PSYCH JOURNALS

1.
This particular evening I was with a new patient in the psychiatric clinic. She had a history of obsessive compulsive disorder and came to establish care do to a recent exacerbation of symptoms. She told us through tearful eyes, anxious disposition, and a quiet voice that the nature of her intrusive thoughts had changed abruptly and only gotten worse. They were now of an inappropriately sexual nature that she disputed/refused consciously but was unable to gain control over the thought cycle. This had impacted her life to such an immense degree, she couldn’t even vocalize it all. She had to write it down. That night was the first night I felt tangible suffering. It’s like it was in the room sitting next to her, its own entity. She was so broken, distraught, and at war with her thoughts that in attempt to not live out her obsessions she had boxed herself into a corner. She was a fraction of the person she once was and isolated from those she loved. She wanted so badly for this not to mean she was a bad person. She wanted to just be herself again and know that there was help available to her. I identified with so many aspects of her social history regarding family and upbringing and gathering the information about the person she was before her obsessions changed, led me to believe she was a good person. So it hurt to see her wrapped in confusion and shame over something out of her control. It hurt to see how much she struggled just to say it. That was my first emotionally challenging patient. She was someone I believed received some peace and hope from our visit. The resident I worked with I truly believe is the best person she could have seen. But she was that person that I fought to maintain composure in the interview. She was that patient I imagined hugging just to offer physical comfort because I knew it could have made a difference. Of course I didn’t hug her or touch her at all, and I didn’t break down and cry with her in the interview… but because of her, I knew what it felt like to want to and not act. I learned how that would feel much earlier than I expected and I know it won’t be the last time.
 
 
2.
This morning was so great, because I am a hands on person through and through. I am a procedure lover and psych doesn’t have very many available to do. So this was a refreshing and pleasant morning. Now I’ve done plenty of joint space injections but never any gluteal/muscular ones so in that way it was a first. So procedure, awesome, a first, exciting, and all in the first part of my day, ideal! This patient has a long history of schizoaffective disorder, incredibly stable. He was receiving a Haldol injection today. It was a great little anatomy review and excuse to actually make contact with a patient! So I delivered it and then patients are instructed to hang around for a while, then get vitals before they are allowed to leave. So I got to stay and chat with this patient as well. Now as good as it felt to do the injection, our chat also contributed to the morning being pleasant. I talked some about medicine but he really just opened up about how the course of his treatment had been, how he came to have the doctors he had and his life now. He was happy and calm and appreciative of how medical education mentorship works and his care and how far he has come. It was incredible to listen to and what should have been  minutes became  very quickly. I took him to get vitals done and said goodbye before heading across town to see on call patients. I missed that kind of interaction. With psychiatry you see such a variety of attitudes, stability in condition, etc. A lot of it isn’t light or happy, so to converse with a patient at his stage in the treatment process and living well was a real privilege.
 

3.
Okay so this not associated with any specific day, so much as the week that I was assigned to psychotherapy with an amazing psychologist Dr. Rila. Wow, first things first, she is amazing at what she does and so obsessed with it still. She geeks out over her field and that makes it all the more exciting to see her work. On the other hand though, her work is full of patients (primarily children) who have faced pain and trauma of a magnitude unimaginable. There are quite a lot of blended families, with children who have suffered things you only think adults are dealing with. Children who may or may not already be genetically predisposed to emotional, physical, mental challenges. It was by far the hardest week of my clinical experience in this rotation. It’s the only part of this rotation where transference, countertransference, and intense emotional reactions were happening regularly. Observing strained relationships, difficult foster home situations, children struggling in behavior and school because of their past, digging into hidden or repressed memories/trauma. It’s heavy all day, every day, and yet somehow she manages to allow these troubled individuals/families to leave with some peace, some light. It’s incredible. I so respect her and what she offers to the people here in west Texas. 


xxO,

The Third Voice