Friday, September 08, 2006

Wasted Mind


I have no idea if this is normal. Going to school in the Caribbean is great, but it isn't the US, and for that reason I always catch myself wondering if my experience is a "normal" experience comparable to my US studentdoctor peers. Here goes:

I'm still in M2 and the school is interested in giving us a lot of clinical exposure before the clinical years. It's the logic of pre-kindergarten. Twice a week I'm off to the hospital with my roommates to sample Peds, Med, OBGYN, etc. In addition, we have Clinical Skills, a class where we take non-sick volunteers and try to work them up for the Congestive Heart Failure that they don't have. So once a week I'm reporting a 3rd heart sound that I don't hear or a nodular liver in another healthy person at the urging of the tutor and feeling very silly. I am fine with all of this.

I am not fine today. Today, an announcement was made in the morning that there will be no Clinical Skills lecture before we see our patients. Mind you that this is four hours away and there will be no effort made by ANY of the physicians available to give a talk, even briefly, on how to conduct a psychiatric exam and the special challenges therein. Almost forgot: I heard a RUMOR that we were interviewing psych patients today. I'd like to get these sorts of announcements from the school before the day of, maybe posted somewhere, but that doesn't happen with the frequency that logic would dictate.

So with no preparation we enter the room. The psych patients will not arrive for another half hour because they have to take their meds at the hospital before being bused over. What?! I don't consider myself a cruel man, but it's going to be hard evaluating someone for a psychiatric disorder when they're TRANQUALIZED. Can't we leave them unmedicated for a while, loosen the leash and let them explore the space? Don't I need to SEE the problem if I'm going to learn to DIAGNOSE the problem?

"You feel fine? You don't know why you're here? You feel happy?"
"This patient is being treated for schizophrenia with delusions of persecution," says the tutor.
"Well the patient can't seem to remember any of that right now."
"That's because he's medicated." I know, you dolt.

What a waste of my time. I could have played tennis against a brick wall this last hour and at least had pit stains to show for it. And what a missed opportunity! This time the patients actually HAVE the problems that we study. I couldn't have been given a heads-up about this for some time to prepare? I hope such poor execution isn't normal.

***


So much of what I read online is written by folks in Psychiatry. We've all read House of God, some of us have read Mount Misery, and all of it seems fascinating. Who doesn't like leafing through the DSM and thinking of the people in our own lives? The mind is why I loved and studied philosophy. It's why I did well in Neuroanatomy. Hell, I've cut a brain out of someone's skull and held it in my hands. It's exciting that so little of what goes on in the brain is understood because that means there is so much more room for discovery. To hear people talk about the patients they treat, the things they say and the sometimes profound shifts in personality that medication can induce makes me want to abandon my dream of surgery and dive right in. I'll admit that, as someone who likes to write, the laziness of just reporting the absurd that someone else invents is attractive.

Instead, it's like hearing about the greatest tasting strawberry icecream and not having a tongue to taste it.

I won't do something stupid and level judgment against a discipline because of a few patients but I will say that, so far, I have not liked psychiatry one bit. I don't have the patience. I don't like staring at a talking rubicks cube, trying to figure out the right moves to let some bit of truth slip out. I don't like feeling that I have to trick a patient into contradicting himself to help him understand something. I cannot stand the repetition. I don't like seeing people tranquilized, or talking to people with no memory, or watching someone fidget and pick at herself uncontrollably. I know that these people need the help to beat those problems; I just don't think I want to be there for any part of that journey. I'd rather just read about the successes.

I hope it gets much much better. I'm afraid that it won't. Any words of (dis)encouragement would be welcome.

4 Comments:

At 1:11 PM, Anonymous Joshua said...

All I can say is this:
Everything feels better with Skittles.

 
At 2:09 PM, Blogger anna gregory said...

I felt the same way when they put me there during my nursing placements. I used to hate smelling of cigarettes every day and feeling that I was never getting anywhere.

I agree that patience is the key - my mum works in a drop in centre now for people recovering from mental illness and loves it. I couldn't do her job for the world

 
At 4:54 PM, Blogger OK.NOWwhat said...

Perhaps they don't approach the psych stuff seriously in school because of this: anyone who knows anything at all about how the care of mentally ill people works understands that it's a hopeless business to begin with, the difficulties then further compounded by the legal civil liberties brigade. If you haven't seen my blog entry "Mania and Justin-fication," take a minute and you may understand a little better why the entire system of care for the mentally ill has gone balls up. For one thing, it's hard to make a crazy person take their medicine, because they don't think they're crazy. So, in order to get the meds into them, you need to institutionalize or at least hospitalize them for a while and get the medicine down their neck. But you can't do that unless they are "a danger to themselves or others," which, most times you can only prove after they've jumped off a roof or beaten their mother to a pulp or driven a car through several hundred yards of cyclone fence to get at a car factory in Lordstown because Jesus wanted you there. Unfortunately, by that time it's too late and the damage has, again, been done. It's a hopeless business. Avoid Psychiatry like the plague. You will do almost no good and resort to being what most psychiatrists are: egocentric pill-pushers.

For further lessons in the futility of it all,and for a clear picture of what it's like to be mentally ill in America, read the book Crazy by Pete Earley. Or, have someone you love go mad and see the futility of it all up close.

 
At 10:48 AM, Blogger M. Dyspnea said...

I'll admit to having done a poor job of balancing what I wrote. I don't feel that Psychiatry is useless or think anything sour about those that practice it. Instead, I'm in awe of both. It's the awe of knowing that there are people with the specific talents to do the best for those in these situations and recognising that I lack those qualities. Like watching someone slam dunk a basketball or with perfect pitch describe a tire's squeel as a C#. I just don't have those tools. Wish I did.

 

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