I am doing my psychiatry rotation at the Denver VA Medical Center, which has a 36-bed inpatient psychiatry unit. The psychiatry patients are cared for by three separate teams, two of which take medical students. My team is composed of one attending psychiatrist, two psychiatry residents, and one classmate.
The psychiatry ward is locked down, as one might imagine. You have to pass through two locked doors and walk by a security station to get into and out of the psychiatry ward. Plus, the security badges that unlock the doors only do so for a quick half-second before locking again, making escape by someone unfamiliar with this timing that much more difficult.
Once on the floor, there's a ten-foot stretch of hallway before reaching a taped red line on the white linoleum. Patients aren't allowed to walk beyond that line unchaperoned. Similar red lines are in front of doorways and serve to keep patients out of restricted areas. It's remarkable how well the red line works and how rule-driven these veterans are, in general.
Everything is designed so that it can't be used as a weapon. Drinking fountains have no spigot head, sinks have no faucet, chairs have no legs and are so heavy that they can't be picked but instead have to be scooted around the room. Doorknobs are not knobs, rather semicircles practically flush with the door with indentations for grips.
A wide array of patients stared at my attending, two classmates, and me as we walked down the hallway during our orientation. Some were poorly groomed; others were clean-cut. Some were wearing government-issued pajamas, a bath robe, and hospital socks; others wore street clothes and were actually sharply dressed for the setting.
An unfamiliar face in the psychiatry ward is the object of curiosity. Several patients stared at us three medical students with an unsettling vacant gaze that all of them seemed to share. One "happily demented" veteran, hunched over and pushing a walker, a smile on his face, approached us just to strike up a friendly conversation.
Another veteran, younger, balder, and unhealthily skinny, sidled behind the group and when he was noticed blurted out in one breath, "What do you know about perpetual consciousness? It's like a circle running around and around and around in your mind not stopping, which is ironic because," and he moved his finger in a circle by his head, then whispered, "it makes you look crazy." I felt uncomfortable. How do you respond to something like that? My classmates felt equally awkward. One of them decided to reply in the only way he knew how: "Hi, my name is John," offering a handshake.
This interaction made me understand that my biggest challenge for the upcoming psychiatry rotation will be to set aside my feelings of discomfort, and other negative emotions elicited by my patients' unusual affect and behavior, to make sure that they don't get in the way of my ability to understand and empathize with my patients. Easier said than done.
When I did my psych rotation I learned a lot about myself and just how judgmental I can be at times… I felt as though I grew a lot as a person and as a health care professional through the rotation. I learned that often times there were no words to be said and often times I couldn’t stop talking I connected well with some patients and others I really struggled interacting with. I hope you find this rotation as rewarding as I did.
ReplyDeleteI'm certainly finding my psychiatry rotation rewarding, so far.
ReplyDelete