Goodbye Locked Ward, Hello ER
So Psych is over. I really, really liked it, and found the patients fascinating–how someone seemingly “normal” can become psychotic, hearing voices, believing strange things–and not even understand that the things they hear or believe are abnormal–is surreal, frightening, and incredibly terrible. I’ve also known people that think mental illness (especially depression) is a bunch of crap, that people should just suck it up–and these are clearly the people that have never seen depression. They’ve seen sadness.
Interesting cultural-cum-insurance caveat (how often do you find those!?): the psych service sees a good number of Stanford undergrads (at least 1 per week) in the locked unit for mania, psychosis, etc. One of the major problems is insurance, as some programs have terrible mental health coverage and won’t pay for hospital stays or outpatient programs. Notoriously difficult are students from Asia with insurance from their home country; there’s a pretty strong disbelief in the notion of “mental illness” in many Asian countries, so often these students have absolutely NO mental health coverage whatsoever. Disaster.
I will miss my team, as psychiatrists tend to have just the right amount of quirk for my tastes, and I will definitely not forget Gertrude walking down the halls screaming the most random of things, “These are the poisonous snowflakes of Santa Claus!” “I need a silver bullet… because I have acne! Zits! Pus! Pustules!” I would seriously just lose it in the halls. It was kind of bad. She later grew fond of me, “Hello gorgeous, you’re quite a ticket!”
Psych is great, but I always had something of a hard time with treating the black box that is the human mind. I’m sure it’s the art of the practice, but I’m so used to having more data, I guess. I also felt a little weird using my own life or experiences as the norm by which to judge a patient’s thoughts, actions, behaviors. I may pull off normal well, but I’ve had my share of issues and poor coping mechanisms, not to mention my, uh, “unique” personality traits and general dorkiness.
I’ve found that I really enjoy the psychosocial of medicine–it’s why I liked psych so much, it’s why I really enjoyed adolescent medicine. And I think it’s what draws me to the ED (Emergency Department, the correct way to refer to the “ER” now), too. I love the idea that you can walk in and see anyone, with anything, speaking any language. It’s a real cultural mashup.
This is also the reason that I’m nervous tonight about my first shift, tomorrow afternoon. I could see anything walk in the door. And it’s been a couple months since I’ve been on adult medicine. Granted stuff usually comes back pretty quick for me, but the idea that I could be seeing just about anything scares the hell out of me. (I of course assume I will only see very scary, serious things, no colds or chronic lower back pain.)
So there we are. The ED tomorrow, working my butt off. Back to studying for now.
Help us, Graham!
Tell the parents of non-emergently ill kids that THEY DON’T NEED TO BE IN AN ED!
best,
Flea
Can’t wait to read about your ED experiences! Ditto what Flea said, but also add adults!
The ER is not a primary care clinic, but if you have no insurance and want to use it as your PCP, please do not expect to be able to make an appointment and don’t complain about the wait! Primary care type patients are NOT emergencies, just job security.
From an old ER nurse in San Diego.
Glad you enjoyed your rotation, hope the ED will also be enjoyable for you. Your remarks about the fun on the psyche rotation brought to mind the following episode that happened to me…
Many years ago I worked midight shift in a hospital with a psyche unit. The head physician there was a fantastic person who had a great sense of humor and worked evenings at the unit for her patient’s convenience. I had the pleasure one evening of giving her some young bantam chickens that she was going to take home the next morning.
As the padded lockup room was not in use that night, the large box containing the chickens was placed in there. Young roosters do not need to see the sun coming up to know it is time to crow, and the next morning, quite a few people were giving that room some very inquiring looks…It was great! mary
My clinical nursing instructor said to me the other day, “Hannah, you sure do comment a lot on the psychosocial.” A while later she went with me to observe me simply convert an IV to a saline lock for one of my three patients that day. She’s in contact isolation because of suspected C-Diff. It took us twenty-five minutes before we could emerge from the room (pulling off our hot gowns and gloves.) The instructor rolled her eyes at me and wide-eyed said, “WOW! That was susposed to be simple.”
“Do you SEE why I have been commenting on the psychosocial a lot?!”
I love it. It’s true. But sometimes even the medical patients seem to be more psychosocial patients than anything.
Hh
I think that working in the psyche ward seems really interesting, and I agree that individuals with psychoses generally do not realize that they are ill. I have had professors actually who seem to be mentally ill, such as some politicial scientists who have researched war too much. LOL. Also, there is a common inside joke among military people and politicians about secretly we are all crazy. ha