I became a psych major in undergrad because I was fascinated by the stories. Fascinated by how the mind could create such elaborate illusions and perceptions. Fascinated that the individual could lose track of reality and become immersed in something that seemed all too unreal to me.During the first two years of med school, my best units were the psych ones. The material was interesting, so I was willing to go above and beyond with the required and recommended readings. Some might also argue that the psych units were much easier than everything else. And I agree that the concepts certainly were much easier than memorizing every single muscle and nerve in the human body and all that preload/afterload physics crap for the heart.
So I was looking forward to starting my psych clerkship. This was where I was going to shine! Or so I thought.
My first day - my first hour! - on the psych consult team, we were sent to evaluate an agitated patient. He would yell out every ten seconds, all while flailing around in his bed. It got to the point that the nurses had to put him in restraints to protect him from hurting himself.
We could hear him as we approached his room - Mercy! Please! Mercy! Help me!- his cries falling on deaf ears as the nurses shook their heads. He had been yelling for the last two hours nonstop so they had resorted to just ignoring him, as inhumane as it might seem to the casual observer.
And now we were there, trying to talk to him. Mr. Schaffer - what's going on? How are you doing? How are you feeling? Why are you yelling? He stared at us icily. We were the bad guys, so he refused to talk to us.
We were all standing so far away from the patient. Then, remembering how my medicine team had commended me for my abilities to connect to patients and understand them, I walked closer and leaned over to reassuringly touch my patient on his arm. We only want to help you sir, I said soothingly. He became still, and I became hopeful that maybe what I was doing was working! And hey! Maybe I am meant to be in psychiatry. And then in the midst of my daydreams - out of nowhere - his fist, confined to mittens to prevent him from getting out of his restraints, whacked me across my arm and chest. F*ck you, he seethed at me.
I was fine - more shocked than bruised, but my resident quickly ushered me out of the room, while the attending tried to talk to him some more. She came out a couple minutes later, with no additional information.
She led us back to the team room, where she pulled out a handout on Personal Safety and gave us each a copy. I probably should have given this to you guys before we went to go visit Mr. Schaffer, she noted wryly, pointing to #9 - Stay an arm's length away from the patient during interviews, especially with aggressive and agitated patients. That qualifies even when they're in restraints, clearly.
I blushed.
The pager went off. Another patient. This one was convinced that he was an assassin. Could we evaluate?
Welcome to psychiatry, my resident smiled. Let's go!
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