25 March 2010


psychiatry. where to begin? today was the last day of my 4 weeks on this rotation. the schedule is great. the patients are challenging. it's definitely not boring.

psychiatry is one of those fields where you collect an excess of wonderful dinner party stories. i'm serious. i probably collected enough over 4 weeks to last me a lifetime.

why? the presentation of acute mental illness is usually completely socially unacceptable, but somehow humorous at the same time. patients are paranoid, suspicious, bizarre, withdrawn, talk to themselves, injure themselves, pace, stare, younameit. they make other people uncomfortable. as someone in the community, this may be all you would ever see. as someone who treats them in the hospital, these patients open up to us. they tell us their beliefs. many believe others are after them. some believe they have special powers. some see codes. still others have even more bizarre beliefs. some see and hear things we cannot. the list of symptoms goes on.

here's one example of many. while on service, i daily interviewed a patient who was very ill. she was brought in by the police because she was found wandering the streets confused. she smeared her bodily fluids at every opportunity (on anyone, anything). she did not answer questions appropriately or know where she was. every morning the nurses gave report that she was constantly naked. she was sexually inappropriate with other patients. she endorsed hearing voices. she saw bright things on the wall. she told us that she had a gift from god. she could open doors that were locked. she could hurt people if she wanted to. on one particular occasion when i was interviewing her, she was looking out the window at construction workers on a nearby roof. "you see them?" she asked me, staring blankly. "i can make them fall off the roof if i want." over the course of her stay she has gotten better - she really has. but it was both troubling and entertaining to talk with her each day. you never quite knew what to expect.

will i be a psychiatrist? nope. i'm glad for the experience. the stories will stay with me for a lifetime.

No comments: