Finally, a rotation that is not wooing me in any way! I absolutely have no desire to pursue psychiatry! Yay! One specialty is for sure crossed off my list! My first week was spent in the Adolescent Psych Unit. This is an inpatient psych treatment center for children ranging from 6 to 17. I found this week challenging. I like working with kids, but I had a really hard time finding common ground with these children. They were dealing with messed up home lives and issues that I have never had to face. I just can't relate. Now the argument can be made that I can't relate to women who are pregnant since I have never been pregnant or children in kidney failure since I have never had kidney failure, but those are situations I can at least imagine. The kids in the psych ward come from situations that I can not even fathom. I never was a 15 year old dealing with a meth addiction and bipolar disease and I have a hard time imagining it. It was also difficult working with such a wide range of ages and problems. A 7 year old with behavioral issues sits in the same group therapy session with a 17 year old dealing with alcoholic addiction. And it was frustrating since most of the issues stemmed from the home life and the parents. A lot of these kids were having problems because their parents were having a hard time actually being parents. I think some parents had their children committed looking for a quick fix with a wonder drug. Well unfortunately no such drug exists. Now this may sound harsh and I admit fully that these opinions are created with the limited view of a 24 year old childless med student, but really how hard it is to love a child and provide them a safe place to grow and explore the world? But enough with my frustrations.
There were definitely some fun times with the kids. A typical day started with group session after breakfast were the kids set a goal for the day and how they mean to accomplish that goal. The psychiatrist would pull the kids out for short individual sessions with each kid during the morning. This was mostly to discuss the medications being used and looking for side effects. The psychiatrist at this facility didn't do any psychotherapy and left it all to the councilors or behavior specialists. Each kid had a family session everyday as well, whether in person or by phone. These seemed to be the make it or break it moments of treatment depending on how receptive the parents were to change. The kids had many group sessions during the day and even recreational therapy (aka play time). I met some pretty special kids that week.
Next I went to the Chemical Dependency Unit. This unit is an in patient treatment for drugs and alcohol. Some stay just for 3 days for detox while others are there to complete a 30 day program. Again a wide variety of life stories. I never really felt like I fit in or that I was qualified to be leading group sessions. Most of the councilors there were recovering addicts themselves so they had more of a connection to the patients.
My last two weeks was spent on a in patient psych ward. The focus there was on treating schizophrenia, major depressive disorder, bipolar, any form of suicide attempt and delusions and hallucinations. These two weeks were more to my liking. My day was more structured and I was working one on one again with my attending. Also, this might sound insensitive but I want to be really honest. Sometimes the patients are just very entertaining. They talk about the world of their delusions and some are really quite creative. Also, you never know what they are going to say or do next. One time a patient just stripped all his clothes off while continuing to answer my questions as if nothing out of the ordinary was going on. Because the patients were unpredictable, everyone on the ward wore a panic button which I can say from experience works. This button causes a hospital wide alarm to go off, almost like a Code Blue that you see so much on TV. Security, nurses, and doctors have to respond until the alert is called off. There is a tracking devise on each alert so that they know where to find you. So all the doors on the psych floor lock automatically. One time I was working in an office with the door open when a patient walked in and shut the door behind him. Earlier that week this patient had written me into one of his delusions. He claimed that I was the one hurting him in his sleep. My attending told me that this was a bad sign and that I needed to avoid this patient until his anti-psychotic medication kicked in. Well, my avoidance strategy didn't really work once I became locked in a room with him. I didn't even hesitate with pressing my panic button. The alert went through the entire hospital and the response time was very impressive. While it only took less than a minute for help to come, it was one of the longest minutes of my life. I think for the first time ever I felt in direct danger. Luckily there was only enough time for this patient to push me into a chair before he was restrained. Yay for panic buttons! Overall, this was the only scary thing that happened during my rotation.
While I understand the importance of locked doors on this floor, they can really hinder things at times. Like when you think you're being a good person and take the stairs up the one floor to the cafeteria. For some reason you can get into the stairwell but then can't get out. So I may have had to call my attending from the stairwell on my cell phone to come let me out. Good news is that there is no way a patient could escape via the stairs! I tested every door before calling for a rescue. My attending was really awesome to work with. I personally think that being a woman in the psych field gives her an advantage. That, and being a mom. She didn't put up with all the nonsense and called the patients out when they were making excuses or just weren't listening. She also stood up for herself and her staff when the patients got rowdy. She was the attending this month that taught me the most. Well, anyway, that's psych...and now home for the holidays! (I know this post is overdue and that the holidays have already happened, but I'm keeping a timeline here. Up next - Danelle's Holiday Special!)
