[Album: Better Dayz]
...at thugz mansion...
"Nothin' but Peace, Love, Street Passion.
Every Ghetto needs a Thug Mansion."
This is week 3 out of 4 on my Psychiatry Clerkship.
As aforementioned, I finished my rotation through the Inpatient Service and spent the past week at my hospital's Psychiatric Crisis Center. It's an Outpatient Emergency Room, of sorts, for Psychiatric and Mental Health emergencies -- in other words it's a wildly different experience.
What Hippos and Crates are in store?
It's for the severe nervous breakdowns, the imminent suicides and homicides, the unrelenting voices and visions that can push any person to the very literal and figurative edge. I'm glad that centers like the one I've been at are in existence, it's not only the body that may require time-sensitive treatment but the mind, also, can oftentimes need the same urgency and medical expertise.
I've found that it's not that simple. Especially for My City and the Patient Population we have here. Detroit is not the healthiest city out there. Or the richest. Nor is it on any top ten list of desirable places to live. But, it's My City.
"Every Corner, Every City. There's a place where life's a little easy."
Many of our Patients are uninsured, or on Medicaid, or on Disability. As it turns out one of the most straightforward ways to obtain some kind of government-provided benefits/income is to receive a Psychiatric Diagnosis of Major Illness. Schizophrenia. Bipolar. Major Depression. Whathaveyou.
As such, the biggest thing I've realized on this Outpatient Service is the difficulty of distinguishing between those who are actually sick and those who are looking for some secondary gain -- the Malingerers.
"Ain't no heaven for a thug, n*gga.
That's why we go to Thugz Mansion."
No matter how hard it is to separate the 'boy who cried wolf' from those who are already being ravaged by a pack of carnivores, it is our duty to stay resolute. There is no where else for these people to go.
Thug. Lowlife. Homeless.
The only labels we use are Patient.
Even though we operate out of an ancient structure next to a
Burger King and a Liquor Store...
I'm sure to those who are in need, it looks like a Mansion.
It's hard, but we have to keep believing that's the case.
"No one knows my struggle. They only see the trouble."
crate --
:::Malingering.
I've already alluded to it, but for formality's sake here is the Crate -- the definition for this official Psychiatric term:
"Malingering involves the feigning of physical or psychological symptoms
in order to achieve personal gain."
Some common reasons to fake sickness are to avoid the police, receive free room and board, obtain narcotic medications, and to receive monetary compensation. In my short time at the Crisis Center I've already experienced Patients attempting to Malinger for all of these secondary gains.
"Tired of gettin' shot at. Tired of gettin' chased by the police and arrested.
N*ggaz need a spot where we can kick it. A place where we belong."
As I've also mentioned before, this Outpatient service differs markedly from Inpatient. We don't have appointments, nor do we keep Patients any longer than their unpredictable visits. We don't have the luxury of getting to know Patients over consecutive days or the opportunity to observe Patients at almost every hour of the day. There have definitely been Malingerers on the Inpatient Service but those can usually be eventually sniffed out and documented. This is not the case with Outpatient Crises.
"Is there a spot for us to roll? If you find it...
I'll be right behind ya, show me and I'll go."
Thankfully. Almost artistically. My Attending Physician at the Crisis Center has been able to methodically pick and prod at each Patient to see if their symptoms are actual or theatrical. He would somehow catch Malingerers off-guard -- tongue-tied and noticeably nervous. Sometimes they'd break character or stories would conflict...somehow my Attending, more often than not, just knew.
When I asked him how long he has worked there he asked me my age. (Warning: about to date myself). I told him 27 and he smiled and replied, "much longer than you've been alive my friend."
The second sub-Crate I learned this week is that Experience can be the most valuable teacher of all. It made me feel more than a tinge of impatience as I knew there is no way to speed up time -- to reach his level of acuity tomorrow (or any day soon).
But it provided Hope. There was a way to defend ourselves and the Patients who truly need help from the Malingerers. Although there is no fool proof way to prevent it....although there may be a number of false positive diagnoses out there...in the end it's not necessarily our role to keep score.
According to my Attending, physicians must wear many hats.
This past week it's been the Crisis Hat.
And the doors are open to anyone. No appointment needed.
"We still visualize places, that we can roll in peace."
hippo --
:::When the Wolf is Real.
I feel as if I've painted a very negative picture of the Crisis Center and of my week's experience, but that is not the case. Even when there are obvious Malingerers, it's still an invaluable learning moment... and I try to remind myself to find kernels of knowledge in every surprise popcorn moment.
"So much pressure in this life of mine, I cry at times."
It has been rewarding too. We have helped Patients with serious issues who have no where else to turn. We have helped a new mother with Post-Partum Depression obtain state insurance so that she can continue going to work as well as school for her incredibly adorable newborn daughter. We have been there to convince a laid-off factory worker that life is still worthwhile...eventually admitting him to the Inpatient Service where we look forward to catching up with him tomorrow. We have provided a compassionate ear...listening to a stressed out teenager who has put up with and borne more than someone three times her age -- scheduling weekly therapy sessions for her where before she had to keep everything buried unhealthily deep.
"I once contemplated suicide, and woulda tried.
But when I held that 9, all I could see was my momma's eyes."
More than anything, the most gratifying moments have been the occasions where we remind Patients why there is Hope, and Beauty, and that just maybe their Dreams are still viable no matter how bleak it may seem. It feels best because it's almost as if we help Patients help themselves. No medications required. Only the kind of human interaction that we crave and were designed for. Patience. Empathy. Encouragement. Understanding.
"Not knowin' it's hard to carry on when no one Loves you."
We aren't robots or statistics or labels.
We're just and always will be Human. Duh.
:::Save me a place, in Thugz Mansion.
"They'd rather see us locked in chains, please explain.
Why they can't stand us? Is there a way for me to change?"
As I mentioned this is Detroit, MI.
I think people forget that Life still happens here.
"Or am I just a victim of things I did to maintain?"
More than anything, the accompanying Hippo of my first week on the Crisis Center service is a reinforcement of a previous sentiment: to be cautious and mindful of Judgements.
"How can I be peaceful? I'm comin' from the bottom."
Only this time it's more than that. This past week has also been a reminder that as healthcare professionals, whether we like it or not, our task is often to provide the benefit of the doubt.
How can I be so sure?
I've seen the most charismatic and young female Patients, tears and all.
Malingering. (No Benzodiazepines for you.)
I've also seen the most intimidating 6'5" gentleman. Covered with tattoos.
Vietnam Veteran.
Major Depressive Disorder and Post-Traumatic Stress Disorder. Crisis.
"Watch my daddy scream peace while the other man shot him.
I need a house that's full of love when I need to escape."
Sometimes we have to wear the Love Hat.
But, it's our duty to always wear our Patient's Hat. Everytime.
"Trouble sparks, they tell me Home is where the Heart is.
Dear Departed."
We are here to heal. I'd like to think I'm echo-ing the same sentiment as all my colleagues-to-be and of those ancient healers that have come before: I'd rather let a million Malingerers have their way...take advantage of me and the healthcare system...then let that one Patient slip through because I doubted their symptoms and the seriousness of their life's situation.
"Picture me inside the misery of Poverty.
No man alive has ever witnessed Struggles, I've survived."
Every Life is Precious.
And there's always enough room in Thugz Mansion.
No Appointments Needed.
"And in my mind's eye I see a place, the playas go in fast.
I got a spot for us all, so we can ball, at Thugz Mansion."
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