Locked Down

"How can you tell the difference between the psychiatrist and the patients? The psychiatrist has the keys!"

This is my third and final week on the inpatient psychiatry ward. Next week I will be moving to the chemical dependency unit and after that I will be in the consult and liaison unit. Anyway, I have been thinking about things to write about the inpatient psychiatry unit, but haven't had the time to compile my thoughts yet. I am having a lot of fun with the other medical students, maybe too much fun!

The inpatient until that we are working on is a voluntary lock-down ward, which basically means that the patients agree to come into the hospital voluntarily but that they cannot leave until (1) the physician decides they are ready to go or (2) they write a 72-hour letter (which is similar to when a medical patient leaves against medical advice, AMA, except that the psychiatrist has 72-hours to get the paperwork in place to involuntarily commit the patient if the doctor does not think the patient is stable enough to leave--they usually don't involuntarily commit until the patient is still extremely sick). Since this is a locked ward, we are also locked on the unit. Overall, it has been fun and some of the things I've heard on this unit have tested my ability to keep a serious face and not burst out laughing. Here are some examples of being on the locked ward...

Middle Aged Depressed Lady (MAD L): MAD L was telling me how she is so depressed that she feels nothing but hopelessness and emptiness. (This is a sign of severe depression and should be taken seriously.) Then she told me that she has hurt herself so that she can feel the pain rather than feeling nothing (also very serious). I asked her how do you hurt yourself and she replied, "I hit myself with a fly swatter until I bruised."

MAD L also is a bit overweight. She told me that she had hurt her knee at one point in the past she fell and with all of her weight she landed on this knee. Then she looked me straight in the eye and seriously said, "That is a lot of weight for one knee."

There is a younger lady who is going through a manic episode, lets call her Ms. Hyper. Because Ms. Hyper is manic, her thoughts race and she jumps from idea to idea. Some of the things she says are downright funny, but her disease is anything but funny. She is the patient that has bothered me the most because she is the only patient that I haven't seen get better...yet. I know some of the medicines that she is getting take a while to work (psychiatry medications may take up to 12 weeks to work properly--patients don't have to stay in the hospital that long), but I just wish she would start to show signs of getting better soon. Ms. Hyper has said a million interesting things, but I am not sure if they will seem funny outside of the locked unit. Her favorite word is "epic" so anything she likes, is epic. She really wants to get married and have kids "to get it over with already." Whenever, she says, " I want to get it over with, already" at least two staff, medical students, or physicians turn their heads so quickly that they get whip-lash because if you miss the first part about getting married and having kids, it is easy to think she is talking about suicide. It is amusing to see how quickly the heads turn, then realize it is just Ms. Hyper (she is one of the few patients who is not suicidal on the unit and she isn't talking about suicide). Recently, she declared that she had to get home because she has things to do and the energy to do them. She wants to clean out her parents basement to give things to the poor and so that she can have "the most epic house party ever." She told us that if we could help the doctor understand that she has things to do and is ready to go home, we could come to this epic house party.

Ms. Hyper has become friends with Ms. Wilderness. Ms. Wilderness is another young lady who is admitted to the hospital for depression. I call her Ms. Wilderness because she wanted to commit suicide by going to the woods, camping, meditating and not eating until she dies.

Anyway, we were in a group therapy session today. Ms. Wilderness said that she thinks she has four options when she leaves the hospital (1) Continue working full time (at her good job with benefits) and be stressed out working for "The Man" (2) Quit her job and move in with her parents then look for work as a gardener (3) Move to the wilderness, live a quiet, peaceful life and eat at food kitchens or (4) "try to become homeless"

After Ms. Wilderness mentioned the third option, of moving to the wilderness, Ms. Hyper went from sleeping on the table to jumping up and declaring that it was so obvious that Ms. Wilderness had to move to the wilderness because it would be "epic". Then Ms. Hyper fell back asleep on her arm. After Ms. Wilderness spoke more about living in the woods and "trying to become homeless" another patient decided to speak up, we will call him The Voice of Reason. I wish you could hear his voice. He doesn't have the deepest voice, but it is rough like gravel. He is a no-nonsense kind of guy, with a troubled past, who is trying his best to keep on the straight and narrow. I expect him to curse, but he never does; however, he always has a look on his face like he thinks someone in the room is crazy (and technically since they are in a locked psych unit, they are). He looked at Ms. Wilderness, while she was talking, like he wished someone would slap some sense into her and declared her "super crazy" for wanting to move to the streets. Despite the look on his face while she was talking, The Voice of Reason calmly looked her in the eye and told her about life on the streets. I think the look on his face made the situation more humorous in person. He looked like he had just eaten something very sour and was disgusted (in this case disgust with stupidity). Besides the fact, he (and the rest of us for that matter) were not sure what she meant about "trying to become homeless." I don't know how you try to do that....

