Monday last week was orientation for clinical rotation on the psychiatry ward. It was exciting and intimidating all at the same time, especially the part about getting security keys, fingerprinted, and having to provide a urine sample for drug screening. It was a calm day regardless though, and there was no work with actual patients until Tuesday.
Tuesday morning I made my way through the string of locked doors at Mid-Missouri Mental Health Center (hereout referred to as Mid-MO), the mental health hospital. I am assigned to the ward on 2 south. I met the psych resident assigned to the floor, Dr. Johnson (not his real name of course), and discovered I and the other two medical students assigned to the floor would accompany him to the county courthouse to start the day. Dr. Johnson had to take the stand to testify to the need for inpatient treatment for a number of mentally ill individuals who were picked up by the law. It was an interesting start to the day.
After court hearings we hurried back to the ward on 2 south to attend rounds at 9 am. Rounds are a meeting with all the members of the ward's care team, and are lead by the attending physician. The other individuals include several social workers, the chief nurse, the medical students, and the resident Dr. Johnson. At rounds every day each patient on the ward is briefly discussed and the plan of care is modified based on the most recent assessment of the individual. Those who interact with the patient discuss their impression of the patient's situation and their thoughts on treatment.
After rounds we have staffing. Staffing is when a new patient gets to meet with the care team and have a conference on the care plan, with all members of the team able to ask questions of the patient, and the patient has the opportunity to ask any questions they want about their care as well. These have been emotionally charged so far.
When those meetings are finished, I take time to round about the ward seeking out the patients I follow, and sit down to discuss how they are doing with them. The first time I went around to meet the patients I am following, I was threatened by one man, eyed suspiciously and avoided by another, treated ambivalently by a third and fourth, and sort of welcomed by another. Some of the patients have sort of warmed up to me, and I'm glad for that.
One thing that wasn't expected was the emotional burden of caring for the people on the psych ward. Not everyone is completely out of touch with reality. Those that are still able to know what is going on are the ones who are most heartbreaking. I've met individuals with hardcore substance abuse on multiple street drugs who have depression, sit and contemplate suicide, get so emotionally overwhelmed with stress and anger that they slam their head into the table during their staffing meeting, patients who's arms have more scarring than normal skin, patients who emotionlessly describe how they took a kitchen knife to their arms to see them bleed, and later break down over the misery of the emptiness they feel. Even harder than all of that is knowing that I cannot simply break out and share the gospel with them, being in the position of a health care provider. At least, it is rather taboo and would likely result in me running into some sort of trouble. There may be some point when I do at least mention it, simply because I can't not want to, but I have to be careful. I am praying for them nontheless. It is perhaps harder having had a friend who was in an inpatient mental health setting and eventually committed suicide, and seeing several people who are experiencing similar problems. The worst is just not knowing what you are supposed to say.
