Psychiatry, Week 1 of 4

Hello from the 8am-5pm world of clinical inpatient psychiatry!

My first week consisted of:

• A code green: at our hospital, code green is the call for restraining a combative patient and de-escalating the situation. The patient had an acute psychotic exacerbation caused by someone speaking to him, and ended up needing 10+ personnel holding him down and transferring to a secure bed. The entire time he spat at the nurses and officers restraining him, and tried to head butt everyone. He bit his tongue and spat blood at us. He screamed profanity and said he was going to kill us all when he got out, and that we were going to be sorry, mark his words. He even broke one of the restraints on the bed by sheer force. It was like something out of a movie: 10 people holding down a patient and injecting an antipsychotic in his thigh. I have a newfound appreciation for psych nurses. One (or more) of them got quite battered in the process.
   
• A attending a court hearing for committing a patient. There's LOTS of legal work involved in psychiatry. We bring in a magistrate and lawyers for both sides. Our side argues to commit the patient involuntarily, and the patient's lawyer argues for them to be discharged. This particular patient claimed that Donald Trump was starving her and said that Beyonce and Nicki Minaj told her through Spotify that they would help pay her bills.
• Learning some Cognitive Behavior Therapy to deal with PTSD. Let me explain. Since my carbon monoxide poisoning experience, every time I hear "carbon monoxide," my throat kind of closes up and my heart beats faster. I have a quick flashback to a moment in time--usually of me lying on the bathroom floor and unable to get up, or falling over and seizing. (This happened just today, when someone told a story of a person committing suicide by CO poisoning.) I avoid thinking about the apartment in Mason City, had to delete all my photos pertaining to that time, and I've refused to go anywhere near that town since the incident. All of these meet DSM-5 criteria for PTSD, and it's been nearly 6 months. Hopefully I'll develop better coping mechanisms on this rotation.
• Trying to take care of a severely depressed teenage girl with suicidal ideation. She only likes to talk to me, and I speak to her privately without the entire team of white coats. The whole idea of a flock of white coats staring at you first thing in the morning is terrifying even to me, let alone a young girl in an psych ward. Sometimes I don't know if we're doing more harm than good....