A frightening and sad realization

Ms. M came in to the Psychiatric ER on Wednesday evening after being found to be aggressive and hostile at her boarding house. When police arrived, they found Ms. M barely being held down by her mother. She was APOWWed from the boarding house to the Psychiatric ER. According to the history given from the boarding house, she had suffered from a serious case of meningitis two years ago which led to encephalitis, which led to her Psychosis NOS and Dementia NOS. Therefore, two years ago, she was a normal functioning member of society. I met her on Thursday morning when I came in at 8 am. According to the staff she had defecated on the floor in the room she was in and had not given urine as of yet. I tried to talk to her, but she would only stare at me and then laugh and walk away. At one point, she became aggressive and was put in seclusion. At this time, her urinalysis came back which showed a UTI and she started antibiotic treatment.

Friday morning I arrived at 8 am to find that Ms. M was still in the Psych ER, and that every hospital possible had been called and than no none was willing to take her in. When I went to talk to her on Friday, she commented on how she needed something to do, and soon thereafter began pounding on the door and screaming to get out. Again, she went into seclusion. This was the first time I had watched Ms. M being put in seclusion and kept there for a time. She screamed desperately for us to let her out. She knocked on the door repeatedly to try to get our attention. We could hear her clearly inside the Psych ER office. I couldn’t help but feel like we were robbing her of the dignity she had left. At one point, I went by the room, only to find her staring at me with deeply sad eyes. What did she think of me? Did she hate us for doing this to her? That afternoon, when Ms. M came out of seclusion, I approached her to check up on her. She smiled at me, and told me she was about to eat. As she ate her sandwich, she told me about what she liked to do, what her favorite food was, about missing her mom and then asked me what I liked to do for fun. Needless to say, I was stunned by the difference! Later that evening, Ms. M was admitted to 8N and I did not see her again.

Through Ms. M and other patients, I’ve come to realize a sad truth. Before this rotation started, I believed psychiatric patients lived a secluded life, away from society, or at Salvation Army. Yes, some of them do live this way. But at some point they didn’t. They had families, they had goals and aspirations, and then an illness affected their lives that for many of them changed their lives forever.

I think it was denial on my part that I chose to believe this, since I didn’t know how to approach patients with a psychiatric illness. In my mind I decided I might as well act as if they don’t really exist. What a frightening and sad realization! These patients are just like any other patient with an illness; they are in need of a compassionate, caring physician who can provide excellent and quality medical care. The difference is that our society ignores and looks down on psychiatry patients, as opposed to holding a 5K or a benefit dinner or sending get-well cards as is common with other patients.

The person sitting next to me in the pew at church who murmurs and stares at the wall, the lady jumping next to me in my kickbox class, the old man sitting next to a child in the public library, the young man sitting next to me on the DART, the young mother of two sitting in the OB/GYN office asking herself if she should mention that she has been depressed, these have all been part of the stories of each of my patients while on Psychiatry. Sad thing is, it is not just I that have forgotten and ignored them – it is our society as a whole.

For example, Texas used to have drop-in places where they could go for daily activities such as games, art therapy, etc. The programs have been taken out of the Mental Health Texas budget. What can I do? How can I help? I am most frustrated by my inability to answer those two questions. I cling to the hope that maybe with one patient, with one conversation, or with one phone call to a family member I can make a difference today.