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