Another middle aged patient was extremely mad at her family for not calling her for advice about family matters. It was all I could do not to start laughing when she said this in group therapy....this is a lady is a paranoid schizophrenic and she thinks "everyone is out to get" her. I understand that she feels left out of the family (and that isn't right), but I can see why the rest of the family doesn't use her as their primary advise counselor.

Another of my patients is a depressed gentleman. He asked me, "why are you here" and I replied "because I am a medical student." He then said, "But why?" and I told him that I wanted to be a doctor since I was a little girl. He told me, "but you could be a model....or an actress. The guys and I have been trying to figure out why you are here. We all think you could have been a model." I replied thank you (and obviously, I had a new favorite patient). Then he said, "You could have been a supermodel, but you are here. Wow, you must really want to be a doctor." If all of my patients told me I have supermodel potential, I think I would have no choice but to become a psychiatrist--it is great for my ego.

Now, being on the locked ward is okay overall; however, on Tuesday it was horrible. They are doing construction in the hospital and the fire alarms were set off. So, there are flashing lights, terribly loud sirens, and a ward full of psych patients. I don't think the patients knew it, but the door automatically unlocks (so they could escape), but there were three medical students guarding the door (but heck, if they all came at once, the three of us couldn't stop them). Anyway, this fire alarm went off for half an hour. I already had a horrible headache (it was so bad that Farley suggested that I stay home, but I didn't want to have to make up the day) and then this happened. To top it all off, the patients didn't try to leave, but they all started shouting about the noise and they got louder and louder. My headache got worse and worse, but I couldn't leave because I was guarding the door and once it stopped, the door automatically locked. Besides, they have cameras so they know when we come and go. So, I was stuck in my own personal hell...on the locked unit

New York City Tour

Farley and I decided while still in Miami Beach, that we would do a tour of NYC once we arrived.  We decided that if we were going to do a tour, we were going to do it all so we chose an 8.5 hour tour which took us all over Manhattan, included lunch in Little Italy, a boat tour and ended with us at the Top of the Rock.  

This first picture is a building in Manhattan's Midtown.  Apparently it was built right before the Great Depression and it was suppose to be a skyscraper; however, the builder lost everything and stopped at the 5th floor.  Sometime in the last decade someone decided to finish it, except that they did it with a modern glass building.  It looks so interesting:

As we headed north to the Upper West Side of Manhattan we passed things like the Lincoln center and lots of places where the rich live.  This building was build, I believe, in the last 1800s and it was designed to be fireproof--the walls were 1.5 feet wide.  Well, it wasn't fireproof but it is soundproof so it has been a hot spot for musicians and classical composers.  I guess they remodeled it a few years ago so it is now "luxury apartments"

 This is where John Lennon was killed, The Dakota.  Sorry the picture isn't better Mom.  The Strawberry Fields are across the street in Central Park, but I was on the wrong side of the bus and couldn't get any pictures.

Another picture of the Dakota.  I guess Yoko Ono still lives in their apartment.

The Apollo Theater in Harlem.

Just a few blocks from the Apollo is the building that former President Clinton has his offices (on the 14th floor).  It was a huge deal when he decided to move his offices here because this area has was very dangerous and run down, but has cleaned up by the city over the last 15 to 20 years.

We took a quick detour to Central Park's conservatories. We only had 30 minutes!

I believe the building in the background is part of Columbia University.  Their campus was something else, but it should be for $45,000 per year tuition (NOT room and board)

After leaving Central Park, we headed down 5th Avenue through Midtown and Times Square (see my blog on Time Squares for pictures of it).  Then we headed through SoHo and Greenwich Village, but I didn't get any good pictures of the area.  After that we stopped in Little Italy for lunch (included in our tour fee).  

 This is the restaurant we ate at.  It wasn't the most amazing food in the world, but the restaurant was cute.  Apparently, every 10 years buildings must work on the scaffolding to be up to city code, so there are covers up around certain buildings to protect the sidewalks while they work.  This was one of those buildings.

 A building in little Italy.

 A view of the Empire State Building from Little Italy.

Literally a block away from Little Italy starts Chinatown.  I didn't get a good picture of Canal Street, where people go to buy the fake designer bags an such.  

Next we headed to Wall Street.  Here is the Bull.

