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psychokangaroo · 3 years

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M3 Diary: Infernal Medicine pt 26 because that's what I'm calling it now.

Kind of stuck between the exhaustion and the pending hospice/goals of care transition/deaths today, I saw something pretty amazing that reminds me of why I loved psychiatry from a long time ago.

We walked in on this patient who is in DKA and grouchy and very hungry and thirsty. Hes angry. Hes angry that he doesn't get to eat food. The intern was not getting through to him at all. And he was starting to swear at all of us and refusing all treatment.

And then my senior did something pretty remarkable. She stopped. She shushed the intern in a nice way, and she stopped. She let the grouchy yelling patient finish. And then she let him fall silent. And then she started replying to him in a quiet and firm voice, empathizing with bis feelings, and somehow getting him to understand why we are doing what we do.

And it turns out, all he was irritated about was not knowing thr plan and feeling not being cared for.

By the time we finished, the man sheepishly apologized for yelling and saying that he's also bipolar and working on his mood swings too, and he's very grouchy today. And what started as an aggressive encounter turned into a softly pleasant one.

Not to toot my own horn, but this encounter reminded me of my first patient at the VA, with a highly intelligent and opionanted man who is probably considered a "difficult" patient, mostly because he likes to set his own schedules within reason amd wants to know everything about what and why he's getting the treatment that he does.

And as a black man, its completely understandable why he is the way he is, given the way that medical research has failed BlPOC again and again. The man was irritated ans done the first time I saw him. Almost right from the get go, he reminded me of the hospitalized patient I saw on psych consult way back in September when I started third year. And I remember all the ways I learned to listen to patients from that rotation. I put my notes and ny pen away, and took a seat on the windowsill next to his bed. And just let him talk, asking him questions about what is the most important thing to him, what matters to him, and how to make everything better. And when there was silence, I remembered what my own therapist once told me in jest (hey, feel free to keep silent. I'm a therapist. I am very good at dealing with silences).

And I came often too. The man was a little lonely. My personal patient list was pretty empty, and he had few visitors. I end up spending an hour or more chatting with him every day, mostly him talking. We talked a lot too, probably beyond what is generally considered appropriate professional conversation, like religion, politics, gender/sexual identity, his own background and my allusion to my own traumas growing up. I think he grew to trust and like me, and I think he was more trusting of us to at least giving him good options he can trust. At least, that's what he told my attending.

Both my patients and thr patient today reminded me some of the things that have fallen into the back if my mind these days and what made me love third year. Medicine is as much about the science of providing treatments with the best evidence for treatment as about the art of building relationships with people, some of whom distrust you and/orndislike you. Its easy to brush them off as difficult people, but more often than not, these people are understandably frustrated for very legitimate reasons. The hospital is a stressful place, and they sometimes need someone to vent to before they feel comfortable with accepting new information from thr endless stream of people parading in and out. And one of the most magical things that I've been told during first year and I now see applied in real time was thr magic of silence. Taking a breath, sitting down, and let your patient have a moment to finish their thoughts, rest, and process. Thag silence isn't awkward. It is restorative, taking people out of the din and chaos and into a moment of peace.

PS. Several years ago, I got into a fight with a classmate I started medical school with. She was talking about patients/colleagues in a way that is almost like she has quite a bit of internalized misogyny. She complained about fitness moms getting a boob job. She complained about bitchy nurses giving her an attitude. She complained about mean co-med students. I called her out on the way she describes her female colleagues. She blew up on me for calling her not super compassionate and promptly blocked me on facebook. I was pretty frustrated with her at the time, but also worried I may have gone too far. Besides, maybe she did happen to meet particularly annoying coworkers and patients. After all, I had not done my clerkship at the time so how would I know? How can I judge?

But now that im almost done with clerkships, I feel that mg criticism of her was more justified. I met some people who are tired and frustrated, but never in a malignant way that she described to me. Amd I have met some interesting situations. I have been yelled at. I have been cursed at. I have been threatened (although the pt is very unlikely to carry out the threat, plus she was manic). I met people who have murdered or committed other serious crimes. I dont know what it says about my distress tolerance, but none of that seem all that bad to me. In the end, these people are in a bad place, and in need of help. And despite all the "scary" encounters, in the end people re just people, flawed and human, much like myself. And I think that it is my job to lend a hand, not only with providing treatments but also doing the simple job of slowing down and offering am ear

#aj does med school #m3 diary #internal medicine #more like infernal medicine #trigger #death #threats #misogyny #internalizd misogyny

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