What did you learn about yourself during this 5-week rotation?
During this rotation, I learned that although I find learning about psychiatric disorders interesting, I enjoy learning and practicing medicine more. During the morning meetings, I found myself more in tune and curious regarding the presentation of psychiatric patients that have comorbid medical issues. There was also a time during an initial evaluation, where the patient described having a headache and ringing in her ears, and I found myself automatically wanting to go investigate that complaint. In another incident, one of our patients with a history of strokes and TBI, had just started on antipsychotics and lost consciousness within a few hours after. I was able to help out with getting the patient awake, to getting equipment and supplies, and observe the rapid response team when they arrived when the code was called. With these experiences at the psychiatric unit, it started making sense why my PA professors had said that rotations help point us in the direction of which fields we would want to work in. I learned that inpatient psychiatry is one speciality than I can cross off my list.

How your perspective may have changed as a result of this rotation (e.g. elderly patients, kids, IV drug users, etc)
When I first started my psychiatry rotation, I was shell-shocked. I knew about the existence of out-patient psychiatry; however I did not know that hospitals contained in-patient units with patients kept for days-years at a time for stabilization and observation. My first day on the unit, I was extremely uncomfortable. The staff that I worked with were located in a small office with windows, where patients walking in the hallway would often peer into. There was an agitated patient screaming in the hallway, and the unit had to call a code to restrain and sedate the patient. There was also a patient who presented as mute, at times was clapping and smiling to herself, as well as pressing her arms up against the glass of our office while looking at no particular member within. My impression of these psychiatric patients were that they were all unstable, dangerous, and that I was “fresh meat” for the patients to mess with. 

I only left the office when I was in the company of the other staff (ie: psychiatrist, psychologist, social worker) initially, since I feared the patients within this new environment. However, as the rotation went on, I found this fear to be unfounded. Not all the patients had violent tendencies, and if there were any agitated patients, there were protocols and sedation medications ready. Because of this, the unit was relatively safe. It was also surprising to see patients from when they were first admitted, to when they were ready to be discharged. They would initially come in depressed, in distress, disorganized, and/or demanding to be discharged; and many left at a better state of mind, and with kind words. It was also eye opening to learn that even the most ill patients, could share similar goals and values as any mentally-stable individual.

What was a memorable patient or experience that I’ll carry with me?
There was a patient who arrived to the unit a month prior to me starting the rotation. I learned that the patient had a past diagnosis of schizophrenia and had discontinued her medication for a few months. In morning meetings, the only updates mentioned was that she remained in her room, was guarded, refused medications, did not engage with the staff, and was still paranoid that her family and husband were imposters (Capgras delusions). It was not until the treatment team won a court case for permission to give the patient “treatment over objection”, that improvement was seen in the patient’s presentation. She started coming out of her room, and pacing the hallway, while wearing her hospital clothes and a beige wool beanie pulled over her eyes and ears. As the days went on, the patient started wearing her beanie higher on her head, and attending activity groups with the other patients on the floor. I found this patient mysterious, and decided to join her during one of the art therapy groups. I sat across from her, fascinated, as I noticed a pile of her sketches and doodles. Some drawings were large, others were small; some colored, some in black and white; some cartoon, some extremely realistic. The patient did not even seem to notice me join her as she was working on yet another art piece. I casually asked if she drew all of these sketches, and to my surprise, she looked up at me, smiled, and started engaging in conversation.

This patient will always be memorable to me because I had the privilege of witnessing her improvement on the unit. We were also able to establish rapport, where she allowed me to learn about her past, previous hospitalizations, and her insight on the circumstances that led up to her current hospital admission. Part of what she disclosed to me was that she is in an arranged marriage, never wanted to be married, and had sought divorce a few years ago, only to be sent to the hospital. Learning this made me wonder if she never actually had true Capgras delusions, but simply did not want to address her partner as her “husband” any longer. (But of course, there are probably additional complicating details she had not shared). Up until the end of my rotation, she had not engaged with her psychologist nor social worker. I found this to be tragic, because without meeting with those key members of her treatment team, she is missing out on being able to work through her beliefs, and her discharge date/plan are yet to be determined.