Pscyh Clinical: Week Five

My fifth week of Psych clinical ended yesterday and, for the second time, my preceptor asked me, "Are you sure you don't want to go into Psych?" Followed with, "You'd be perfect for it." I kindly told her I was sure and we laughed, but later my groupmates said that I made this terrible face when she said it and that's what all the laughter was about. I really gotta work on my facial expressions! It's not that I can't see myself as a Psych APRN, it's just that I can't see myself as NOT being a midwife. This conversation happened after my conversation with a patient (another black woman on the unit who, like my last patient, is also addicted to cocaine) lasted an hour long - significant because she had refused to talk to staff and other students on the unit. This woman had had an "outburst" earlier in the week; she had called the social worker on staff a "racist bitch" and was screaming at her uncontrollably. Of course the staff just considered her to be very angry about something else, and requested that she apologize to the social worker after speaking to her about her feelings. Which is all fine and good (and necessary) but I also wanted to validate her feelings about the social worker, because angry or not, drug addicted or not, right now this patient is techinically clean (albeit only a month's worth, but still clean) and so she knows what she's saying and my guess was that she had a reason for saying it, so I asked her about it. Sure enough, the patient had an altercation with the social worker earlier in the month in which the social worker decided to interview another patient (a white patient) who had just got admitted that morning instead of her, despite the fact that she had been there 3 days already. I asked her why would the social worker do that...what would she get out of it? She said that she and the other black patients on the unit have all had negative experiences with the SW and the patient herself had had some negative experiences with the SW on her last stay on the unit some months ago, and that she felt like she just didn't like or wasn't comfortable interacting with them, and that maybe she was intimidated. So we talked for a while about all of that, and how to get what you came to get despite her or anyone else and then we moved on to other things. But later I followed up with other patients about their experiences on the unit, specifically as they pertained to racism (or not) and the same sentiments were expressed without my mentioning the SW or anyone else specifically. So it made for an interesting day, and when I questioned my preceptor about the SW, she said she thinks it has less to with race and more to do with the fact that the SW isn't very good at what she does, and some patients (I add: "especially the black patients who proabably have more experience because of socioeconomic differences on the unit") know more about the system than she does, which really irritates the patients. That sounds like it could be true. Anyway, I also spent a long time talking to this patient about books (she was thumbing through O mag while we were talking) and she happens to be very well read and *almost* (LOL) put me to shame! (now isn't that snobbish...elitist...ohhhh, someone like *her* could not possobly be more well read than *I*...mhmh) What a great Friday at clinical.

*The photo above is of Africans Americans at Spring Grove Hospital Center. When (if) you go the page to read about this place, look in the right hand column of topics and you'll find "African American Patients at Spring Grove." It's probably the first Psych hospital to accept free or enslaved African Americans.