Tuesday, July 16, 2013

Mental illness: Why?

I have had to talk to God a lot about patients lately. Specifically, the very psychotic and very addicted patients in the pysch hospital I work at right now.

I see men and women who can't recognize reality any more. Illness has thrust a different world on them! They see and hear things that aren't real, they have well-constructed pasts that aren't real, they can't remember where or when or who they are. Depending on how severe their psychosis is, their families grieve as though they have died.

One woman, "Petra," seemed like a shell of a person. She walked the halls, disheveled and clad in pajamas and a blanket. She stared blankly, spoke little, and had no idea where she was or why she was there. She crawled into other people's beds if they left them empty. And her family could not care for her.

Another woman, "Leah," began to curse at me and yell at people who were not there: she looked off into a corner of the room and yelled, then apologized and insisted that nothing was there, and that she was not crazy, could she be discharged please?

There are less severe cases, too. A young man I met was sure that he had no disease, at least nothing that needed medication. I look at his face and know that he'll see the inside of the hospital again if he decides not to take his meds. And another woman  was clearly splitting (as she idealized me and demonized the doctor, then idealized the doctor a little while later) and was disorganized in her speech and thoughts and future plans.

The other day in Adoration I asked Jesus, "why do you allow this? Don't You want our higher faculties to be intact so that we can follow You?"

I'm so in love with my intellect! I practically identify with it. St. Thomas Aquinas stressed the importance of the intellect in the Christian life. In heaven, the intellect enjoys the sight of God as He replaces concept and phantasm in the Beatific Vision: "since the Divine essence is pure act, it will be possible for it to be the form whereby the intellect understands: and this will be the beatific vision" (IIIQ92A1).

And although it is finally the will by which we choose good and avoid evil, the intellect informs the will of what is good and evil.

So why would God allow some souls to have such intellects that can't distinguish reality from internal stimuli?

In Adoration, I pleaded hard for Maggie, Leah, Petra, and the others. I really wanted them to be well, I didn't want them to be unable to see and choose God's mercy before they died (sometimes the lives of psychotic and mentally ill people is tragically short). I asked for it on their behalf.

I was particularly touched by Leah's condition, and I imagined her, lying as she did in her bed, shrouded in sheets to hide from the inescapable voices she heard. I imagined her like that and my kneeling next to her, both of us before the throne of God. And then I realized that I would not be praying so desperately if it were not for her. She was a little guardian angel to me, spurring me on to greater dependence on God. I have heard parents of disabled children occasionally remark that their children help redirect them daily towards God; Leah was doing this for me.

So maybe God allows mental illness for reasons like that. Let's pray for the mentally ill. (As a side note, Leah is much better now; it's amazing what antipsychotic drugs can do. She's no longer hearing voices and she was discharged.)

Friday, July 5, 2013

Thoughts on Psychiatry

This post conforms to the blog rules.Phew! There has not been much time to blog lately. Two weeks ago, my first rotation started. Since then, my schedule has approximately been:

6:00am: wake up, drive to Mass
6:30am: Mass, Morning Prayer, and drive to the hospital
8:00am: see patients with my attending and one other student
12:00ish: lunch, Midday Prayer, and sometimes commuting to another place.
Afternoons were very variable: since I just finished two weeks on the alcohol and drug dependence unit, I often got out before 3:00. But on Wednesdays, I worked until 11:00pm in Admitting (and I would go to an evening Mass the following day so that I could get some extra sleep). Three afternoons, we had lecture, so I got out at 4:00 or 5:00. Since I am living at home now, I
Some time during the day: 30 minutes of Meditation
9:50pm ish: Night Prayer
10:00pm to 12:30am: bed

There have been about a hundred stories I wanted to retell here. I had no idea that opportunities for "medical matinses" would come so thick and fast in the third year. In almost every patient I see a huge, magnificent, intricate tale that deserves treatment by Homer or Hugo! I'm very grateful to be living at home because people are willing to listen to me, and that has replaced some of the function of this blog (good thing, too, because talking with someone has a much smaller activation energy or barrier cost than writing a blog post, in terms of time).

