation, so here’s a summary of those 6 weeks. Psychiatry felt a lot like being a camp counselor. It didn’t help that I didn’t wear my white coat, and instead had a long lanyard with my hospital ID, keys to the ward (it was a locked ward, you know), a pen, and a flash drive clipped onto it, and everything would jangle as I walked around on the psych unit. Oh, and I had a clipboard with notes in it, and one of my patients drew me pictures during an art therapy session, and I stuck the pictures in the outer window. Between the art groups, the recreational walks, and then interpersonal drama between patients, it was like camp for adults. Involuntary camp. With ID bracelets and big security guards watching your every move. But still, kind of like camp.
I had a patient who told me that the tv talked to him directly, that newscasters could see him through the tv, and then he confessed his masturbatory habits to me (it made me so uncomfortable that he, even through his social awkwardness and um, psychiatric psychosis, actually said to me, “I can tell I’ve made you uncomfortable, sorry,” and I was like, “UM… Yeah, okay, you’ve made me really uncomfortable, um… yeah.”). It was actually a hopeful story, because he responded really well to medications and psychotherapy, and was committed to continuing therapy, and had a family that was supportive, which are not things that other patients tend to have going for them. So, anyway, even though I had to sit through a really weird conversation about marijuana and masturbation, he ended up being one of my favorite patients on the rotation.
Only on a psych rotation can your patient tell you that he’s with the CIA and the Israeli government. Or, a patient can freak out on you and tell you she’s bisexual and wants you to hit on her. (That conversation, by the way, really did make me freak out until I told one of the nurses, and the nurse was like, “Oh honey, that’s just Janie* — she asks everybody that.” That was… oddly comforting.) I ended up liking psychiatry a lot more than I thought I would, as much as I feared I would, and now it’s on the short list of specialties that I would consider doing my residency in. Yikes. I have some issues with becoming a psychiatrist (mainly: the total lack of medical respect that other doctors give psychiatrists, and the idea of going to med school to become “just” a psychiatrist), even though pharmacological treatment of psychiatric diseases is a lot more medical/science based than I would have suspected AND treatment often involves the psychological and social aspects of patients and overlaps a lot with public health and public policy, and even law.
Psychiatry is just very exhausting, and moreso than in Internal Medicine or Ob/Gyn, you can’t always hold your patients accountable for their actions. Psychiatry can be even more paternalistic than Internal Medicine, given that the physician always has to maintain the therapeutic relationship and basically rise above any immature stunts or behavioral issues in order to preserve a good treatment relationship. And whatever the patient expresses is supposed to be encouraged so that we have an idea of what’s going on in their lives. And you know what, maybe I’m not a big enough person to rise above it and listen to some of my patients who cannot let shit go or stop being such whiners, and one day I would give in to the urge to yell, “OHMYGOD, WHATEVER, OKAY?” Maybe that’s one point for medicine — you don’t have to be exceedingly patient with people who just don’t get it, over and over. In Ob/Gyn, if your patient refuses to come in for pre-natal care, you don’t go find them and drag them into the hospital, and a lot of the time, the baby turns out okay anyway. In Internal Medicine, you try your best and at some point you can wash your hands of a competent adult patient, but in psychiatry, part of the reason these patients are in the hospital is because they literally are not allowed to make decisions for themselves and need people who won’t give up on them. So maybe what I’m saying is that I’d like to be a quitter. But then I think about how fun it was every day to go to work, to play mental chess with the overtly hostile patients, to talk with the cooperative patients who understood that psychiatric help is a type of healthcare need, to hang out with nurses who have seen and heard the craziest things, and I think maybe it’s worth it. And you know, the hours can’t be beat.
*Names changed to protect patients… and me.
