Borderline Emotions

IMG_6185

Those are my keys for my current rotation: inpatient psychiatry at the county hospital. Other students in my class have done inpatient psych, but from what I understand, it’s been a little… tamer for them.

I showed up at 10:15am today for orientation and a tour. Every door we went through had to be unlocked with one of the above keys, and then promptly closed after us because the patients there are all being held against their will (involuntarily admitted) and all posed major flight risks. The woman walked me through what to do if certain codes were called, telling me to “just jump behind that red line on the floor if it gets bad.”… Maybe it’s just me, but I don’t think a colored piece of tape on the floor will keep me safe from a combative patient. She went on to tell me more about the types of patients they have here, how they have all done something to someone or themselves, and can’t function in society as is. She wrapped up the orientation by asking if I had any questions. The first thing that popped into my head? “My only question is how do I get out of this place?”

After orientation I met my doctor. She’s an amazing woman from Panama and has SUCH a passion for her patients. We sat and watched 2 lectures: one on Child Psychiatry and one on Court Ordered Evaluation and Treatment. They were both interesting topics (especially the child one!) but I didn’t have time to ask questions because we immediately went to see patients.

Our first patient was a young guy in his early 20’s who had been admitted because he was threatening the people he lived with. To be honest, I was shaking when he walked in. Call me sexist, but the woman giving my orientation had pretty much told me to be scared for my life, and I was.

Oh, how very wrong I was to pass judgement so soon. He was a very sweet guy, one who had been hurt so deeply and beyond any depth of my imagination. He kept saying he just wanted to get out of there so he could be with his little ones and start a new life. He told us how much he wanted to change and how horribly he had been taken advantage of growing up financially, sexually, and emotionally, and how that has held him back from being the man he wants to be. He begged us to believe he wasn’t this crazy person everyone was making him out to be. He held out his hands and asked, “Do you see these hands? Do you see them? These are the hands of someone who’s been taken advantage of.” It was heartbreaking and brought tears to my eyes. I had to stare at the ceiling and blink numerous times to keep my eyes from leaking. We wrote a quick note to admit him and formed a loose plan of his goals while in the facility, then moved on to our next patient.

The next was a woman whose husband had physically and emotionally abused her for 41 years. She also said her son had 2 surgeries due to injuries induced from the husband. She had attempted suicide and became teary when she talked about how he was coming to visit later and how she didn’t know how to leave him when she was younger and didn’t think she had the strength to do it now. She detailed more of her life to us, a life scarred with substance abuse, trouble with the law, fear for her children’s lives, and domestic violence. We told her that telling her story out loud doubled as information for us and therapy for her, because the more she acknowledged her struggles, the more she can learn to own them as her story and begin the healing process. The session had us all teary- even the doctor- and this time I didn’t feel the need to hold back as much. I think seeing health care professionals be affected by patients keeps us all human, and reminds us of why we started down the path of patient care. We saw another patient after her, and as we left, we saw her abusive husband enter for visiting hours.

I left today feeling so many emotions that I can’t really explain. I got in my car and cried and cried. Talk about raw human emotion and vulnerability. In a place where you are locked up against your will and asked to tell about your deepest insecurities while strangers like myself observe and take notes- that seems like hell to me.  I once heard someone say nakedness is the most vulnerable you can be with another human. But I would argue revealing your heart to another is a deeper level of vulnerability and requires a trust that I’m not sure many people have. The people I saw today were brave beyond words. I have to be honest: my ignorance of what a psychiatric rotation would look like before today offended me. I wanted to see psych patients and have them fulfill my need for a good medical school story. How very selfish of me. And how wrong of me to assume I had nothing to learn from them. Today showed me just what it means to be humbled and gently corrected. It was painful and uncomfortable and emotional, but I can’t wait to see how much I change from this month’s rotation.

Self-confident Selfies

Why do we all take selfies in our surgical gear? I know I’m guilty of it and most of my colleagues have done the same. I never take selfies on other rotations… I started wondering today “why is that?”

Conclusion: Same reason we all took a million pictures the day we got our short white coats… And now we can’t wait to get out of them for good.

It’s so funny how the way we dress dictates our behavior and how we are treated. It sends a strong nonverbal message to those around us of our standing in our medical education (which is sometimes complicated by non-medical students wearing short white coats…a rant for another day). I don’t know about the rest of my class, but I am fairly confident in my short white coat now and the newness has definitely worn off. I’m now at the point where I would rather wear scrubs and surgical booties and be “that girl” in the cafeteria at lunch, because it broadcasts a new/more interesting role than the dime-a-dozen short white coats.

Some patients don’t know the “code,” though. I’ve been asked almost daily if I’m almost an orthopedic surgeon, because I am currently finishing my internal medicine rotation on the post-op orthopedic floor for knee and hip replacements. It stuns me every time one of them calls me “doc” or “doctor,” or asks if I did their surgery while the other surgeon watches. Gosh I hope not!

But these increasingly frequent interactions have made me realize I’ve grown in my confidence when I approach patients. I never felt uncomfortable with it, not even at the beginning of the year. But no doubt has my bedside manner improved and become more natural. I definitely have gotten the “flow” of a patient encounter down, and can tweak it based on the clinical setting- be it pre-operative, in a peds clinic, in a hospital setting, or in a family practice office. I guess that’s the whole point of third year! Those sneaky administrators must know what they’re doing!

As my third year of medical school draws to an end in the next couple of months, I would like to take a moment to thank all of those people who have encouraged me along the way- my husband and family, friends, Attendings, and support staff (including nurses, occupational therapists, physical therapists, medical assistants, nurse practitioners, and office managers). This is not an easy road- looking back over my posts shows I have been challenged physically, emotionally, spiritually, and intellectually. But it has also been the most rewarding time of my life, and I wouldn’t trade it for anything!