Psych Week 4 of 4

So this last week of psychiatry my "outpatient" assignment was Electroconvulsive Therapy...aka ECT. Basically ECT is controlled seizures induced in patients with refractory depression or have some need to avoid medications (pregnant women, people with immediate suicidality, etc). It has come a long way from the old days of "shock therapy" and pictures of people's brains getting fried while being strapped to a bed. While infinitely more clinical now, no one still really knows exactly how it works...haha...

ECT is performed in an OR suite because anesthesia is given to the patients. Typically 6-12 treatments are given to each patient, and response monitored. Muscle relaxants are also administered, so that body convulsions are kept to a minimum (except a tourniquet applied to one foot, so we can keep the muscle relaxants from paralyzing the foot. We do this so we can monitor when the clonus ends.) Electrodes are applied bitemporally or with one bypassing the left hemisphere. We do this in attempt to spare memory. The most common side effect from ECT besides muscle aches and headaches is memory loss. Sometimes retrograde up to the weeks before ECT, and anterograde for weeks after.  Sometimes they come back, sometimes they don't. Things like childhood memories and self-identification are preserved, thankfully.  Sometimes they are glad for it, since the weeks of depression leading up to needing treatments are some of their worst, and they would rather forget it anyways. It's something out of Eternal Sunshine for the Spotless Mind, that's for sure.

So I spent the week administering ECT and chatting with the hilariously boisterous anesthesia doc, Dr. W. He's an older African-American gentleman with a voice reminiscent of Morgan Freeman and the penchant to talk about food nonstop. More bizarre topics we talked about included cannibalism, witch hunts, ancient Romans, Korean alphabet, and medical Spanish. We mostly talked about food though, and I was quite homesick for any semblance of good food. It's not easy being Asian in the Midwest. Good thing I'm adaptable. But coming up on 3 years in Iowa has significantly lowered my standards and another several years might turn me into a Panda Express fan. Just kidding...

My experience on psych has been a mixture of the frightening and fascinating depths of the human psyche. I could spend a lifetime learning about this stuff (not as a primary interest, but for my own intellectual satisfaction) and I hope to never stop considering the body and mind as a whole.

I was grateful to be able to follow several of my inpatient unit patients to ECT. I was able to reassure them and provide some continuity so that as they were getting wheeled into the rooms I could at least be a familiar face. My heart about melted when my acutely suicidal meth addict patient (a youngish man who was probably very good looking in his day, but now has no teeth and completely gray hair) said "Thanks for everything, hon. I am hopeful." He came to us huddled in an angry mess, sweaty and belligerent and wanting to hang himself with anything within reach, as his father and grandfather had. Our team persuaded him to have ECT. And on the last treatment that I was a part of, it finally looked like he was starting to lift out of the fog.