Friday, December 6, 2013

"Wait, did that make sense to you?!" 2 days Psychiatry-- A Review

Well, its been a whirl wind of two days in the psychiatric hospital.

Yesterday morning, I was picked up by my friend with her car which was already packed with other friends. Our destination was the same. The psychiatric hospital on the outskirts of town (typical for old psychiatric hospitals).

After wandering around the very Harry Potter-esque grounds, we eventually found the conference room. The medical director was responsible for my group. He gave us a short history on psychiatry before heading onto the wards. We were split up into groups of two and then dispersed onto different wards. The set up on the two days was the same:

Ward with 1 or 2 patient interviews
Discussion of cases
Ward with 1 or 2 patient interviews
Discussion of cases

And that both days. Essentially we were on 4 different wards and saw between 4-8 patients.

So yesterday morning, I was on the addiction ward. My friend and I talked to two alcoholics. They were very honest with us. They had different ways of becoming alcoholics and it was interesting to see how it started with each of them. It was also amazing how sweet the lady was. She really doesn't want to be an alcoholic and quickly sought help this time around. Neither of them had very supportive social circumstances. It is hard to tell how much of that is because they are alcoholics or they became alcoholics in part due to those circumstances. In the end, it is devastating to see what alcoholism does to the people. I wish them both the best on their way to recovery.

The medical director was a character. He did a great job explaining things and we had quite the laughs during lunch. He was motivated, which is important for such days.

After lunch, we had two schizophrenic patients to interview. This was exhausting. The conversation was fluid and on first glance made sense but if you did the math of the years they proclaimed things happened it didn't quite add up. At the end of the conversation, I felt like I had a lot of information but it didn't fit together. Luckily, my friend felt the same. Even luckier, the doctor told us that that is the way conversations with schizophrenic patients often go.

After the discussion with the group about their patients, we were free to go. We were all a bit exhausted from all the impressions we had gained that day.

Today was not different. During the morning meeting, the medical director gave us a history lesson on how psychiatric patients were euthanized during World War II and how the medical director of the hospital at the time was one of the very, very few psychiatrists that were against it and were active about stopping it.

My partner from yesterday wasn't here today, so I was on my own (which was absolutely no problem for me, the others hated doing things alone). I was sent to the depression ward. I had a very nice lady to interview. She was at the end of her treatment and it had worked very well for her. It was nice to see that with the right therapy, these people can be helped. After our chat, I chatted with the ward doctor a bit and then headed back for group discussion.

Then came lunch! They have quite the good food there.....almost everything is better than what we have in the hospital were we study.

After lunch, I grouped up with two of the others and we had two patients to interview. One of them was an Oxycontin addict (although he didn't tell us that, the patient records did) and the other was also schizophrenic and his symptoms had worsened, leading to his admission. Both of them were some what difficult to interview. The second just got up at some point and said he had to go and would see us next week.....?! I guess he will be disappointed this time next week, if he can remember it.

I was quite drained after the three interviews today. It is literally crazy to see how quickly someone can develop a psychiatric disease. It's frightening sometimes to see how many characteristics I share with some of the patients. In the end, everyone has their issues. It is about how you deal with them which differentiates where you are at in life. And a stable, supportive and loving social surrounding is essential. So love the people around you and be nice to them. Don't do drugs. And don't be afraid to ask for help should you need it.

The last few weeks in psychiatry have definitely changed my views on some issues and the way I perceive things. It was very enlightening.

We start with Pediatrics on Monday and that continues through winter break and into January. After Peds, we have a few weeks of OBGYN.

You can all catch me here again in February, at the latest, when I do my Peds Internship and OBGYN rotation.

I wish you all a lovely holiday season. Enjoy your family and friends. Be thankful for your health, your family and hopefully supportive social surroundings!



Wednesday, December 4, 2013

Psychosomatic Medicine--Should I be here?

So sorry I didn’t post the last two days. No Internet connection will do that to you. And very big lack of sleep.
I had a night shift Thursday, Friday and Sunday. After the night shift on Sunday, I directly went to the train station to catch a train to a town 1.5 hours away from Göttingen. A few friends and I were attending an internship in psychosomatic medicine.
We arrived in the town and took a taxi to the hospital. It is a huge hospital specialized on psychosomatic medicine and psychotherapy.
We found out room on the top floor in the medical directors department. We had a conference room waiting for us including a cart with tea, coffee and cookies. (We had so much of tea, coffee and cookies over the two days that none of us wanted to see cookies anymore.) I was very happy about the offering of caffeine.
The director of the hospital welcomed us and discussed what to expect for the next two days. Then we were asked what our expectations were.
The next point on the schedule was a patient interview done by one of the doctors. Patients in this hospital have psychological issues that cause bodily ailments or the other way around. I tried to listen as much as I could, fighting the tiredness, drinking more black tea and doodling to keep myself awake.
After the patient interview, the patient left and we discussed what had just happened. The interesting thing about how they taught us the patient history taking here apposed to how they do it in the university hospital is that we have a lot more time and we discuss how we felt during the process.
Over the course of the days, I noticed that a big difference in psychology compared to the other specialties, is that the interaction is so dependent on the therapist as well. In other specialties, the patient has an ailment and there is a process of taking care of it (hopefully, and this is a extremely simplified statement). With one patient, half the group thought he was a nice guy and felt bad for what had happened in his life whereas the other half didn’t like him at all. That shows that the therapy could be completely different depending on what the therapist feels, has gone through in life personally and how he identifies with the patient.
I mentioned this point in one of the discussion and was then informed that the doctors have a period in their training where they focus very much on themselves and their own issues to better understand them while treating patients.
We had lunch in the hospital and then were off to music therapy. That was fun. We all grabbed an instrument and started playing and seeing where it goes. Afterwards we discussed it and found that many had had musical training, which might have led to us quickly finding a rhythm.
We had another patient interview to see before the last thing on the schedule. Relaxation therapy! We were all in a cozy room, got a mat, a pillow, a blanket and a cherry seed pillow and the therapist starting explaining a few things to us and telling us how to relax. After 24 hours of no sleep at this point, I totally fell asleep and slept for about 10 minutes.
We stayed in the hospital for dinner before heading to our hostel. There was a Christmas market in town and everyone wanted to go. I was at 27 hours without sleep and managed to go along for one hot-spiced wine before I headed back before the group and slept…like a rock.
The next day we had more coffee and tea and cookies while interviewing a patient again.
Then we had the opportunity to have a one on one conversation with a patient. We were given 50 minutes for the talk. I talked with my patient for an hour before realizing it and having to go meet up with the doctor. My patient and I got along so well. I’d say we were on the same level on 80% of the time. The other 20% is the reason he is in the hospital for treatment and I am not.
After the one on one, we talked to doctors about our experience and got feedback.
After lunch, we had another patient interview. This time a friend and I did it for the group. It was amazing. Again, I could identify with about 90% of what this patient felt and had gone through and those little 10% were the reason I wasn’t in the hospital as well.
It was crazy just how well the patients fit to my personality that I saw yesterday. Maybe this should concern me on some level.
After that last interview, we had Qigong. That was fun to experience. It’s the Asian exercise you see people do in the morning. Slow movements and energy flow.
We had a last discussion with the chief and then caught a cab back to the train station and then headed back to Göttingen.
Tomorrow starts the first of two days psychiatry. Let’s see what that brings.