Then we headed to "Ground Zero."  However, we were told that New Yorkers don't call it Ground Zero anymore because it is cleaned up and they want to move forward, so they just call it the World Trade Center.  The black building is the 7th tower (I might be mistaken, but I think I am remembering correctly).  Apparently, there were eight buildings in total that went down on 9/11--the seven world trade center buildings and a hotel.  The 7th building was the first to be rebuilt and it is 55 stories.  The twin towers were 110 stories---imagine it twice as large!  The tour guide also said the fires could not be put out for 6 months.  If I remember correctly between 2,500 and 3,000 people died, but there were over 55,000 people in the towers.  It is amazing that more people didn't die.  Also, I didn't know that they people who live near there couldn't return to their homes for 6 months because of the asbestos and the horrible smell in the area lasted for years.  They are working on rebuilding the site now, as can be seen below

 I believe the crane on the right is where the first tower was and off to the left is where the second tower was.

This is inside the world financial center, where we took pictures  of the World Trade Center.

Our next stop was South Street Sea Port for a tour of Liberty Harbor.  Here is the Brooklyn Bridge!

 Ships at the dockside that you can tour.

 The Brooklyn Bridge from the water:

The Manhattan Bridge.  There are three bridges connecting Brooklyn to Manhattan Island.  From South to North they are the Brooklyn, Manhattan and George Washington Bridges.

Photos of downtown Manhattan from the boat tour:

The short round glass arches in the photo below was destroyed on 9/11.  They rebuilt it quickly (with the exact same design) and I believe it reopened on 9/11/02--one year after 9/11.

 Midtown Manhattan from the boat--the Empire State Building.

 Ellis Island: I had no idea how beautiful it was.  I can only imagine how it would feel to see the Statue of Liberty and Ellis Island after the long journey to finally reach America.  It was very moving to see.

The Statue of Liberty!

After the boat trip, we headed to the "Top of the Rock" observation deck at Rockefeller Center.  There were great view of New York City and we had a perfect day without clouds.  The first photo is zooming in on the bridges near my house.  If you look very closely, you can see the Robert F. Kennedy and Hell's Gate Bridges that I wrote about when I posted on Astoria Park.

 Central Park!

The Empire State Building, which also has an observation deck that you can go up and see the city from.

After finishing the tour, I wanted to walk down 5th Ave again.  Here is a picture of Cartier.  The building is almost as beautiful as the diamonds.  

Mom and I watched "Breakfast at Tiffany's" after my surgery last winter.  I am not sure if Tiffany & Co. are in the same building, but it sure looked the same to me!

I think I covered most of the tour.  It was a long day and I am not sure that I remembered all of the details correctly, so I hope everything I posted is accurate.  After walking around, we headed to Starbucks to get Farley some much needed coffee.  We decided to watch a move and order delivery.  We had Indian food.  It was such a wonderful day!

Time Square

On Sunday the 8th, Farley and I decided that we would head into Times Square and spend a day having fun. Actually, I had been harassing him to go to something touristy since I have never been here before. Usually I am the responsible one, but this time it was Farley who constantly had to remind me that we had to get to bed at a decent hour for school and buy groceries. Anyway, we hopped on the N train and got off at the Times Square stop.

It is hard to capture in a picture exactly how it feels. The buildings are all so tall around you. I hope you get the idea.

If I understand correctly, Times Square and the Theater District are basically the same neighborhoods. As you can see, Broadway is right there. I have learned that Broadway divides the island of Manhattan into east and west halves.

Here is one of the many theaters with a Broadway production. This is the Ambassador Theater, the home of "Chicago."

A few blocks from Times Square, you can find the Federal Reserve. To make your vacation to NYC even more fun, they post the national debt and it is updated constantly.

My favorite part of exploring the area around Time Square was St. Patrick's Cathedral. I was breathless. It is strange to see a Gothic Cathedral sandwiched between modern buildings.

Right next door to St. Patrick's is Saks 5th Ave!

Directly across the street from St. Patrick's is this statue of Atlas.

This is one of the entrances to Rockefeller Center. The following pictures are from Rockefeller Center. There are many sculptures there.

We also went to Bryant Park. It is much smaller than I thought it was based on t.v. Nonetheless, it is really pretty and it stands out with the trees and skyscrapers in the background.

Le Carrousel in Bryant Park

One of the NYC public libraries is adjacent to Bryant park. There is a restaurant on the right side of this photo too.

The Chrysler Building. I am not sure where I took this photo from

Farley really wanted to go see "Inception", so we went to a movie while we were in Midtown. After the movie, we were able to get some nighttime pictures before heading home. Here is Time Square at night:

The Empire State Building: it was red, green and white for a Chinese festival

Finally, I took a picture of Radio City Music Hall before we left Manhattan for the 20 minute train ride home.