We're All Mad Here (18/30)

From Alice's Adventures in Wonderland by Lewis Carroll

     This month I finally began my very first clinical rotation! As you might be able to guess from the quote I chose for this post, I started off in psychiatry of all places. I'll admit that I was a bit nervous when I looked at my rotation results after the Spin and saw that. After all, in school we tried to cover everything we could possibly see in practice, but rather than having a section in clinical medicine that covered psychiatric conditions, we covered everything in primary care psychiatry during our first year, and then hit upon conditions again as they related to our systems or topics (delirium and dementia in neurology, autism spectrum in pediatrics, treatments of anxiety and depression in therapeutics, etc.). It made sense to do things that way since the majority of the cases we'll see in practice will be medical and not psychiatric, but it does mean that I spent the last month of classes reviewing my notes from previous psych lectures and feeling woefully unprepared as my first day loomed closer and closer. And then it was here. 
     I lucked out with my first day of rotation because the morning and afternoon were primarily filled with orientations on different subjects and so I was sort of eased into everything. I didn't know that would be the case ahead of time though, so I'll admit that I was pretty nervous as rotations came closer. I actually texted my boss the night before I started and asked if she'd be willing to "mother" me a bit and give me a hug in the morning if I stopped by to get coffee on my way. She did even better than that and not only gave me a hug and coffee, but she sent me inspirational clips from the Rocky movies and an encouraging message. It was exactly what I needed, and, after another message of "good luck" from a dear friend, I was ready to tackle this first rotation with gusto.
     Because of concerns about HIPAA, I cannot say specifics about my rotation, though after three weeks in psychiatry, there are certainly stories I'd enjoy telling. Instead, I'll just include a few of the lessons I've learned so far.

• It is so important to get input from multiple disciplines in order to treat a patient. In part, this is something I already knew. I actually chose to be a PA partly because I love that one of the major emphases of the profession has always been to recognize that PAs work as part of a team to provide care. It's one thing to know this in theory though, and another thing to see this in practice. In psychiatry, it's not just the PAs, NPs, MDs, and RNs working together, but there are also the occupational therapists, mental health counselors, and social workers. It's been so helpful to see how many people can work together to provide care for a patient, whether it's a social worker who helps the patient plan for discharge or a nurse who is the first to notice a change in mental status or an OT who can provide insight into a patient's participation in groups. Family members are also key players because they know the patient best and can provide clues that you would have noticed on your own. It's tricky to get the whole picture without everyone contributing their pieces, but when people work together, it's a beautiful thing.
• Sometimes you cannot "fix" the problem. Sometimes the problem is a condition that progressively worsens over time and you might be able to return a patient to their baseline, but not to "normalcy." Sometimes the problem is not a medical one, but a personal or social one, and all you can do is provide the patient with the tools they need to make changes, but those choices remain their own. Sometimes you do everything right, you use treat the patient with the standard of care, and it doesn't help, or it works, but so, so slowly. This last case might be the hardest and most frustrating, both for clinicians and patients, but it doesn't mean we give up or stop looking for other options. 
• I've come to recognize the joy of "normalcy." It's the joy of realizing that the problems being discussed at a family meeting are no longer a patient's psychotic delusions, but rather issues that could be seen at any family counseling meeting. It's the difference between asking a patient, for example*, why they think their parents are spies for the KGB, and asking the patient to explain to their parents why they would like a little more privacy and responsibility when they return home, and to be treated like the young adult that they are, and not like a child. It's the joy of realizing that your patient has improved to a point that you can now identify with their problems. 
• Sometimes you just have to jump right in. I hate talking to people on the phone, but when your preceptor tells you to call another doctor for a consult, or a patient's family member to get more information, you have to do it. You have to swallow your fears and your nerves, pick up the phone, and announce your name and title with pride.
• When passing through locked doors, always make sure no one is following you through who shouldn't be. Just trust me on this one.

We are ridiculous, but great.

     I still have two more weeks left in this rotation, and I can only imagine what more I'll learn in that time. It seems like everyday is filled with lessons about conditions, medications, treatments, what questions to ask, and how to solve tricky diagnoses. I actually might just miss psychiatry when I move on to my next rotation, which is not something I expected I'd ever say. I still don't know if I'd go into psychiatry once I begin practicing, but I will admit that this time has been challenging, but fun. There's never a dull day. Of course, I must admit, there's a very good chance that I enjoy it so much because I'm not that "normal" myself (after all, how many people spend part of their last day at home convincing their parents to join them in dressing up like hobbits?), but I'm okay with that, just as I'm okay with keeping my options open for all the rotations to come so that I can enjoy and learn from each of them in turn. It's an adventure, and I'm enjoying it all.

I love my parents.

*This is not a real patient example.