.jpg) |
| Eager for the first day! |
I will never forget my very first patient. It was the first patient, of the first day, of my first rotation. My team was composed of an attending physician, a resident physician, another medical student, and myself, and we sat in a small conference room, with our patient seated directly across from us in what we term a "patient interview". I watched on as the resident spoke with the patient about her most recent symptoms. "Have you had any thoughts of wanting to harm yourself?" "How are you sleeping?" "Are you hearing things that others might not be hearing?" The meeting seemed to be going relatively uneventfully, and I found myself relating with the patient, able to understand her frustrations at being kept in the hospital against her will. I was just starting to let my mind wander in the midst of a seemingly uneventful encounter, when the resident asked the patient, "you seem distracted; is everything okay?"
"Yeah." the patient responded
"You seem like you aren't really paying attention to what I am saying anymore. Can you tell me why?"
The patient's face stiffened, and eyes widened. "Well, quite frankly, I don't appreciate you flirting with me right now!"
Hiding her surprise, the resident responded, "Would it help if I told you that I am not flirting with you?"
"No. I know you're flirting with me, and I don't appreciate it!!"
With that, the patient rose from her chair, and stormed out of the room. The other team members and I exchanged wide eyed glances, and tried to contain our snickers. "WELCOME to Psychiatry!" chimed my attending physician.
From there, every day seemed to be filled with something incredibly exciting and entertaining - both from a medical standpoint, and from a purely "are you serious?!?!" standpoint. The medical students would convene in our workroom at the start and end of every day, and exchange the bits of excitement we felt we morally and legally could (identifying details kept confidential).
 |
| The Harborview Psychiatry medical student workroom. Most days Mt. Rainier could be clearly visualized out the window. |
But as the drama of in-patient Psychiatric care at Harborview unfolded, I began to see something more, beyond the obscure and entertaining.
The psychiatry clinical rotation at Harborview is set up such that I worked with the same attending physician throughout my time there, and followed my physician's nine patients throughout their stay in the hospital. I was assigned to follow two of the nine patients in depth, and when one of my patients was discharged, I would be assigned another, so that at any one time I was providing direct, in-depth care for two individuals (doing all pertinent research, obtaining medical records, calling consults, talking at length 1-on-1 with each patient after our group interviews), and following the other seven patients.
In spending significant amounts of time with just a small number of patients, and following the same patients from their admission to their discharge, I came to intimately know each individual. With each passing day, each delving conversation, and each hurdle overcome, I came to know these individuals beneath the "crazy" the rest of the world had labeled them with - and that at times, they had come to label themselves with. I came to understand these people as just that - people!
This was none more apparent than when I would have the opportunity to see a patient admitted with severe psychosis - where socially acceptable behavior was not possible, and the words from their mouth made little sense - and would watch on as the medications we prescribed had a chance to take effect, and the patient given a chance to find stability from their illness once again. When the same individual who came in cursing and spitting, exclaiming that they were God and had all the powers of the universe, came to be a relaxed gentleman, rightfully frustrated with his illness and grateful for the chance at stability we were offering. Or, when the same individual who came in after a serious suicide attempt and had to be restrained for repeated further attempts, came to the point he could share his hurting and broken story, and find hope in the life that could be.
In coming to know some of the darkest and pain-filled lives, I began to see each as God's child whom he loves, and found myself in turn feeling legitimate love for even the most publicly outcast and despised. That same person I had once stared at on the street corner, termed as "crazy", and wondered how they had let their life come to what it was - I came to recognize as an ill and hurting mind, desperate for someone to see their soul for its true worth. I found myself questioning to what ends I would go if I were to see one of my homeless patients, after discharge, again roaming the streets of Seattle speaking to themselves for having mistaken the seeming stability they felt while on the meds, as healing that would sustain (and so stopping their meds). And my heart hurt at the possibility of a relapse, for having seen what health and well-being meant for each individual. I even came to see some of the "murderers" under my care as ill individuals with chemical and physical imbalances they could not control, who wanted nothing more than a way "out" - an out they could not find on their own.
In one scenario, having heard the patient's heart-wrenching life story, I found myself thinking, "How does a person go through this and not break?!" And then I reminded myself...that's right, mentally, they have broken. And then I would find myself wondering, "How does a person go through all this and continue to live?!" And then I reminded myself.....that's right, they are here for having tried to end their life.
I was given the extraordinary gift of staring into the darkest of places alongside hurting and broken hearts. I was allowed to see illness and brokenness like I had never seen it before. And I was trusted and leaned on, purely for the white coat I wore. I was unworthy to share such secrets and to take part in such life-giving transformations, but it was handed to me all the same.
The piece of their lives my patients shared with me were gifts more precious than gold, as they allowed me to see humanity and hurting in a new light. For each story is one to tell, each soul a unique creation, and each heart a broken heart.
