Helpless and Hopeless

We start everyday with a report from the overnight resident about the admissions that came in since we left the day before. Many patients are depressed and come in from the medicine or surgery team after a suicide attempt. The tired, overworked resident rattles off their tales, which all seem to fit into a nice neat template:  

Mr/s Doe  is a xx year old male/female admitted from medicine/surgery status post suicide attempt by xx mechanism. Patient reports feeling depressed, helpless, and hopeless and has signed into the psychiatric floor.

"...depressed, helpless, hopeless..." The words simply trip off the resident's numb and over-tired tongue. But honestly, I can't even imagine what that might feel like. We learn to say we understand and empathize with our patients, and our patients always protest that we don't understand. And I am hear to say just how right they are. At least for me, I have no concept of what "depressed, helpless, and hopeless" feels like. Well, I tried...

Depressed is darkness, blackness, emptiness filled with pain, the pit in your stomach filled with nothing, swirling gray fog, tears, yet pain so bad the tears can't come, you drown in it, gone in it, nothing left in it, no points of light to lead you through the deep velvet blackness, no way out, you are helpless, you can see the world around you like a diver stuck below the surface of the water in a cage, see the air the life but unable to reach it as your lungs burn but there is nothing but water around you and you're going to die, there is no more to life, all effort is futile, all motion is hopeless.

Please, please, please...

Traumatic times on psychiatry the other day. We had to restrain a patient to do a simple procedure that the patient clearly did not want done. It was terrible to see. The patient was surrounded by 6 workers from the floor - 2 per leg and 1 on each arm. There were three doctors in the room - 2 doing the procedure and the patient's psychiatrist. And then there was me. The procedure wasn't physically painful, but it was mentally one of the worst things we could have done to this patient. It was a terrible specter to behold.

Screaming... crying... pleading... trying to wiggle out of the six firm grasps.

"My legs hurt! Please let go of my legs! Please don't do this! Please! Please! Please!"

I felt like I was watching some horror movie. Or a medieval torture scene. It was so uncomfortable being in that room as we treated the patient this way.

But it had to be done. The patient was so far gone that they couldn't listen to reason. They weren't even in charge of their own healthcare - there was a legal guardian making the decisions. And this wasn't a hard decision to make. The patient needed this procedure to keep them safe and hopefully help make them healthy again. It was a straight forward call, but one that the patient couldn't understand because of their mental illness and the altered perspective it gave them.

I know doing the procedure was the right move. I understand that from an academic perspective. But my heart has a problem accepting the suffering and pain sometimes. In that moment, standing in that room, I wanted more than anything to make the patient understand my perspective, why this needed to be done. But I just couldn't help. We had all tried to do this less painfully. And maybe we simply weren't creative enough to see how we could manage to make this easier. But how I wish I could remove this patient's suffering.

Perception Deception

What is life? What is the world? What is going on around us?

We call our patients delusional. We say they are experiencing the world abnormally. Their hallucinations are things that really don't exist.

I know this question has been asked many times before, but what makes us so sure that we are experiencing the real world? Most people only ask this question when they are high (like the cute kid in the youtube video after getting his teeth pulled), but really I found myself asking this a lot on my first day in the locked psychiatric unit. These patients can be very persuasive. They believe wholeheartedly in their delusions and sometimes they make you really question your own world view.

And what is our "normal" world view? It is a consensus perception of the environment around us. But just because we all experience it does that really mean that it is the truth? Or that it is correct?

Enter the Matrix. Or a bad acid trip.

Orientation Day

Today was orientation for psychiatry, as the title completely gave away. We had a lot of discussion in the morning about what we expected, what we feared, what we wanted to see, etc. It is a short rotation, only 5 weeks, and the director wanted us to hit the ground running. The large goup discussion made me think about what I was most scared of going into psych. I realized in every other rotation I had something that scared me.

• Neurology - It was my first rotation and I was just terrified to be a third year clerk. It wouldn't have mattered what the rotation was, I would have been just as terrified.
• Internal Medicine - Death. I didn't think that I could handle it if any of my patients died. None of them died on that rotation, so nothing to fear I guess?
• OB/GYN - Dropping a baby or pulling its head off. Yes, that was my legitimate fear. Babies are (1) very slippery and (2) require some twisting of their heads to get out. I really thought that I would hurt a baby and that terrified me. I did not injure any babies, but if there was a pregnant lady in labor in front of me I would still be just as scared.
• Surgery - Getting screamed at by the residents/attendings/nurses/scrub techs/ anyone else in the hospital. Perhaps it is an unearned reputation, but surgery is not known for being warm and fuzzy. I was so afraid of breaking the unwritten rules unknowingly and then getting screamed at for it. Turned out that my teams were all fabulously nice for the most part. Nobody had the time or energy to scream at the medical students. Not sure though that it was any better being invisible...
• Pediatrics - Breaking an infant. Notice a theme here? You should be proud of me though because I am now able to swaddle an infant, hold an infant, calm a crying infant, and feed an infant without looking too awkward.

And now I am on Psychiatry. What scares me? The violent patient? The drug seeker? The patient trying to escape? Or just having no idea what to say or how to make someone better? Can you imagine being stuck in your own head and unable to trust what your senses tell you the world is like?

New Clerkship Tomorrow

Tomorrow I start Psychiatry...

I know that I have been horrible about keeping a blog, but now I feel like I am going to need it. Psychiatry is going to be a tough 5 weeks.

Emotions are hard.
Hard to process.
Hard to listen to.
Hard to absorb.
Hard to respond to.

This will be my place to unload the emotions. The challenges. The pain. The confusion.

Welcome to my newly used blog. A place to help me get through my psychiatry clerkship.

I can't wait!