CHAPTER 12: PSYCHIATRY POSTING.
And to the last of my clinical postings, welcome to the Psychiatry department.
A place of several tales, some sad, some strange and others absolutely shocking.
Psychiatry was a bitter-sweet experience for me. It was the one post I excitedly looked forward to, telling all that cared to listen that I knew what I wanted and I was determined to embrace it.
For as long as I can remember, I have been fascinated by mentally-challenged individuals, whether in literature or on the roadside. I often wondered how some people ended up becoming weird, homeless, unkempt or completely dysfunctional. While most people would see such individuals and turn up their nose in disgust, I would often take a second or third look at them, and imagine if they have any family or home to call their own.
Medically speaking, the factors that lead to mental (and specifically Psychiatric) impairment, can be genetic, neurologic, environmental, or a combination of these.
On the other hand, some indigenous folks (at least where I come from), believe that mentally-impaired people might actually be demon-possessed or under spells. Of course, it seems a ridiculous way to think but cultural/religious sentiments have a way of shaping our perspectives.
As a Christian, I believe that demons do exist but I also know that mental health has remarkably improved through medical care over the years.
So all through my medical school journey, I really looked forward to my Psychiatry posting.
I mean I’d liked the idea of Mental Health for years, and Clinical Psychology was one of my favorite subjects during my pre-clinicals. Even before I completed my Secondary School Education, I already had much interest in Psychology. And because I wanted to study Medicine, I decided I was going to become a Psychiatrist. Hence my fate was sealed (or so I thought), until I actually started my Psychiatry rotation.
Despite the pep talks my colleagues who had done the rotation ahead gave to me, I wasn’t prepared for my encounter on that first day…
The Mental Health institution in SVG is situated apart from the General Hospital, and is currently (temporarily) located in an area called Orange Hill, which is along the countryside.
The institution which is more of a community than a facility, gave patients the privilege of roaming the immediate neighborhood with little or no restrictions.
On my first day there, we went in to see the female patients. I was stunned to say the very least. All I saw basically was a sea of faces staring mindlessly about, with some out of touch with reality. How could anyone live this way? I wondered. I left the place all sobered up and emotionally drained.
As the days progressed into weeks, I got to know a number of the patients and their story. We followed up some of them repeatedly in the outpatient clinic and what an experience it was.
The cases we saw ranged from mild/moderate depression to cognitive impairment to acute manic episodes to chronic schizophrenia to parasuicides, and the likes. And some of their stories would always remain with me. One of such remarkable cases was that of Ms. X:
Ms. X was a known patient with Bipolar disease who was admitted to the Casualty department during an acute manic episode that was triggered by an emotional experience. I had never seen an adult throw such tantrums before. This patient was hyper, continuously jerked her limbs against the bed restraint and cussed loudly. It was quite a sight. She was later transferred to the Mental institution. Over the next few days, and after a number of medications, the patient significantly returned to baseline.
Despite the emotional circumstances, Psychiatry posting was an adventurous ride for me. I got the opportunity to travel to parts of the island I had never been to. There was a community outreach where we had to visit patients in different villages like Chateurbelair, Rose hall, Troumaca and Spring village. Those areas were on the leeward part of the island.
My Preceptor, Dr. K. Providence, an amazing woman dealt kindly but firmly with all the patients. According to her some of the patients can become very manipulative and threaten the caregiver. The most difficult patients to deal with are usually those with criminal charges. They are prone to take the “victim stance” where they make others think they are being victimized. This was especially common among the prison inmates.
We learnt how to take Patient history, do the mini mental status exam (MMSE), PHQ-9, CAGE questionnaire, BECKS Depression inventory, and other forms of assesment. We were taught to be confident and empathic while handling difficult patients.
My colleagues were fun and supportive. The interns, nurses, social worker, counsellor and clinical psychologist made a good team to deliver care to the patients. This was important because many of the patients we saw had social issues as well e.g. Lack of employment, drug use (Marijuannna especially), alcohol abuse, lack of finances, domestic abuse, homelessness and social stigmatization.
Aside the emotional demands, Psychiatry also gave room for lots of adventure. I saw new places, met new people and learnt new things too. And I took lots of pictures too.
Studying during my Psychiatry posting was perhaps the most interesting. I used Lange Q&A (Psychiatry), PRETEST for Psychiatry, Kaplan step 2 videos and Paul Bolin’s YouTube videos for Psychiatry to study. Any material on Psychiatry with DSM V criteria updates, should serve you well.
And to the big question. Would I be interested in pursuing Psychiatry as a speciality? I like it enough in theory but I’m not sure I can handle the clinical aspect, so I honestly can’t tell yet. So fingers crossed until then…✌✌
Kudos to all the Psychiatrists out there. Thank you for making a remarkable difference in people’s lives.
Thank you for reading,
PS: Here ends the Chronicles Of A Student-Doctor posts. I appreciate all the feedback and support I got. I hope I can share aspects of my post medical school journey with you in subsequent posts.