Life of a medical student part 7: January 2019
Current activity: Studying Psychiatry notes at Seattle Coffee shop (my second home for the past few months).
Pro: There is...COFFEE!! I can people watch when I unable to concentrate and I am nowhere near my bed so the temptation to sleep is not available at the moment. Nerd mode initiated!
Con: I have so much work to get through...
Music track: Cursed by Jacob Lee (Listen to the lyrics – I feel like they perfectly describe psychiatry patients and it makes me want to cry).
WARNING: This chapter will contain a lot of my own opinions and views based on my own experiences. Key words being "my own" which means that they are not meant to be offensive or agreed upon. It is just my perception and you are perfectly entitled to your own views on the same subject.
Okay so the main topic of discussion as usual is what I am currently focused on study wise at this moment in time: Psychiatry.
Some things in medicine are not easy to be exposed to (understatement of the century). I am aware that some of my colleagues are made of stronger stuff than I am...but I am not yet (and I don't think I ever will be) as desensitized. I acknowledge that it is a coping mechanism for countless who work in the health care system. It is hard not to be but I still feel everything. And to watch how someone's life is falling apart or how all their decisions are made for them...it is not something to be taken lightly. Especially when you do not agree with the system making those decisions. As a student you have no say in the matter which makes it so much worse. You are there to learn, clerk patients and observe. Your opinions mean nothing and you cannot change the system. You are literally at the bottom of the food chain. Face the reality early one. If you DO want to make a change learn the foundation of the system first and see how you could approach it to achieve an actual intended outcome.
Many systems (generally speaking) are carefully laid out, discussed and planned. They are very pretty on paper yet completely different when applied to real life situations. A perfect example is the concept of Communism. The idea that everyone is treated equally and given equal rights sounds amazing yet history has shown and proven how corruption can take over and dictatorship rules nations. The same can be said for psychiatry. In this field of medicine a multi-disciplinary approach is used. It makes use of a large pool of specialists (a multi-disciplinary team; MDT): psychiatrists, psychologists, social workers, nursing staff, physiotherapists, occupational therapists and holistic approaches too such as spiritual support. Ideally when an individual is admitted to a psychiatric hospital (I will be referencing to public hospitals which run differently to private in South Africa) he or she will be interviewed and observed by each of these specialities. Then a large ward conference will be held where each specialist will report their findings and together they will decide future actions to be taken – Will this individual be admitted or not? What medication will be prescribed? Does this individual go home eventually or require permanent care?
Funnily enough said individual's personal wishes do not really play a role here. Yes, they will be mentioned during the conference but do not be mistaken; they hold no weight. This ideal process sounds reasonable enough does it not? By comparing notes delusions, malingering and psychotic episodes can be identified. Considering that even the best liar slips up when he retells his story a million times. True the ultimate liar will pass but the average individual will be properly processed in this system. I am not denying that these individuals need professional help – they honestly do and mental health is a major and significant issue. I am merely pointing out that the system is not in any way perfect. For this system to work you expect each of these specialities to do their job and the sad truth is that this is rarely the case. Because if one of these specialities falls through then the whole system crumbles and the system that was supposed to be the pillar of hope and salvation to this individual is the same system that does not do him/her justice. This system fails, disappoints and utterly annihilates all faith I have that a true difference can be made in this branch of medicine.
As I have previously stated – you have to be a special type of strong to be able to work in this field. I am not that resilient.
Now you are probably getting curious... "What the hell is this girl talking about? All these cryptic remarks but never getting to the point. What did she see? What went wrong? Is it really that awful?" Fine I will give you an example. No names, some of the details but that's about it – as patient confidentiality is still a thing. This event occurred while I was rotating through the Child & Adolescent Firm. In many ways it made it that much worse for me. Now when you start your psychiatry rotations the Head of department is a pleasant fellow who warns you in advance that some of the things you will be exposed to might trigger something in you. Maybe you have had a rough childhood or you have a family member with mental health issues. It may get personal for you. And if it does you are welcome to be excused from that current triggering event and may even make use of the student psychologist available on the facility if you are in need of someone to talk to. I am mentioning this because the event that I am about to recall is the one event that lead to my mini-breakdown. You will experience a few of those in medicine. We all do. Many are usually sleep-deprivation or stress-related.
