Thursday of last week was my last day on psychiatry. I was actually incredibly sad to leave the unit. I had to say goodbye to my patients and goodbye to the amazing nurses I had come to have a great relationship with.
Leaving psychiatry was much more difficult than leaving my internal medicine rotation. I think it was partly due to the fact that I had become quite close with some of my patients (even if they didn’t think so, I thought we were close). Also, psychiatry is a great field to see your patients improve tremendously. You meet them when they are acutely psychotic and you send them home in a completely different state. It’s amazing to see how the human mind can do a 180 like it does with many of these patients. I didn’t want to leave without seeing each of my patients improve!
Although I don’t think I will go into psychiatry for my career, I truly enjoyed every minute of this rotation. Here’s what I learned:
1. People are crazy!
I don’t mean this in a derogatory manner; and I mean this about everyone, not just people suffering from mental illness! The nurses that work in the psych unit and put up with patients yelling, screaming, spitting, fighting, crying, and smelling (it’s true- some of them smell very unpleasant) are crazy! They are amazing people to deal with the craziness that goes on in psych each day. I admire them so much. By spending time on the unit each day, the wild stories people tell you and the outlandish beliefs some of the patients have, start to shock you less and less. I finally just accepted that people are crazy!! Everyone is a little crazy- and I think, the crazier the better! I had way too much fun listening to the absurd stories these people have. It’s so entertaining. Sometimes it’s sad to see how delusional people can be, but when you look at it in a lighter way, it’s fun. When you see them get better and reject the delusions they once had, it’s even more fun!
2. I will never look at a homeless person the same way again.
Working in the inpatient psychiatric unit at Wishard was something I will never forget because it opened my eyes to the poverty that exists in Indianapolis. In psychiatry they talk about a theory called ‘downward drift’. This theory exists to explain why so many people with mental illness are impoverished and live in a very low socio-economic class. One thought is that mental illness is so debilitating that people end up unemployed and living in poor conditions. Another theory is that mental illness is more prevalent around heavy drug use which is more common in lower income areas. It’s kind of a which came first- the mental illness or the poverty question?
Anyways, the majority of the patients I saw were from very poor conditions and had a long history of drug use. Many were homeless. Now, whenever I see a homeless person, I wonder if they have a mental illness. I am sure that the majority of them do. My professor said that walking downtown to a Colts game, he passed 4 or 5 of his patients begging on the street. It is a sad truth.
So the next time you see a homeless person, it’s true that they may be suffering from alcohol and drug addictions, but they also may be suffering from schizophrenia. I will think twice before I decide to not give them my dollar 🙂
3. Pharmacology is SUPER important!
I think that pharmacology is the substance psychiatry is made of. We treat every patient with so many drugs it’s nuts! But what else is nuts, is how much it works!! I had one patient who was so incredibly aggressive and would NOT calm down! For 2 weeks she was in seclusion every day for hitting another patient, yelling at nurses, making a scene. Her name for me was bitch- that was all she called me. When I told her I was leaving on Thursday, she calmly said, “Ok Andrea, thank you”. No joke- she is a completely different person. And that is all because we finally got her on the right combination of anti-psychotics.
4. Every patient deserves to be treated fairly no matter what.
It’s easy to treat a psychotic patient however you want because they don’t understand what’s going on and they don’t know what’s right for themselves. I had one patient who constantly would ask for a certain drug that we knew was bad for him- it is an addictive anti-psychotic and he had been abusing it in the past. He did not understand why we wouldn’t prescribe this drug since he thought it had worked in the past. I had to sit down with him and explain over and over again that he had been abusing the drug and had ended up back in the hospital, so we were going to try something different. It is very difficult to explain something to a patient when they are psychotic but every patient deserves to have their treatment plan explained to them. They might not like it, but they should know why we’re doing what we’re doing.
5. Psychiatry is a field you will see no matter what type of medicine you practice.
People with mental illness are everywhere! Millions of people suffer from depression and anxiety. It is important to have a basic understanding of psychiatry because people with schizophrenia get cancer too. People with heart attacks can have PTSD (post-traumatic stress disorder). I am so grateful to have had such an intense psychiatry rotation where I learned tons and tons about mental illness. What a great experience!
Once my rotation was over, I really wanted to watch A Beautiful Mind. I had never seen it! So Kyle and I rented it. Great movie! I cried (I cry at everything- even Friends and Folgers commercials).
Have you had any experiences with mental illness?