I'm back, after a nice relaxing Christmas, and ready for my last set of rotations as a medical student - an exciting (and very scary) thought! I am starting back on a 4 week psychiatry rotation, something that I haven't done since my 3rd year (3 years ago!). It looks to be a really interesting selection of things planned for me, mostly based in the community, but with some short stints in psychiatric hospitals. This week, I have to brave all of the introductory lectures, have a very interesting session in a 'Substance Misuse' clinic, have a few psychiatric clinics, and have to section a patient and admit them to a secure psychiatric hospital.
The introductory lectures were more interesting than normal, as the people running them had thought up engaging games to help 'teach' us about teamwork and so on. My favourite part of this was a game where they created four groups: one made of consultants, one mixed consultants and students, one of random students, and the final one of students who had chosen to work together. They had to each look at a complex picture and talk amongst each other to recreate it as perfectly as possible. The idea was to show how people take leadership roles, how teamwork is important and so on. This was all well and good, but the fun came from comparing the sketches done by the three teams with students in with the one which came from the consultant group. I am not sure if they were meant to do very well, as they are all used to working in teams, but their picture looked as though it had been drawn by a child who couldn't be bothered to play. Despite it being a grid-based-robot-like figure, they had just scrawled a shape onto it. Perhaps their brains are attuned to recognising difficult diagnoses, to the extent that their art skills have regressed to pre-primary levels.
Most people's pictures looked a bit like this
The consultant's image looked more like this
Well, I digress away from my clinical experiences. The best part of this week was attending a 'substance misuse' centre, where people who are addicted to various substances come to receive safe doses to help them stabilise their lives. This may mean giving them methadone every day (pending an alcohol breath test), or may mean giving them other medications such as benzodiazepines to keep their addiction in check. The thought behind providing these medications is that many of these people who are addicted to drugs spend much of the day trying to beg/steal money for those drugs, then trying to find a dealer, meet the dealer, take the drugs, and then starting the cycle all over again. As the people take the drugs as a coping mechanism for problems they have had in life, supplying the drugs in a safe environment means that they have a lot more time in their day to do things like train for a job, or look for housing. Once these problems such as education and housing are more stable, the person is less likely to need to rely on the drugs, and then you can look at getting the person off of them. Just trying to take away drugs doesn't work, as it is removing their coping mechanism, which they need for their difficult lives. Talking to patients, I heard some very upsetting stories about abusive childhoods, about losing loved ones and friends, and one person had his girlfriend stolen by a pimp who wanted her to be his prostitute, and was then kidnapped by this pimp, who tried to get money for more drugs by holding him ransom for over a month. I have had such a 'soft' and easy life, I cannot begin to imagine what some of these people have to go though. Its impossible to judge people for using coping mechanisms such as drugs and alcohol when you have no idea about the torment they have to go through in their lives.
As well as this enlightening trip to the substance misuse clinic, I spent some time in psychiatric outpatient clinics where I talked to a number of patients with different psychiatric complaints, such as schizophrenia and bipolar disorder. The most interesting part of the week came when my consultant and I were called to come straight to the hospital to assess someone who had been admitted through A&E who seemed very manic. This was a 40 year old Irish lady who had come across to Britain to look for some records. It was very hard to find out anything more on top of that, as she spoke very fast (pressured speech), and was very hard to follow (flight of ideas). As well as this, she was very dis-inhibited and tactile, and was trying to stroke me and kiss my hand while I talked to her. By calling around her current GP practice, we found she had a diagnosis of bipolar disorder (though she denied this) and usually took medication for it. She could have left the pills in Ireland, though I think she stopped taking them while over there, leading to her spontaneous trip to Britain. She was clearly very unwell (though I am sure some of the 'pressured speech' just came from her being Irish), and so was sectioned under Section 2 of the Mental Health Act to be assessed and hopefully taken back to Ireland as soon as possible for proper treatment. A very interesting experience for me, though she seemed so lovely and caring - I felt very guilty being part of the team who was keeping her in hospital when she just wanted to 'go outside and do roly-polys down the hills'.