So let's set the scene. It is a random weekday rotating in Child & Adolescent Firm. Today there will be a ward conference held for seventeen year old boy. Now medical students do not partake in these conferences. We are just privileged sit in and listen. It was awful. I basically had to relive this child's story six times as each speciality gave their findings. In summary this young male had a shocking life. He grew up in an unstable household with a bipolar mother and a strong family history of bipolar disorder and schizophrenia. The mother neglected her children and was verbally abusive. The boy had a younger brother and a cerebral palsy sister. Being the eldest he took over and caring for his disabled sister motivated him to do and be better. He did the washing and cooking. He studied hard in school (an A student) and he took care of her because she was his world. She drowned. She drowned one day when they were by some dam or something while the mother was intoxicated and away. And the mother blames him. Even he blames himself. Now his main purpose and motivation was gone. His marks dropped in school. He started dating a girl who was into Satanism and thus adopted the practices himself. He started cutting himself. His mother caught him a few times but egged him on saying "What you can't cut deeper? Pathetic." His latest cut was so deep on his thigh that it became infected. He was labelled suicidal. This is what alerted the authorities and prompted his admission to the psychiatry hospital. This story was repeated from different perspectives before they invited the mother in to question her. And. The. Audacity. She blamed him. Made it sound as if he was a troubled boy who created so many problems and that she was the victim not knowing how to handle it. She even brought his papers that he posted on his wall with his rantings of hate and inner turmoil. It felt so real. It was in your face real. Next they brought the boy himself in for questioning. All this took three hours. Now...the time came to make a decision on what to do with him.
The multidisciplinary team (MDT) discussed a few things. They agreed that he was a bright boy who had potential academically and needed help. They mentioned that the mother was also not well and that they would recommend that she too admit herself to the hospital. Recommend? Seriously? They discussed the final diagnosis and the medication to be given. And you know what the worst part for me was? That absolute worst? They were sending him back there. Back to the toxic environment that created what he had become. What was now termed a "mental illness". There would be no mental illness if he wasn't there in the first place. But that was the final decision. You see the system promotes 'family preservation'. They don't like to break families apart. Even when I enquired why; they said that he had one more year left until he would be the legal age of eighteen and move out. Mind you a lot can happen in a year. They also mentioned that they could attempt to find him a placement in foster care or an orphanage but there would be no guarantee for his well-being there (assuming that there would even be space available). Those placements could be abusive and rape cases are quiet common. So basically it was a fucked situation with no genuine solution. For that I apologize to the boy because the system failed him. The system with its set protocols and rules and social worker who did not do her job properly in my opinion. Or maybe was it the psychologist? Who knows? Better yet – who cares?
I couldn't handle it. I cannot handle working in a system in which you cannot change anything. Because as a doctor in that MDT your only role is to prescribe medication. It is the social environment that is causing the problem and you are not removing him from the problem. You are prescribing medication. Do you not see how messed up that is?
Now in adult firm I saw different kind of cases. They too made me sad. To be honest there was nothing wrong with the patients. They were people. Good or not; they were people. The only defining factor that I could see what that they could not function in our society. That's the only problem. An example I can give you was a thirty year old young male who was normal in every sense except that he had a delusion that his foster mother was trying to keep him away from his real mother. Coupled with obsessive thoughts he had attempted to assault her numerous times. A person like that cannot function in our society. He cannot find a job and work for money because these thoughts and obsessions take over his mind and soul. He heard voices in his head that made him laugh and made him happy. Why is that such a bad thing? For all I know his foster mother probably abused him as a child that he cannot function in her presence and developed a mental illness that consumes his life now. Many patients prefer their delusion to reality and are not adherent. Can you blame them though? Wouldn't you rather live in a world where you are related to royalty and are awaiting for money to come through to pay for your current stay at this hotel? That certainly sounds a lot better than awaiting the day to leave a mental institution and that day will never come as you are a permanent resident there.
Funnily enough another observation I made is that psychotic patients and intoxicated people have something in common. They come across as very childlike in nature. They behave in such a vulnerable way that you just want to hold and take care of them and protect them from the world, from their thoughts and from their own personal demons.
Now that I have made some grand statements I still stand by the fact that Psychiatry as a subject is absolutely fascinating. Read the DSM-V criteria if you would like an in depth and concise description of all the disorders. But in practice I couldn't handle the fact that if I was put into those life situations that these individuals were handed...I would have reacted the same way. They are coping mechanisms. Like turning to drugs and now being labelled as a patient with Cannabis induced psychotic disorder. Or a child being branded as 'inappropriately friendly to strangers'. Listen here; if I was in foster system for life and not once received any form of attention I too would crave any sort of acknowledgement even if it be from a stranger. Now you diagnose it as a psychiatric disorder? It makes you lose faith in humanity...even die a little inside. I hold great respect for the MDTs that work in this field and attempt to make a difference when their backs are up against the wall most of the time. I wish I could be of assistance but alas this is not my calling. By criticizing the system I am not saying that these disorders are not real. They are. I just wish there was another approach or method in terms of the care these individuals receive. And if there is I wish it was the uniform standard across the board.
SO...I just figured out how to attach YouTube links to each of my chapters. Late I know haha but I'm not the ideal Millenial to be honest. Anyway you can now check out the music tracks that I have been mentioning. Any thoughts? Or recommendations if you think you have a track that would suit any of my chapters better?