An year in Psychiatry
Nonetheless the 1 year journey in Psychiatry has been amazing with its cyclothymic ups and downs. From blankly staring at slides during academics to trying to make sense of things ; From being tremulous while giving ECTs (1)to patients, to appreciating it's miracles (and wishing someone could give it to me, to improve my mood); From getting annoyed by the only TELUGU speaking patients, to asking em "Endhuku yee jeevana.. Chechi povala.. Atla anupisthundha? "; From missing food for patients, to missing food out of laziness - has an year passed by in Psychiatry.
I feel blessed to have seen a variety of patients in our hospital, but among them were some who have a special place in my long term memory.
1. Nuppi saar
A 22 year old 12 weeks pregnant lady with hyperemesis gravidarum, showing no response to treatment whatsoever, (despite of treatment from multiple hospitals)is extremely agitated, crying out loud " NUPPI" (pain in Telugu). OBG couldn't tolerate her cry and decided to call Psychiatry. It was tricky to diagnose her, as she was only complaining of pain. She was inducing vomit and refusing oral intake. The family was planning of aborting the fetus. One of our consultants, finally diagnosed it to be antepartum depression and started her on ECT . And VOILÀ, after 3 cycles of ECT she wanted mutton Biryani for lunch and started nagging her husband for drinking. She got readmitted during her second trimester and had to be given ECTs again. Mental illness during pregnancy is more common than we think and mostly remains undiagnosed and often leads to maternal as well as fetal complications or even death. However this lady delivered prematurely and by God's grace both herself and the baby are doing fine now!!! Well, it's not just OBG, at times even Psychiatrists can save 2 LIVES.
2. Who's the patient?
A mother with SMI (2), brings her daughter with an SMI. This duo has been roaming around from hospital to hospital from Mangalore to Bangalore. The mother doesn't understand that her daughter (as well as herself to be honest) require psychiatric medications. The daughter has some inappropriate behaviour towards men. And since the mother (who's the nominated representative to take treatment decisions, as patient herself couldn't take treatment decisions) wasn't allowing us to give any Psychiatry medications, our hands were chained. This mother daughter duo has none except God to take care of them, as apparently the extended family has abandoned them. (Not sure where the man of the house is). Psychiatric illnesses are known to run in families, and at times Psychiatrists become helpless when the care taker of the patient themselves are mentally ill.
3. The LORD spoketh unto me
He had Chronic Kidney disease, uncontrolled blood sugars, a really bad foot wound and Schizophrenia. He was refusing to take any medications or getting dressing done for the wound, because of his mental health condition. It was not the Psychiatric illness which we were worried about. It was his sugars and kidney condition which was deteriorating. Making him take the medication needed some nacks. He was very guarded about his psychiatric symptoms. He was saying that God was speaking to him. But what was God telling him - only he knew and God knew. He was a single unemployed guy who hasn't held a job over the years ever since his illness began, and was being supported by his sister who herself had financial problems. They couldn't afford hospital stay and he wasn't getting better either. Sadly we had to transfer him to a Government hospital. Apparently he got better there. Certain Psychiatric illnesses are known to debilitate you socially, occupationally and economically.
4. I wanna kill myself and others
Even the faculty were confused what he was suffering from. His words seemed like he had depression. But it was just not depression, he had something else as well. Because his MSE (3) wasn't that of a depressed person. And the first one to suspect that was our senior most professor. Us Psychiatrists, we don't have blood tests and scans to diagnose. For us it's history given by family, patient's complaints and our observations. One of our senior resident picked up that along with depression, he had OCD (4). The hint was that he was saying 'I have these thoughts to harm myself and others, but I am stopping myself'. He had obsessions (5) to harm himself and others which he was resisting. It really takes some detective work at times to pick up those subtle symptoms of Psychiatry!!
5. The miracle worker
He had something called organic mood disorder. To dumb down for non-Psychiatry peeps, basically he was depressed. And his depression stopped him from eating and drinking and even walking for 2 years. His parents were extremely poor, who could hardly afford a day's stay in our hospital. He was a candidate for ECT, but it was cancelled at last moment as anaesthesia refused to take him up due to some ECG changes. He was started on medications and he started improving bit by bit. One fine day, he just asked the PG who was taking care of him "Doctor, Can I walk? "; "Sure why not" replied the PG. With PG holding his hand, the guy started walking. It was a "Hallelujah" moment for me to witness!!! The PG appeared to me like a miracle worker as he held his hand and made him walk. Tears of joy were evident in the eyes of the parents. And perhaps, even the gates of my lacrimal glands was about to burst open!
To conclude - Despite of it's difficulties (not because of the subject but because of the course), the satisfaction this field gives to bring a smile on the face of those overburdened familes (perhaps not always), and the gratefulness in their eyes at the time of discharge, is the biggest reward you can get in this field. And that's why I still love you Psychiatry, despite of all your quirks.
Abbreviations/ Psychiatry Jargon
(1) ECT = Electroconvulsive therapy
(2) SMI = Severe mental illness
(3) MSE = Mental status examination - Objective assesments made by Psychiatrists based on certain parameters like behaviour, speech, patients beleifs etc.
(4) OCD = Obsessive compulsive disorder
(5) Obsession= Repeated thoughts coming against a person's will and not under his/her control which causes distress to a person
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