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Apr 26, 2010

On to the Next

Neurology ended on Friday. About all I have to say about that rotation is that the residents were great, the patients have the potential to be interesting but are more often hopelessly tragic, and that either steroids or Keppra (for seizures) with the occasional gabapentin (for nerve pain) seem to be the treatment modalities that neurologists prescribe for everything. Neurology is lauded as this hugely intellectual pursuit, done in spite of the fact that there is rarely anything to be done for the patient, but one of my attendings told a patient, “Believe me – it’s better if I don’t know what is wrong with you. I only know the bad stuff. Whatever is wrong with you will probably clear up on its own.”

Thanks. But no.

I started psych this morning and am looking forward to it being a interesting and probably unique month. My placement should allow me to get to know patients really well, although I will admit to being slightly terrified. I will be learning about and interacting with patients who have been convicted of very, very bad things, as I was told this morning. I rather wish I did not know the details of these very bad things because I am afraid that I won’t be able to care for these people the way that I would have had I not known. My attending told me that one of her educational goals is for students to realize that they will encounter people that have done horrible, unspeakable things and that the students will know about these things but like the patients anyway, but will often be uncomfortable with the fact that they like and get along with a person who is, by all cultural standards, a terrible person. Psychiatric illnesses are nothing more than a chronic disease which interferes with a person’s thoughts and behaviors. While the person is not to be excused for his or her actions, there is an explanation behind them and deserves the respect and attention that any other patient receives.

It’s not that I don’t disagree, but… well… I’m scared of them.

I walked through the unit today for two seconds to grab a nurse and my blood pressure shot through the roof.

Tomorrow, I might try actually talk to a patient and see what happens. If you don’t hear back, send in the big, burly nurses.

(P.S. I asked Patrick for a title for this post and he suggested "Welcome to the Mind Field". Ha! He is so proud of himself.)

4 Readers rock!:

barrie said...

As you know, I was diagnosed with MS in 2001 and I once told my neurologist that he had THE most depressing specialty because while most oncologist's patients will probably die sooner rather than later, every once in a while they get to pull off a miracle and save someone with cancer. He said, "well we can do a lot for migraines now."

Katie said...

Have fun on psych! My patients also made me nervous but they were hands-down my most memorable patients of the year!

Anonymous said...

Just remember they may have done bad things, but those are actions and not the person. People can change, some of the bad things were probably done because of painful things in their pasts.

I used to be scared of my gangbangers but now they are my favorite clients. Just treat them with kindness, respect and compassion and they will love you forever. Because rarely do they encounter those three things from other humans...
Love ya

Leonore said...

Interesting post. I'm looking forward to reading more about your experiences this month with this patient population.

In working with juvenile offenders my approach is: work with the kid in front of me. Not the crime, not who s/he was, not what the did, but *who they are now*, in this moment. Otherwise I would never be able to trust them.