Confessions

As difficult as it is to admit this, there are times at the psych ward that scare me.  I am not one to be easily put-off.  In fact, I deal with most incidents that might make one frightened well (though, if you ask some people I scared easily when I was a teenager).  Whatever the case may be, some of the patients on the psych ward give me the creeps, the heebee-jeebees, and otherwise make the hairs on the back of my neck stand up. 

The reason: we have some patients who are not your run-of-the-mill mentally ill folk.  We have a couple of hard core patients who have gone above-and-beyond - they are psychotic criminals.  These are the guys who hear voices in their heads ("nice" or "happy" voices some say) that tell them to do things like kill their entire family.  Now, admittedly, none of them have killed anyone.  But they have caused serious, permanent disfigurement of others as well as themselves.  And these guys are the ones who make me look over my shoulder every time I unlock the ward door at night.  They are the ones who cause me to sit with facing all entrances into the room, and they are the ones who make me extremely uncomfortable when we are in the same room together and they are between me and the door. 

Perhaps these guys are the reason I don't like psychiatry much.  I can't really pin it down.  But the other confession of the day is that I am having some trouble enjoying this rotation like I have enjoyed other rotations.  I am working shorter hours, I am home before the sun sets, and I get a one hour lunch break.  This is by far the least medically intense rotation I have had, but it is also the most mentally taxing in some ways.  Never before have I been required to NOT wear a tie for fear that I will be strangled with it.  At any rate, I certainly enjoy the medical side of what we do for our patients - and we do quite a bit.  One aspect that I have identified is that psychiatry has few objective measurements by which we can measure progress.  Much of what we know is subjective reporting and there are few examinations we can do to obtain any objective idea of how the patient is doing.  I suppose I prefer the objective measurement of a patient coming to the clinic or ER ill, receiving treatment, and leaving well. 

And once again I come back to the truth that there is yet much I need to learn - not all medicine is objective.  There is a lot that comes down to judgment of the provider and I know this in an academic sense.  Nowhere is this more important, in my fledgling opinion, than with psychiatry.  I welcome the challenge and hope that by the end of my time here I can gain at least a little bit of insight into this judgment.