The stories I can't tell

A belated Happy New Year. 2010 was a good but I am somehow convinced that the year to come will be even better. I just completed a six month stint on the inpatient psychiatry unit and my relief is palpable. I saw many fascinating patients and learned a great deal, but the hours were long and the unit was becoming claustrophobic. My first 3 months of the (academic) year were spent on the psychosis team. Some of my patients had substance-induced psychotic disorders but many of them had chronic schizophrenia. One of my more unique responsibilities was administering electroconvulsive (shock) therapy on Monday mornings. It gets a bad rap, but ECT is actually a very safe and effective treatment for depression, catatonia and other difficult to treat conditions. In this country, ECT is performed under general anesthesia, the procedure's most significant risk. I was responsible for setting up the ECT machine and adminstering the shocks. The purpose of ECT is to induce a seizure, the mechanisms are not clearly understood but ECT is essentially thought to "reboot" a patient's brain. Pretty cool.

My second three months were spent on the women's service. I had expected to see a lot of women with post-partum depression but this almost never happened. Most of my patients were young pregnant women with severe chronic illnesses, typically substance abuse and/or psychotic disorders. Many of these women had little insight into their illness and some of them did not even recognize that they were ill. In the case of one such patient, we had to call DCFS when her child was born and she didn't even understand why. It was intense but probably less so than one would expect. It seems that I have adjusted to this type of work as discussion of suicidality, hearing voices and smoking crack has become routine for me. Just a few nights back, I interviewed a man whose voices were telling him to attack people and set things on fire (something he had done in the past). I didn't even flinch. Heroin withdrawal? No big deal, won't kill you. You tried to break down the door with an axe? Sorry, but you'll be needing to stay with us for a few days.

My newest endeavor is the consult service. Our team is called to the medicine and surgical floors for a wide range of psychiatric issues. We determine if patients are fit to make medical decisions, help detox people off drugs/alcohol and make recommendations for use of psychiatric medications. We are called for most any "difficult" patient and work is anything but dull. If not for HIPAA, there would be so many fascinating stories to tell!