Psychiatry #3

I have decided to start numbering the blogs because I can't tell if they are displayed in the right order or not. Helpful? Who knows.

I have been dreading my psych rotation for the last year. We did not spend a lot of time on this subject in school, and what I did see did not capture my interest very well. I guess the subject may be a little too close to home. The diagnosis seemed to vague and intertwined to be very clear, and in actual practice this still remains true. Diagnosis seems to depend more on who is making it than any real structure.
The drugs that are prescribed are a crap shoot. Nobody seems to know beyond generally how each patient will be affected by the drugs, so they pretty much just ask if anything has helped in the past, and use that as a starting point. If the patients have not been on anything, the starting points are either the side affects you would like to have , or those you wish to avoid. Some for example make you sleepy, and you start with that one if your patient has insomnia, while others may rev you up, so they go to the people who can't seem to get out of bed....you get the idea. Not an exacting science. The psychiatrists do have a ton of experience with these medications, and seem to be pretty good at predicting what will happen. The one thing that seems common is that they will routinely prescribe medications beyond the recommended dose, again resiting experience as the reason. Much of what I have seen leaves me with the feeling that this will be something I will refer to a "higher authority" if I run into it in the future.

At this point I can't believe I spent so much time dreading this rotation. Observationally, it has been one of the coolest rotations I have had. Incredibly interesting. The patients I have seen are nothing like what I had envisioned in my head, and are actually quite a bit of fun. Anybody who knows me knows how much I love a story, and baby these people have some whoopers!!

So far I have worked in the childrens, teen and adult units in a couple of hospitals, and I also did some drug and alcohol detox in a another hospital. As you might guess, the drug and alcohol was where I felt most comfortable...my peeps ya know. It was a great experience and my past history was a valuable asset. The doctor I worked with was a little surprised that I was so comfortable, and that I knew so much about the program. After a couple of visits with the patients he looked at me and I just said, "January 26th, 2000." His reply...."December 14th, 1987." Guess I don't need to tell you we kind of hit it off.

Even though this has been a wonderful rotation, and interesting beyond belief, it is certainly not my cup of tea. As much as I enjoyed the drug and alcohol work, I spent most of my time with the kids, and the teens wanting to cry. Of the 50 or so that I worked with, only about 10% had a pathological illness. The sad part is that most of these kids just come from crummy homes, and received no training in how to deal with their emotions and feelings. They were not bipolar, schizophrenic, or have some other DSMV IV diagnosis, they were for the most part suicidal because they didn't know how to manage the way the felt. I had this one kid who was so cute, and had the most gentle face I think I had ever seen. He had been admitted for cutting himself. During the interview I asked him why he did it. His answer was that he just felt terrible (emotionally) and needed some relief. He had a friend who had been cutting himself, and told the boy that it gave him relief...so he tried it. When I asked him if it helped, he just teared up and said "No". He had no one in his life to teach him how to deal with his feelings. His father was in jail, his mother was a meth addict. I wanted to take him home, along with about ten others.... How could I?

To make it even sadder, because of insurance, or other monetary forces, we were only able to keep them for 3-5 days. This is just not enough time. So they are medicated, and released, with the hope they will get outside counseling... which is short supply, and not very good quality for these kids. No one expects the parents to get counseling, though they would like to see it, it just doesn't happen, so the cycle continues. No end in sight. These kids will probably not get the education they need, and soon they will be producing children who will not have the skills, because you can't give what you do not have. And that is why I don't think I could do this. I can't bear to watch.

On the other hand, the adults with the pathological illnesses can be sooooo funny. Some of the stories they come up with are hilarious!! I often catch myself laughing out loud (with the patients, not at them) and several times during interviews I have caught myself saying, "Are you crazy?"

A good reason why I probably should not do this.

rto