i feel like i’m finally sort of starting to understand that phrase. a woman came in today originally needing pain meds from her injuries after her accident about a week ago, but it turned out she was also running from her abusive husband and needed psych help as well. i spent quite a lot of time with her, and at first she was kind of guarded and defensive, but then broke down, crying about how much it hurt to have finally realized her husband didn’t love her and was just using her for drugs, and kept repeating that she always tried to be strong but couldn’t do it anymore and needed help. she mentioned believing in God, so I offered to pray for her, which she accepted, after which she said, kind of with some side-eyed scrutiny “that was a powerful prayer! are you a prayer warrior??” to which i was like… um, i don’t really think of myself that way, but if it helped you, then i’m glad. she then tried to show me that she carried her Bible with her all the time, but couldn’t find it in her bag i’m bringing one with me tomorrow to give to her if she’s still there and wants it.
at one point though, she got defensive and tried to leave, so i went to talk to her and calm her down until psych could come see her. she said quite a few times today that the only person who could make her stay was me (to other people too), and at one point, she also mentioned that she had meds in her bag, which i didn’t understand at first, and then she pointedly said, i’m telling you, i have a bunch of pills in my bag that they didn’t check or take away, and i’m not saying i’m going to do anything, but i might and i don’t want to. then it clicked, and i was like “oh. i see. do you want me to take your pills away from you?” and she nodded yes as she teared up, and i took them from her and gave it to her nurse. when i came back, she was crying again, and said she’d never had a friend before, and didn’t know how to have friends, but if she did, she’d want them to be like me. she kept asking me to stay and that she wouldn’t talk to others or go unless i was there. later, after she finally agreed to go to the psych ward, she said it was fine for me to leave (it was past my shift), and i made sure, saying “will you stay?” and she said yes, and then said off-handedly, after i mentioned that i’d be working tomorrow and would check her chart, she was like “well you can come see me too, you know, if you want to,” so i told her i would come by after my shift, as long as she was in the hospital.
so i got to thinking… where is the line though, between physician and patient? technically i’m not her doctor now b/c 1) i’m a med student, and 2) she’s now being overseen by psych so we’re no longer in that type of relationship, but if she thinks of me as a “friend,” how do i maintain distance with her, or even future patients, especially if i end up doing psych to some capacity? will probably need to ask some of the residents/attendings on psych later on to figure that out. but i also happened to talk with an IM resident who had also considered psych apparently, and he mentioned that you can kind of always do psych as an IM doctor (“and no one’s going to fight you for it” because there’s such a high demand, and i guess not many want to do it), but not so much the other way around. and that makes sense. and i think it’s ok to let go of that – to realize i may not have the time to save everyone by spending many hours over time longitudinally to work through the healing, but i can be the first one to recognize they have that need, and make sure to get them to a point where they are amenable/receptive to the idea of seeking help, and that it’s ok to seek help. that’s actually a very common theme i’ve come across with the psych patients i’ve met with and referred to psych while in the ED. they didn’t want to seek help because they’re trying to shoulder all the burdens on their own, until a breaking point.
the key after that will be to find really good partners to work with though – people who will be actually very empathetic, with a strong desire to help people/listen to them through issues like i would be.
and it’s also making me realize there’s a HUGE need for psych guidelines in the ER setting, because pretty much all of the patients i talked with so far, the EM residents were initially quite dismissive of the seriousness of the condition of the patients. >.< also notable is that so far, all used drugs to cope. we need to teach people better coping mechanisms to people, and find a way to get rid of the drugs (2/3 also had schizophrenia relating to weed use, so to all the people who say weed is harmless… it’s really not, and studies have shown it does mess w/ cognitive function, esp the younger you are when you start using it, not to mention the potential for inducing psychosis like schizo, regardless of whether it’s due to “predisposition” or not. all mind-altering drugs can really mess ppl up in some way, shape or fashion, and i’m almost surprised that most docs, esp ER docs, don’t all come to similar conclusions. maybe i’m still green yet, and sure, of course the ER setting is specific to those who run into problems so it’s a biased sample in that aspect, but 1) we also don’t know how many suffer for months or years with side effects and broken familes from them, or others that just die in the streets from these kinds of problems, and 2) from a bigger perspective, if we can cut to the root cause of all these problems, we would save so many ER visits and deaths. I can’t tell you how many traumas come in because someone has abused alcohol or other drugs, and while not super high, I’d say that drugs of some sort (including alcohol and nicotine) have caused a fair portion of ER visits too. If you include things like COPD exacerbation or heart or liver dz from chronic abuse of substances, I’d say the number is even higher.)
in other news… dang. my eyes are SUPER red right now, and they actually kind of burn a little bit T__T. what the heck is going on?! it’s been almost 3 months already now, whatever it is >.<
also family flew overseas today for a month-long trip – first family trip without me :(. haha but i guess now i know how my parents feel when i go out of the country without them (in terms of worrying about safety, etc). hope they have a safe journey and fun time!