Finished up Psychiatry!

Today was my last day on APTU. It went really well! I enjoyed followed my patients and getting to know them while guiding them to recovery. Of course, many of the stories are horribly sad. Suicidal ideation, suicide attempts, paranoid delusions, trauma history, and substance abuse become a very normal part of everyday conversations. Questions like, “are you hearing voices today” and “are you thinking about hurting yourself” are standard. I found that I brought a lot home with me, wondering if the patient we discharged today will be ok. It’s a hard job and while I think I may be a good fit for it, I don’t know if I want to pursue something so emotionally involved. I had a convo with my preceptor about this who replied that is where much of the reward comes from, you can really make a difference.

A typical day went like this:

8:00 – grab a coffee, and head up to the locked unit. Before we open the door, we are taught to make sure there are no loiterers around, warning us that any time someone attempts escape, its most often under the supervision of a med student- great! I head to the resident room and look up the patients I am following- read any nursing notes, what “as needed” meds they got, how they slept, did they go to groups, ect.

8:45- The nursing huddle- the teams gather for 5-10 minutes to discuss what is going on  in the unit, introduce new patients that came the night prior, and talk about any safety concerns of people to watch out for

8:45- 10:30 – See my patients. Talk with them about how their night was, and how they are doing overall. This is the one time of the day where I talk with them alone, so it is nice to establish rapport and get to know them better. Some patients are easier to talk to then others. Floridly psychotic patients are sometimes hard to have a linear conversation with, sometimes they are distracted by thoughts or hallucinations in their mind.

10:30-11 ish – Team meeting. This involves the psychiatrist I am working with, a resident, the team nurse, counselors, and treatment coordinators. We go through each patients on our team (typically 7) and discuss how they are doing, any improvements, any set backs, treatment, and discharge plans. I’ve learned that the treatment coordinators play a huge role in recovery, as they look at outside programs that may be beneficial, setting up housing situations, connect patients with outpatient therapists and psychiatrist. They have a fund of knowledge of services available in the area.

Lunch! (sometimes)

12-5 – The remainder of the day is spent seeing my patients again with the psychiatrist, who observes me interview, and chimes in to discuss specific medication plans or use psychotherapy techniques that I have not learned. I have really come to appreciate the skills of a great psychiatrist. I then write up progress notes for the day and write discharge notes for whoever is going home (so much desk work on psych!) I also spend time on the phone reaching out the family members or providers to get collateral info on my patients, or reach out the other programs to get medical records. The afternoons are also time to interview new admissions, get their entire medical, psych, and social history, do a quick physical, and write their admission note (which takes foreverrrrr). Many time, the patients who come to APTU have extensive psych histories with multiple hospitalizations, and sometimes do not have the mental status to share it with us, which means lots of digging in medical records, ugh. If I am on call that day, I do any admissions that come in the evening, and normally leave by 9-10.

Then I get to go home!! Sometimes I have to work on a few notes at home depending on the day. But overall, the psychiatry schedule is great!

Super interesting- I spent one morning observing ECT, electroconvulsive therapy, which sounds ancient and unethical, but it is actually very effective in particular patients, like those with chronic, refractory depression. You are essentially pushing the patient into a seizure, but it is way more gentle that it sounds. Many other the patients love it and get it relatively frequently for maintenance.

I’m taking my shelf tomorrow morning, then heading back to Boston (and treating myself to a mani/pedi). On saturday, Will and I are headed to Martha’s Vineyard for a wedding!! Ob/gyn starts on Monday, eeeek.

On Labor day weekend, I went on the most amazing whitewater rafting/ camping trip with a bunch of friends in the the middle on nowhere, Maine. Such beautiful weather and happy vibes. We even got to stop in Portland on the way back!

And #100happydays continues: (I’m a few days behind right now, oooops)(the upper right corner is trying to showcase my voluminous hair after camping for 2 days, ha)

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