Psychiatry
Posted 09:04 PM, April 24, 2007, by thomas.tsaiI never thought psychiatry would interest me until we began our psychiatry lectures and practical sessions as part of the second-year POM course.
We had our last psychiatry session today, and I have to say it has been an eye-opening experience. Each Tuesday afternoon for the last few months I have been trekking down to the Palo Alto VA hospital. The preceptors there have been terrific--they are really engaging.
Today I saw patient who committed suicide by eating a box of rat poison. As you medical types may know, rat poison is essentially coumadin. After downing the poison with a cup of coffee, the patient looked down and read that it would take at least four days to kill the mice, and he being much larger than a mouse, he figured it would take over a week. A few days later, he was shaving and ended up bleeding uncontrollably, at which point he went to the ER of the VA hospital. He ended up becoming unconscious and spent several days in the ICU while the doctors scrambled to figure out the coagulopathy he had. Eventually, he told the doctors of his suicide attempt and was transferred to psych ward.
Speaking to him, it really hit home how much psychiatric and emotion health plays into our overall health. Because of my interest in surgery, I have tended to view disease as physical and biomedical manifestations. But listening to his story (the loss of a loved one and subsequently all his life savings and his home), reminded me of the truly human aspect of medicine--not just pathology, physiology, pharmacology, but the quotidian fortunes and misfortunes of life.
I have to admit before I started this psychiatry block, I approached psychiatric illness with more than a little bit of skepticism. Having no real frame of reference, I wondered why these patients couldn't just tell themselves to get better. But after seeing patients with schizophrenia, delusional disorder, PTSD, and major depression, I realized that they are truly suffering and sick--that psychiatric illnesses are just as debilitating as medical and surgical ones and as worthy of all of our attention. Seeing the effects of the numerous antipsychotics and antidepressants have been eye-opening as well--we really can make these patients better.
Comments
Comment by: No. 1 Fan at April 27, 2007 03:39 PM
Great to know. Sharon is also studying the psychiatry section of the great medical school. It is proven that life and emotions can go haead and cause such sicknesses requiring medication, therapy and medical attention. Sometimes if the right ingredients are there some nature some nurture, some drugs, abuses and the right person you get a difficult case.
Adios
Comment by: Eric at May 3, 2007 04:33 PM
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A well-learned lesson, Thomas. Psychiatry is such a fascinating disease simply because it involves a little thing called the brain (much of which we don't know about yet). You must wonder how much individual cognitive control one has over a 'mental illness'. There are nuances in psychiatric disease-- there may be biological underpinnings to the disease but it may take an environmental trigger and the inability of the person to cope with the situation and may fall prey to those biological risk factors. In evaluating a person who should 'will themselves to be better,' you have to measure to what extent a person can assert will against biological factors. In the example just mentioned, the opportunity to assert 'will' or 'personhood' would be in the 'coping' with the environmental trigger. This is the prime window in which a medical professional such as yourself should intervene and provide the necessary 'coping' factors (social support, outlets for frustration, sense of control, etc.). Unfortunately, there is no system of ensuring a person at risk is going to get that help - usually when they seek it help it's too late. This makes me think about the interesting point of the importance of social support-- in 'coping' a person instead of seeking a specialist would probably just call up a friend, talk to a family, etc. so it highlights the importance of having a strong social network. Afterall, we are social creatures - and having others helps to put problems into perspective. Personal resilience is important too. However, with certain psychiatric diseases, they are purely biomedical -- and how ca n you attribute personal responsibility for biological pre-determination? Unfortunately, we're limited in our control for schizophrenia as much as we are limited in our control for diabetes II.