Psychiatry.

  • How did I feel when I got home?

I got a glimpse of what life was like before medical school again! Not only was I sleeping more than I have in the past 3 years, but life in general slowed down for me – I actually got ready in the morning, prepped tupperware lunches, and went snowboarding for the first time in years. I learned a lot about mental illness, addiction, and the biochemical imbalances that can push us off the deep end, and I know these problems really do permeate every field in medicine and I’m going to encounter them on a daily basis in my practice. I also realized that psychiatry offered a similar aspect that surgery did. There’s a saying that claims, “Those who don’t go into surgery end up going into psychiatry.” At first, I couldn’t wrap my mind around this. What could these two specialties possibly have in common? For weeks I tried to piece the two together and it wasn’t until a psychiatrist finally explained their similarity to me: both are extremely invasive, and both expose the taboo: the rawness of the human experience. Both fields throw the windows wide open, forcing you to stare inside the very essence of life.  Just like surgery, there were days that left me sitting stunned in my car – feeling awestruck by the beauty and the pain. But surgery’s twin sister was so drastically different in countless other ways. People walked slower. Talked slower. Smiled at each other in the hallways – instead of that look when you spot a surgical resident – like spotting a deer in headlights.

  • Did I feel excited to look up the illnesses and diseases in the patients I was caring for, or to study for the shelf exam? Was there diversity in the conditions being treated?

I tried my best to dive in and soak up everything I could, to learn the intricate details behind anti-depressants, opioid detoxification, socioeconomic factors impacting hospital care. But the truth is, I found myself feeling bored really quickly. For the majority of the time, the work felt passive: “How’s your mood today? Is the medication working? Should we try a different one?” There was definitely the few patients who were the exception to this  rule- and I was able to witness the enormous impact psychiatry can have in helping someone suffering from mental illness. But overall, I was constantly hungry for more. I kept finding myself turning back to surgery – looking up various topics in surgery, getting my name on more surgery papers than ever before, and sneaking back to the OR to close flaps or see traumas. I was grateful for the pause that psychiatry offered – a break in the grind, a chance to breathe – but in the end, I knew it was just that. A pause.

  • What were the main feelings I encountered while working with the patients? The medical team?

The medical team was AH-MAZING. My attendings became some of my absolute favorite people I’ve encountered in medical school so far, and honestly made me take a long, hard look at the stone cold personalities in surgery and truly come to terms with it. These attendings, in stark contrast, were overwhelmingly supportive and complementary, allowing me to take ownership of my patients, propose treatment plans, and write all of the notes. I’ll never forget the day the social worker was on the phone explaining members of the treatment team when she added, “and then Hailey, she’s the medical student on the team.” It sounds ridiculous, but being listed as a member of the team like that has not been a common occurrence (we’re not listed at the nurse’s station, on progress notes, in team meetings, etc). After all, it’s like you’re not really part of the team – you’re just a temporary transplant who only requires a formal introduction when standing face-to-face with the patient or about to put your gloved hand in their abdomen. But in psychiatry, I truly felt like I was fully embraced as part of the team.

As far as the patients I encountered, honestly a lot of my patients blended together in a blur of depression, anxiety, and detoxification. But then there were the select few who deeply impacted me and made me realize the fulfillment that psychiatry – in it’s finest moments – can offer. It was the young man presenting with his first psychotic break from schizophrenia, who became “my” patient – the patient I sat on the floor with and persuaded to agree with treatment, the patient who drew me a picture every day, the patient who left the hospital remarkably symptom-free with anti-psychotic flowing through his veins. It was my patient who stabbed himself in the chest in a suicide attempt, but miraculously missed every vital structure and left with only a handful of stitches. It was my pregnant patient withdrawing from heroin. It was my patient who, after hours of deep conversation, finally disclosed their suicide plan after discharge – and all of the ups and downs that followed: clever suicide attempts, riddles and games (“it’s all a game of chess”), and lastly, my letter (“checkmate”). In the end, psychiatry was both blissfully relaxing and an emotional whirlwind – with a lot of crazy sprinkled in-between.

  • How much direct patient contact was there? 

So much! I would say more than any other specialty. I loved getting to spend hours just talking with patients, hearing their stories, learning with them. I’m going to miss that.

  • What were the humdrum aspects in the patient population or workflow that would have to be tolerated for the rest of your life?

Borderline personality disorder and addictions. The former left me feeling absolutely emotionally drained. The latter left me feeling like there was nothing I could do and like I needed my own drink.

  • Does this specialty address one of the leading causes of death in the world?

Suicide is the second leading cause of death in young adults worldwide, so I guess it does in that sense. Otherwise, it probably does in many ways indirectly.

  • How easily can motivational impact be integrated into a career in this specialty?

SO EASILY! This was one of my favorite aspects of psychiatry! I loved feeling like I was helping to shift a patient’s path in life. I want to carry this with me. It’s easy to lose sight of this motivational potential with patients. I also loved the personalized descriptors used in the documentation of these patients and want to carry that with me as well – you never really see that in other specialties (like when my psych attending included “Appearance: well-groomed, eyelash extensions in place”).

  • Does this specialty focus on preventing problems or fixing problems?

I would say fixing. But truthfully, I never felt like it completely got the job done.

 

psych

When your favorite attending greets you with a present and pastries for your last day. 

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2 thoughts on “Psychiatry.

  1. I will be applying for psychiatry residency and was also confused when people told me that those who don’t become surgeons become psychiatrists. I ended up having as much a knack for surgery as I do for psych and said that if I wasn’t applying psych, I would apply ortho. Seemingly strange, but I realized that both fields require you to compartmentalize extensively. Both specialties are unique, too, in that you see patients when they’re most vulnerable in different respects. I really like the way you explained it here!

    Like

    • I love this! Yes it is so strange at first, but I completely agree with you – compartmentalization is the only way to deal with some of the extremes you see in those fields. Excited for you on your journey in psych!

      Liked by 1 person

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