One Day I'll Tell You

It's been a while since I've written a "medicine" post, and that has a lot to do with the personal nature of psychiatry. I try to keep the larger details of my schooling private, and write from a detached perspective about medicine as opposed to patients. It feels wrong to write about this clerkship for several reasons, including: 1) you can probably guess at what makes this a difficult rotation, and you'd be right, only off by an order of magnitude; 2) these patients really need and deserve their privacy (of course all patients do, but psychiatry is about a whole life, as opposed to a single illness); and 3) my responses to patients say a lot about my own psychology that maybe I'm not ready to share. It's tremendously important in psychiatry to pay attention to your responses to patients, a phenomenon known as "counter-transference," because there's a ton of information buried in your response. I take on less of the patient's depression and more of the anxiety. Patients describe akathesia, a side effect of anti-psychotics that manifests as restlessness, as like having coca cola running through your veins. Well, I kind of have coca cola running through my psyche.

So, how about some observations?

1) Never, ever call a STAT page as a medical student (a mistake I made today) - you're in for a world of pain from the service you paged.
2) Patients and parents sincerely expect you to fix entire lives in 7-10 days. You must work doubly-hard to correct this misperception.
3) I'd rather have a patient who knows too much about drugs than one who knows too much about psychotherapeutic language. The former patient is out for their best interest, the latter patient is dangerous because they know what to say to trick you into thinking they're okay.
4) There's no cure for bad behavior. Behavior is a beast unto it's own.
5) It's hard to get out three weeks of pent-up tears.
6) Depression coats a room like a slimy film; it cannot be escaped. Pain is different, it can only be transferred if you accept it.
7) Most psychotic and schizophrenic patients are not like what you see in movies. Their thought disorders (what we know of as hallucinations and delusions) are usually too confusing to express themselves in the blaze of glory we expect. The most common phrase used to express their thoughts is "confusing." And the anguish they feel is real.
8) Patients with untreatable depression are more likely to die than patients with untreatable diabetes or untreatable asthma. Seriously.
9) People will listen to you. Even if you are "just the medical student." This is a truly scary thing.
10) You can ride out suicidal thoughts in a bipolar patient. Never, ever, ever leave a suicidal and psychotic patient alone.