[Album: Magna Carta... Holy Grail]
"i just can't crack your code."
I just finished my second and final week on the Inpatient Service of my Psychiatry Rotation.
I joked that with the completion of my Inpatient stint that the service just discharged their most bizarre patient (referring to myself of course). Haha.
They say that Humor is a mature defense mechanism and I realized that the joke itself was my attempt to reconcile just how much my perspective of Psychiatry and Mental Health has changed over the course of two surprisingly short weeks. 'Surprisingly' because I thought the days would drag along like a rusty anchor on concrete.
I'll be the first to admit that I wasn't looking forward to this Rotation with the greatest enthusiasm. I know I showered my first week on Psychiatry with overwhelming praise, which I still stand by, but in hindsight I realize I was so caught up with being pleasantly surprised I never took a step back to mull over how I viewed this medical specialty...and really everything else in life.
If there is one thing I need to work on it's self-awareness.
If there is anything these first two weeks have taught me...that the Patients I've seen have taught me...it's just how valuable that kind of awareness is. Fortunately, I've also gotten some clues and some inspiration as to how I can work towards it.
"but I still don't know why, why I love it so much."
crate --
:::Insight
Insight is one of the concrete qualities we are trying to assess as part of the aforementioned Mental Status Exam (MSE) that we perform on every Psychiatric patient we see. One part of that Crate we call a Psychiatric Work-Up.
What we are assessing, essentially, is whether the Patient is aware of her/his illness, state of mind, and general well-being. It's very telling. For some of our sickest Patients they have no idea that their delusions of electrified floors or headbands that grant the wearer certain powers are not real and, frankly, quite bizarre. They believe everything is fine. In the absolute worst case some of our Patients mentally exist in an entirely different world that they have fabricated...and we are lucky if we are ever able to 'visit' them there and somehow get in touch with anything tangibly human that resembled their former selves.
Sometimes we break through. We achieve a moment of lucid innocence. There is Insight.
"one day you're here. one you're there. one day you care."
Too often, unfortunately they sink back. In others, we can not get through to them at all.
"you're so unfair."
When Patient's have some Insight, even just a little, their Prognosis and our Hope for them increases exponentially. Perhaps with the appropriate therapy. Perhaps with strong family and social support. Perhaps with proper assessment and modulation of surrounding stimuli. Perhaps with the proper administration and dosing of medication. Just maybe we can help our Patients when things seem most unfair. Just maybe we can help them stabilize so they can return to their lives and their loved ones.
Just maybe.
"sippin' from your cup 'til it runneth over. Holy Grail."
hippo --
:::it's not a Fail if you've found the Holy Grail
Cure is a relative term I realize.
In actuality this sentiment can probably apply to all of Medicine. When one can prescribe an antibiotic for a minor skin infection that promptly resolves it is considered a Cure. But when a cancer Patient gains another 3 months to say goodbye to their loved ones...that can also be considered a Cure. It's also possible that a comatose Patient in the ICU with no brain activity and is on every life-sustaining device ever created can be Cured...by turning the ventilator off. A final Cure. As Final as can be.
"you get the air out my lungs whenever you need it."
As I have learned and mentioned, some of our Psychiatric Patients will never or only briefly reach a state of conscious lucidity -- free of any hallucinations, delusions, or other mental traps preventing them from being their true and beautiful selves. But how about the rest?
"and you play this game, in spite, to drive me insane."
For the rest -- for better or worse -- the only Cure we can offer is to prevent as many pervasive thoughts as we can with the tools available to us and to achieve a stable baseline for the Patient. It's all relative. Each Patient in Medicine is unique and Psychiatry is no exception.
~~~~~~
We have had a Patient for the past week with a diagnosis of Catatonic Schizophrenia.
She was relatively young which only served to make the entire situation more tragic and heart-wrenching. She displayed extremely bizarre behavior with abnormal postures and erratic movements of her hands and feet. During a particular interview with her and my Attending she started banging her head on the table and subsequently threw herself to the floor -- all with the same flat facial expression.
No Emotion. No Insight.
The next day I was caught off guard. Entirely off guard. I sat for another interview with her and my Attending and she was now making eye contact. She sat quietly and answered questions intelligently. She said she felt much better. She apologized for her actions the previous day. She laughed at a light joke my Attending made and I saw her wonderful smile creases for the first time. Was this a Cure?!
"one day you screaming you love me loud."
I spoke to soon..as she then began to rock back and forth in her seat. The eccentric and repetitive movements returned...albeit to a much less dramatic degree. She still retained some Insight, however, and although there were still instances of bizarre movements she had regained the ability to express emotion with her facial expressions and her eyes. Her face had regained some humanity.
"the next day you're so cold."
After that interview my Attending revealed that he had increased the dosage of one of her medications and added another one on top that. My Attending expressed that this may be the best baseline we could achieve for her as medication costs and side effects would likely soon outweigh the benefits.
Was this a Cure?!
For this Patient, yes this was a Cure.
And she was Aware and Thankful for it.
~~~~~
The biblical Holy Grail is an object sought after in story after story. In all of history, Dr. Indiana Jones was probably the closest to finding it (Nerd Alert). But in all seriousness it is that kind of Search for the ultimate treasure -- that ultimate cure -- that parallels what I have seen daily on the Inpatient Psychiatric Unit.
Many Patients will never come back to us from the exotic worlds they have ventured to, but we sometimes can stop the floors from electrocuting them and sometimes we can quiet the voices and conversations that constantly intrude into their minds. And that's about it. They will never be 'normal' according to society's most widely accepted conventions. We do all that we can.
That is far from a Failure though.
It's just their particular Holy Grail.
:::Inside Insight
Seeing and trying to help Patients who have no choice but to exist completely unaware of everything they are, let alone everything that surrounds them -- it's very humbling.
I am lucky.
I don't have fears, and impulses, and voices that are so pathologically potent that I can not function. I am free to take stock of all that I do and all that I say and see if they all match up to the kind of person I would like to be and the kind of life I would like to live.
I have no excuse if I lack Awareness...if I lack the Insight that eludes so many of our Patients.
And since it's a feat and certainly an accomplishment to determine what's going on in one's own head, I've never understood the need for others to assume the content and thought processes that others may have. Gossip is gossip I suppose but when the purpose is to bring down another human being what good does that do for the Patients or for the world at large for that matter?
"you curse my name, in spite, to put me to shame."
I've seen it in the Hospitals and I've certainly seen it in almost every walk of life. For better or worse, I recognize hearsay as a very human activity, but I don't think I could ever see any good reason for the spread of negative words and sentiments.
"have my laundry in the streets, dirty or clean, give it up for fame."
Life is already challenging as it is. And when I see all these Patients that are looking for help and peace of mind it's always a reminder that there are bigger things at stake. I've heard a number of negative comments about others and I've heard a number of negative comments directed at me as well and the only thing I can think about are the Patients who could care less about miscellaneous conversations that may or may not be true.
What a waste of time and effort that could help others.
"fool me twice, that's my bad, i can't even blame her for that."
Regardless, I respect so much those individuals who are very self-aware and have a very profound sense of Insight. I will be the last to ever make that claim, but it won't be for lack of desire or effort. At the very least I have Insight into what drives me -- helping Patients. I have Insight into what I consider valuable -- the Hippos -- the relationships and memories and struggles and intangible human inspirations that are too easily overlooked and forgotten these days. There is no one that can refute these initial Insights I have of myself.
After these past two weeks I've realized we're all just searching for our own Holy Grails.
Those elusive Cures.
Mine is to help others find theirs.
What's yours?
(Let's find it!)
"why you mad? take the good with the bad."
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