"Respect the Patient's Wishes"

Today was a short but insightful day. I was assigned to Psych and Behavioral Meds with Raquel and we got to shadow Dr. Mullet and her team. I was very lost at first but luckily ran into m3s who were also on their way to the workroom. Dr. Mullet was in her office but in the meantime Raquel and I talked to Dr. Komal Patel, who is a second year resident. She was on Dr. Mullet’s team so we spent a lot of time with her and another student from USCOMG. They were all so kind and open to hearing Raquel and my questions throughout the entirety of our day. When we walked over to Dr. Mullet's office, they discussed the cases they would see today and by hearing everything we would see I got so excited to see the physician and patient interactions. One specific case about a suicidal attempt interested me more than the others. It was about an older male who has a toxic marriage with his wife and repeatedly threatened to not only leave her but also take his own life. With the most recent instance he was packing his bag and held a 22 (a pistol) right below his chin pointing up towards his head. Him and his wife were going back and forth yelling “I am going to kill myself!” and “do it!” The patient claims she pressured him further into pulling the trigger. When I heard that I was more concerned with what sounded like a homicidal attempt of the wife more than I was with the patients suicidal attempt. Dr. Mullet said that although the patient and his wife have a very toxic relationship, it wasn’t the wife who pushed him to do it, she thinks that it was the patient and his major depression that caused him to pull the trigger. She claims that the patient won’t admit that it was a suicide attempt. Although I do think his depression plays a huge role in what happened, I still believe his wife was who pressured him into shooting himself. When we walked in to check on him, he was very calm but also very calculated. Calculated in the sense that he didn’t want to be stuck in that room anymore and wanted to get out one way or another. He was slow to respond to questions to make sure he said what the doctors wanted to hear to sign the release form. However, he didn’t know that his dishonesty would do him a disservice and would actually make his stay longer. What was really hard to watch was that he didn’t like to admit that he doesn’t have the best relationship with his wife. Most of the time that he was talking, he was mentioning how she felt and what she thinks and was less concerned with himself. The doctors advised him time after time that going back home would not be best for his mental stability, however he refused to believe that. I learned that even with domestic violence cases, all the physician can do is offer advice and respect what the patient chooses to do.

Next, we all walked across to the other side of the building to what looked like a conference room. Dr. Mullet and her team had a chance to talk to a group of others from different fields about the cases they have. The team consisted of social work, nursing students, pharmacy students, utilization review, and insurance workers. Dr. Patel shared each case she is overlooking while everyone listened, gave updates, and answered any questions. I love that team collaboration is a huge part of this role because I think it is so valuable that when it comes to writing a prescription, a pharmacist is giving their input or when discussing a certain procedure the insurance company is present to approve or deny it. I also think that healthcare isn’t like any other field like real estate or even law; you are literally taking care of the health of PEOPLE. So, I think hearing second opinions is extremely vital when it comes to decision making.

Raquel and I got to see one more patient after the conference. She was an older woman who also deals with depression. Her case didn’t look as severe as the first one we saw. She was able to have a very fluid conversation with the resident and looked like she was even enjoying her time being inpatient. She mentioned that she is using the alone time to reflect and to have time for herself. She also likes attending group collaborations. This is something the ward designs for patients to come together and work together to reflect. Today’s activity was called “Thinking Errors''. According to the patient, she learned to stop taking blame for things she didn’t do. For example, she struggles with constantly apologizing about stuff that didn’t need an apology. She also learned to stop talking herself down by saying stuff like: “he won’t ever date me.” Everything she mentioned that she struggled with are things I struggle with myself so it makes me really happy to see that she is getting help and working on bettering herself.

There were a lot of things I noticed about the rooms and unit in general that are different from a normal inpatient ward. Everything was ligature resistant like the door handles and sinks. There was very limited furniture inside and outside of the rooms, only the bed and a chair in the room. The bed was drilled to the floor and the cabinet to the wall. Every chair was filled with sand to make it harder to lift up or move around. Sometimes there would be two beds if two people live together. There is also a bathroom in each room that is ligature resistant as well. The patients have assigned time when they can hang out with other patients outside or to watch TV in the common area near nurses. There are no TVs in the rooms because it requires a cord which isn’t ligature resistant. However, there is a speaker in each room and in the halls for announcements. One of the announcements we heard was to notify the patients to meet at the door if they wanted to go outside. It is clear that there is intention of providing structure to the patients day, however in a closed room there is so much autonomy one can have. One question we asked Dr. Patel was “how do we expect patients to improve if the rooms and the entire building is so gloomy?” Dr. Patel said that it is much deeper than that, but I am honestly not convinced. I think if someone has no freedom, is locked up in a place, and has nothing entertaining, then that could slow down their recovery process.

By then it was 11:30am and there was nothing else for us to see since the rest of the patients were outside. Raquel and I had lunch together and debrief in the medical school. Overall, I really enjoyed this rotation and know that I learned a lot, like a scheduled melatonin dosage works better than a larger as needed dosage. However, if I do go into psychiatry, I would not choose inpatient psych and behavioral meds.

Can’t wait for tomorrow!!