But I've also struggled with this rotation. I have had a sheltered life, and to see so many dysfunctional families, so much drug and substance abuse, so much poverty and desperation, and so much mental illness all in two weeks was a little overwhelming. There was a woman around my age seeing and screaming at her hallucinations, while I was trying to talk to her. There was a young man who can't accept his diagnosis because it doesn't fit into the reality created by his psychosis, so he can't see that he needs medicine. There was a little girl with new-onset intrusive thoughts, who cried in my arms because she was so afraid of her own thoughts and scared of all the other (even worse) pathology on the pediatric unit. And then there were all the addicts, with pasts full of loss and with futures of fragile sobriety (and I could never tell when they were lying to my face). Will the ones I got close to be safe on the outside?

I was struck by how human everyone is (and I've talked about that before). For instance, I spoke with at least two men who came in with homicidal ideations. In both of the conversations that I am thinking of, I was not afraid, but only filled with compassion and love.

I'm also in the process of pursuing my vocation, which means I'm in formation one night a week and trying to use Sundays for formation, too. I'm navigating the city and trying to attend daily Mass and Adoration in the midst of a crazy schedule. I am living more and more of the particulars of my future life, and it's hard and wonderful. I might post my vocation story here...we'll see.

Tuesday, July 2, 2013

Psychiatry Clerkship Begins Well

My first rotation is Psychiatry. I know nothing about psychiatry and wouldn't have chosen it as my first rotation, but because I switched with a classmate, this is what I ended up with.

Yesterday was my first day of third year and my first day of my first rotation: psychiatry. The hospital where we do most rotations doesn't have an inpatient psychiatry service, so we go to a psychiatric hospital elsewhere in town. I'm still new to the city and I'm not a great navigator to begin with, so I thought I might have trouble finding the place. I mapped it with my iPhone and with Google the night before, and planned to leave twenty minutes early so that I had some time for U-turns.

Well, I followed the directions and ended up in a manufacturing district of a suburb. Driving around, I thought, "maybe they just put the hospital out here to protect the sensitive nature of the problems?" but after finding nothing but an Urgent Care, I decided to whip out the email that the clerkship coordinator had sent and open the Welcome Letter, which had a map at the end of it.

the map was about two inches square, very pixelized on my phone, and had almost zero streets marked. In my haste, I didn't read it properly and saw that one end of the path landed in a different part of town. Quickly I tried to find that area on my iPhone. Without street markings, I headed in the general direction, hoping that my extra twenty minutes would save me. I got stuck in rush hour on a highway I'd never been on before. I called the clerkship director twice, and the clerkship coordinator once, to no avail.

Still wondering what street I would be looking for, I found myself downtown, where one-way streets, bizarre intersections, and other driving disasters about. My iPhone's map was carpeted with streets, and the map on the welcome letter had very few, with no labels. Where was this psychiatric hospital??

I was trying to trust in Jesus and abandon my on-time self-image to Him, but I started crying at this point. I was already late to orientation (and the 8am time was marked in red on the Welcome Letter) for my first rotation during the year when personal characteristics and first impressions matter so much! I pulled into the parking lot of a random high-rise to ask for directions. As I parked I tried to compose myself. Hoping I wouldn't be towed, I headed toward the door and left my white coat in the car.

Another woman got to the door at the same time I did, and I was so desperate that I blurted out, "can you help me?" My eyes were probably red and my voice was soft and shaky.

"Sure!" she said, concerned. "What do you need?"

I don't remember what I said, but it was something like: "I'm lost. I need to get to ____ Psychiatric Hospital," and as I said it a sob broke out. How embarrassing! Even as I was saying it, I was thinking what a great story this would make if everything turned out well.

Well, it turns out she was on her way to a doctors' appointment. We went into the building together and she took me with her to her OB/GYN's office, where she checked in and she let me ask the receptionist for directions. I repeated to the receptionist that I was looking for the psychiatric hospital. Tears were still welling up in my eyes. (I was now forty minutes late for orientation.)

The receptionist's face was instantly concerned and she offered quickly to find out where it was and print off a map for me. Then she said, "I'll call and verify where they are." I thanked her as she dialed. "Hello," she said, when someone picked up. "Hello, this is ___ at ____ Obstetrics and Gynecology. I have a patient of yours here...."

I didn't hear the rest, I was laughing and going hysterical inside! I wanted to cry, but that was just too funny. I eventually got to the hospital (which was a frustrating few minutes away from the manufacturing district that the iPhone had me visit), an hour late for orientation. However, the clerkship director was very forgiving, and now I have a hilarious story.