Psychiatry

By Saurabh Sinha

”Dude, I have nobody.”

Here is a guy who you wouldn’t want to mess with. He’s probably 5’9″, 195. Built like a fridge. When he walks, his arms hang off to the sides because his lats just take up too much room. He’s dressed in a tattered wife beater so that you can see them. Now, I have to share this just to illustrate a point, but I’m a pretty hairy guy. But this guy has SERIOUS hair. It’s growing on his lats as they bulge out from his shirt, following the plane of the muscle upwards. I don’t even come close to that. He’s got a baseball cap on backwards, the kind with the plastic adjustable strap with buttons that snap together, with a little half-moon window above. You can just about see his hair through it. He takes his cap off sometimes and you see he’s got a full head of it, and it could be pretty stylish if he did something with it. Actually, this guy has some of that Marlon Brando-in- Streetcar tough guy, chiseled jaw type of thing. Some stubble to go along with it. Bottom line, I would not want to cross this guy.

And he backs it up. Sometimes he gets angry. His eyes shoot open and you feel that this must be what it’s like to see the beginnings of a tornado. His arms, tree trunks at the ready, quiver imperceptibly and you brace yourself for something imminent. But the resident I’m working with says the right thing, tactful as ever, and quells a modern manchild on the other side of the table. It’s a lucky thing, because this guy needs help. If you’d have seen him at any other point in the conversation, you would see a man, perhaps never having cried in his life, doing exactly that. Crying in broken sobs that sound like a little boy playing a saxophone for the first time, unsure of how to control it, but trying his best to. Crying for his dead brother and his dead friends. His brother who died in an opiate overdose. And now Brando here is drowning in opiates every day because there’s no other way he can figure to hang out with his brother anymore. Who knows, maybe he’ll pop too many some day too. There’s no one. He has nobody. We’ve gotta help him, he says.

This is one of countless unforgettable stories that I’ve heard from patients on my psychiatry rotation. They’re not all quite so drenched in pathos as this one. But they are, at their core, all human stories. I look forward to going in every morning because I never know what I’m going to see. What I do know is that every day is full of lessons: about psychopharmacology, about treatment options, about how to dissect and analyze information, and about how to listen and learn from people.

My psychiatry rotation is my first one of the clinical years of medical school. Going into it, I was full of uncertainty and excitement. I recently talked to a friend of mine who is starting her first year and the sheer excitement she has about starting has me reminiscing about what I felt like then. There’s an element of similarity in starting third year. The first day, I really did have no idea what to expect. In fact, it may even be a deeper uncertainty than first year because you are waltzing into something that doesn’t really care if you’re there or not. The hospital has been running just fine without you. Consider, in the time that I’ve been sitting at a desk studying over the past two years,
the number of patients who have been seen and treated, and all the new ones who have come in again and again. So what exactly am I doing?

I’m a full month in now. I’ve done three weeks on the inpatient psychiatry service and one week on the consult service. I started off my inpatient experience by interviewing two women in their 30s who had attempted to commit suicide. I talked to both of them with the other med student on the team and one of the two residents I’ve worked with, and their stories coursed through my head feverishly for the next week. They still make their rounds on occasion; I receive them as old friends when they do. I followed up with them — my patients — every day after that for almost a week, got to know them better, got to know how they were doing each day.

“How are you feeling today?”
“How’d you sleep?”
“Appetite okay?”
“Tolerating the medication?”
“Tell me more about that.”
“Tell me more.”
“Tell me.”

My words like invitations would float across a table in the corner of the psychiatry floor, a place so full of fascinating character study after character study, humanity splayed in splashes of fanatically Kafkaesque color. And I heard them. I heard their deepest concerns, their regrets, their disbelief, their now ironclad wills to live.

“Do you have any thoughts of harming yourself right now?”
(Eyes once sunken now awash with resolve averted downward by gravity’s grip. “No”, says a voice from deep within.)

Their most intimate reflections, crafted while mostly alone on a psychiatric floor, I conveyed to the medical team. I channeled their voices through the filter of medicine and became those voices at rounds. And in those sublime moments, the entirety of events involved in patient care working together like a poem hidden within prose, I realized that I am an important part of the medical team. There is a role I play, and I’ve been truly enjoying it. I believe it’s something that will continue to evolve, my understanding of myself in medicine growing like the colors of a sunrise as they gather en masse on the horizon, and I am beginning to recognize it.

This is a strikingly different world from the last one I was on. On the other, I largely did my own thing. Called the shots about how my day would go. Now I’m surprised I’m actually afforded the opportunity to pick what I’ll eat for lunch, because I sure as hell am not choosing when I’ll be going (some of my classmates aren’t even going at all). It’s worth it though. These days, I’ll sit with a patient’s chart and wrap my head around every piece of her story. I make out what I can from old histories and physicals, lab values, and nursing notes. I’ll pull up an x-ray or CT just to remind myself that the images mean a tiny-bit-more-than-nothing to my tiny-bit-more-than-untrained eye. I’ll talk to the nurse to get some extremely valuable perspective. Then I’ll go in and talk to the patient and the big picture of who this person is will come together in my brain, the science lighting the firecracker of humanism and my neurons shooting off cascades of electrical activity as impressions coalesce, and I’ll remind myself that I’m doing this all for something. I could do something like this for the rest of my life. I feel this all so powerfully. I went to med school and I’m helping people. Isn’t this what it was supposed to be about? (And would you look at that, some idealism or naivete or whatever you want to call it made it across the Atlantic unscathed!)

This world is much different from the last. But you know, it’s not bad. I think I’ll stick around for a while.

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