maybe psych really is medicine...

I've never really been interested in psych or the brain for that matter...I find the subject matter a bit too amorphous with too many unknowns.  I always felt like it was a field of long drawn-out sessions in the outpatient setting, where people just need someone to listen to them because they don't have supportive friends (ok...that's an exaggeration, I don't really believe that.)  And in the inpatient setting, it just seems like doctors are just loading them up with haldol and tons of other sedating drugs so that they won't cause trouble.  But today, I feel like we really did help out the patients, and maybe there is some science behind all these Axis I disorders.

Today, I (or more like my resident and attending) discharged a patient with depression and anxiety.  I've been interviewing her for the past few days, and honestly she's a pretty easy patient to talk to.  She voluntarily committed herself to the psych ward because her anxiety was incapacitating her.  Honestly, she sounds like a pretty normal person with normal concerns, like trying to get back together with her boyfriend, what other people think of her, her weight,her boss, etc...things that we've all dealt with, except just to an obsessive degree.  Sometimes I just really wanted to say "stop being so dependent on others, be responsible, take care of yourself and child, and stop obsessing over things".  Of course, I can't really say such things...nor did I really want to give her advice that may actually be counterproductive in an unstable patient.  

Anyways, we changed her medication--we added klonopin (clonazepam, a benzo) and trazadone and omg, what a change just overnight.  She wasn't anxious anymore, kind of excited about going home (when yesterday she kept say she is def. not ready to go home).  She was like a totally different person.  She still had her concerns, but she was no longer obsessed about them.  She made a list of goals, about eating less, working out, doing laundry, helping around the house...(gosh...her list sounds vaguely familiar)... Anyways, it was pretty rewarding when she left saying "thank you" (I know cliche...but v. true)

The guy who talked me to death yesterday is getting discharged tomorrow.  And gosh, he was so much better today too, you can tell within the first minute of talking.  He didn't give me a headache today!  I actually told my resident pretty colloquially (I really should start practicing the art of presenting patient's histories) that "the patient is doing much better today.  He didn't annoy me today."  Hahaha...she started laughing at me saying..."we actually try to refrain from that term."  Oops.

Oh...and more laughing at me (of course in good fun, at least I hope). At the end of the day (actually 5 pm, and my resident was anxious to get out), I had to find this new patient, a Jane Doe.  So I quickly scan the floor, and I'm pretty sure I found her, but of course the patient doesn't talk.  I look at her wristband and saw no name, so assumed it was her...brought her to the nurse's desk, apparently looking confused and saying "I think I found her..."  Apparently it was very amusing to the residents.

Anyways, my resident was very happy that our last admit of the day was a 5 min interview.  Jane actually had a really pleasant demeanor.  She wore this sweet soft smile on her face, and just politely nodded and shook her head at questions.  She could only whisper one word answers, like "fine."  My resident asked her the question, "do you have racing thoughts?"  And Jane nodded yes.  Then my resident said we have drugs that will help you.  Anyways, it was a very short interview...we had no history, name, meds, etc.  But my resident assured me that risperdal or any antipsychotic will quiet her thoughts down.  She told me that this was a classic example of extreme psychosis.  A psychosis so severe and overwhelming that the patient has way too many thoughts that she can't even verbalize her thoughts and answer questions.  Apparently, after the drugs, our Jane Doe will be Ms. Chatty-Mc-Chatterson.  I really hope I'll be able to see this dramatic transformation... I'll only be at the hospital for 2 hours before heading for 5 hours of lecture...hoorah!

Gosh...I didn't mean to ramble this much.  Now no one will read it, if they have my kind of attention span.  But other non-hospital highlights:

-eating tasty Thai food with other med students...playing pseudo-hooky after morning lectures, going to the hospital a bit later in the afternoon (I think I always mention food in these posts...)

-watching Rachel Getting Married (only half way through)...I feel like I can't escape psychiatry

-getting my pants tailored

....what an exciting life I live!