Psychiatry anecdotes

There are a few stories that are worth sharing.

This patient hears voices but the voices are not violent at all. So the doc try to provoke him by provoking his voices to see how much control the voices have. Doc said, "I'm f**king your mother. She is a prostitute. I'm f**king her." His voices didn't respond to the provocation, only said that the spirits from above will judge on the last day of earth. This was repeated multiple times. This was just not the usual provocation and much more shocking.

Here's another one, this patient first came into the ward very paranoid and doesn't want any students around, but our doc basically said that if she wants to stay, the students are in. At first we didn't know why he did that, but she did eventually talk to us and tell us what's going on with her. The next day, the other male students came and want to talk to her but she refused because she thought they were cops. Once we explained that they weren't, she was more than happy to talk. We got to know her very well and really do wish her well. So on her last day, as her leaving the ward present, we got our doc a cop hat right before we see her. Then we brought her into the office, she just stopped at the door and her jaw just dropped and refused to step into the office. It took her a full 5 seconds to realize that there are no cops, just our doc with a cops hat. Ha Ha. We all had a good laugh.

Being a doc is really what you make of it, fully dependent on relationship with the patient. As our preceptor says it, the best therapy is the physician-patient relationship.

Psychiatric ending

Psych ward out here is mostly for chronically ill patients like schizophrenia, depression or bipolar. The patients here are interesting. I kinda forgot that in the city, "crazy" people like to hit on single gals. In undergrad, I always get hit on by guys on the bus, either crazies or foreigners. So it's been a while for me. It's kind of funny now. For the past 4 weeks, I've had about 5 male patients flirting with me and 2 marriage proposals. What a crazy world since to them, this is all reality but I know that it's only reality in their minds, delusion or hallucinations. Part of me find that it's really frustrating dealing with them day in or day out because it's not something I could understand. But it's actually good for them since they can re-focused by coming into the psych ward and not doing something harmful outside on the streets.

The patients here really know how to play the system. The key phrase they use most often is "I'm thinking about killing myself." That will get them an automatic committed admission to the ward where they don't have to pay for rent (Medicare pays), get 3 meals a day, a bed and people to talk to. But the thing is most of them really do have a pysch problem. It's just that our system is not perfect and can be totally be taken advantage of.

Another thing that they do is the they come in around the 25th of the month when they ran out of money from social security check then they will stay until the 3rd of the next month when they get the next check. This is particularly true for the druggies.

Even though they play the system, our preceptor plays with them too. His reasoning was that it's better for them to be in the ward and trying to get help then get in trouble out on the streets. That does make sense and it seems to be working. To each their own.

Psychiatric start

Finished peds rotation almost 2 weeks ago. The NBME shelf exam, end of rotation exam, wasn't too bad. It was mostly case scenarios and trying to figure out what the diagnosis for each case was. I got the score back and I passed. I didn't really study much, just read the Blueprints and Pretest. Well there goes my first end of rotation exam. One down, 7 more to go.

Now I'm on psychiatric ward. It's an inpatient unit with mostly schizophrenics and depressed patients. So far it's been interesting. Even though some of them has the same diagnosis, they all behave very differently. The best or the funniest part is our preceptor (our doc in charge). He's in his 70s and is from Cuban so his accent is still quite heavy. He likes to lecture us on philosophy and it would be on a tangent topic of what we have asked. Also he talk to us about treatments that slightly far fetched and antiquated. Between him and my psych professor in med school, I feel like most of the psychiatrists are very eccentric and borderline being diagnosed with a psychiatric disorder.

So far the schedule has been morning group session where they talk about their goals for the day and meeting anyone that's new. Then either exercise session or we read then lunch time for us. After lunch, we see the patients with either Dr Gomez, our preceptor, or with Dr. Lizardo, the doc for the involuntary committed patients. It's been a relatively light rotation with lots of time for reading, chatting or taking breaks. I got to know a few students from UNE, Firas, Ryan and Eric. They are funny and very informative. This is the first time since I've been here where I feel like I'm actually meeting people and being able to talk to them.

We'll see how the rest of rotation pan out.