Courtrooms, plane masks, and mad kudos

IMG_6351There I was, sitting in the waiting room for court to start. All around me were the families of the patients, jittery and nervous. Some sipping coffee, some praying their rosary, some doing deep breathing or pacing…

I realized I get to see such a “zoomed out” view. I’ve seen their family members medicated and doing well. I’ve seen them when they are aggressive and have slept less than 2 hours and refuse their medication. I’ve seen them when they call their loved ones and yell or cry or squeal with delight. I’ve seen them gain insight into the voices they hear and learn to ignore them. I’ve seen them accept their strengths and weaknesses. I’ve seen them grow and volunteer their time as peer support people and “give back” to other patients living with mental illness. And here I was in the waiting room with their families. This is probably the closest I’ve ever come to an “out of body” experience, where one feels they can see all aspects of a situation- because I actually had in this scenario!

I was called into the courtroom to watch the hearing for a patient I had who wanted to go home so badly she could taste it. She kept acting out on the floor and refusing her medication, so we were having a tough time constructing her court documentation to convince the judge that she could do outpatient court-ordered therapy (ie: live at home and go to a psychiatrist once a week and take her medication daily on her own). I was nervous for her court hearing because her behavior had recently become unpredictable which threatened to sabotage our efforts to get her discharged from the hospital and sent home. She had to be brought into the courtroom in 5-point restraints because she had become violent earlier that day, demanding she be allowed to leave. The hearing started and we heard from 2 people who had witnessed her psychotic break and suicide attempt. Next we heard her defense and my doctor’s recommendations were read. The closing statements were being made when my patient slammed her hands on the table, stood up (as best as she could in restraints), and started screaming at the judge “please, please, please, let me leave, please please please” over and over again. The judge demanded she calm down and stay seated- so she sat down and got quiet. I was in the middle of thinking, “whew, close one. Come on, we’re almost done! You’re almost allowed to go home!” when she slammed her hands on the table again, and started screaming another time- this time she got violent with the staff and had to be escorted out of the courtroom. I was devastated. I couldn’t help but think she looked like a caged animal. She wanted to go home and honestly I did too. It broke my heart.

I was interviewing a new patient the next day who came in with an odd collection of symptoms, so we were running all kinds of cognitive and behavioral assessments on him to rule out dementia and delirium. Part of the mental status exam is to write a sentence down. He wrote “I would like to be able to go home as soon as possible.” I’m seeing a theme among these patients. I can’t really blame them for not wanting to be there, but I also can’t argue with their court petitions that landed them at the hospital in the first place. They need help and many of them have proven that trying to get help on their own hasn’t worked well in the past. It’s difficult to help people when they don’t want our help.

We were in a meeting with a disheveled patient with rotten teeth and stringy hair and her case manager (the person who meets with the patients at their homes and coordinates care and transport for patients to help with accountability). He wrote “doc meth” in her chart. I thought, “what does that even mean? Doctor meth? Meth doctor?” I came to find out “doc” in this case meant “drug of choice.” As I had this realization, the patient’s sister entered the room. I never would have guessed these two women were related! Her sister was so put-together with a cute outfit on and makeup and hair done… and she was there to discuss the appointments she would have to take her meth-addicted sister to once her sister was discharged. My first thought was, “wow, that’s a good sister,” then I considered the alternative (group homes, lack of support, and inevitable relapse into her “doc meth”). Wouldn’t I do the same for my sisters and brother if they fell into a dark place? Wouldn’t I help them go to their appointments so they could become the people I know they are again? Of course I would! So why was I so amazed by this woman’s actions?

My Attending told me multiple times this last month how I have a heart for psychiatry- and she’s right. Yes the hours are nice and yes the food is great where I’m at… but I really love psychiatry. Anyone who knows me well knows that I am extremely emotional and embrace my feelings pretty openly. So working in a field that encourages that and challenges me to understand the emotions and motivations of my patients has been incredible for me. The hurt and healing I got to witness on this rotation were just amazing. It goes deeper than just a good rotation- it really rocked me to my core, brought me to tears during my drive home multiple times, and awakened a sense of justice and fierce passion for my future patients that I hadn’t tapped into for quite a while.

My doctor had a lot of cutesy metaphors she used to illustrate points to our patients. One of my favorites was this:

“On a plane, what happens when there’s a change in pressure? The masks drop and what do the flight attendants tell you? To put your mask on first. Why is that?”

Patients came up with the best and most unique answers, but they all generally involved “if you can’t care for yourself, you can’t care for others.” I think this is a good reminder to all of us medical students and physicians out there. We must first care for ourselves emotionally, physically, and spiritually before we can hope to care for others.

My last day of psych was wrapped up with a patient I had just interviewed alone. My Attending asked him how I did in the interview and he said “I give her mad kudos!” He may have had narcissistic personality disorder and bipolar disorder, and his medications may have needed adjusting, but I really appreciated the compliment! Because, like I said before, I’m all about the emotional fuzzy moments. I’m gonna miss psych.

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One thought on “Courtrooms, plane masks, and mad kudos

  1. As you visit each one of these I watch you focus on the core of what is happening with the patients. It seems like with every specialty you experience you reflect on the humanity of being in the learning situation. You conquer your fears of the new role and integrate the science that assists you in working with patients and mentors.
    Most medical situations have a beginning, middle and end. Infection is diagnosed treated and most times conquered. Cycles occur, are identified, organized and directed towards expected resolutions. Babies are born, grow have challenges and old people die. With this one I am reminded of the difference that accompanies mental illness. Psychiatric practice is a practice without control, you watch human capabilities splay out without boundaries. There is processing and realization in baby steps, accepting loss and difference each day. There is no winning or conquering with this specialty there is only maintenance and relapse. What ever specialty you finally settle into I am glad you have set up a life where you process your ideas and feelings, relax and enjoy the world around you, and most of all take care of yourself.

    From a fan.

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