Monday, February 12, 2007

Psych Mid-clinical Evaluation

I have a Pathophysiology exam in a week, then my Pharmacology final, Biomed final, and Psych final all in the span of two days...a hellish Monday and Tuesday.

I've started reading 72 Hour Hold because it's over 300 pages and my paper is due in three weeks, but I want to turn it in in two weeks because there's a lot going on the week it's due...

Thursday I have to present a case report on my chosen psych patient...and do a skills check off to prove I haven't forgotten the skills I learned last semester - eventhough I have.

I never talk about my psych rotation...here's the patient I'm presenting this week...which should give you some clue to what I'm going through:

In a few weeks, the day before my birthday, she will turn 36. She has five children ranging in age from 5 months to 19 years. She has a history of marijuana, alcohol and cocaine cocaine abuse, starting at age 13. She does not have custody of any of her children, they all live with her grandmother. She has been hospitalized twice for post traumatic stress disorder, depression, and substance abuse. Her mother was addicted to cocaine when the patient was born...when she gave birth to the patient, she went outside the hospital on a smoke break and never returned, and later died of AIDS. The patient supports herself via prostitution. The patient has been raped and her perp is serving time in prison. She is on our unit for a "treatment seeking" substance abuse study - a cocaine stress test. Because she is treatment seeking, they are not allowed to inject pharmaceutical grade cocaine into her veins, which makes my heart happy because there are others who are NOT "treatment-seeking" and therefore their version of the stress test is to have pharmaceutical cocaine injected intravenously to study the effects of the drug. But her study is a little different: when she came on the unit, she told (and they recorded) her worst experiences with using cocaine...now (for the study) she listens (via headphones) to these stories and they record her body movements, affect, etc.

This is why I chose her to present on:

When the patients are given a mental exam, they are asked to write a sentence. She wrote, "I am sombody productive in society." Her answer to the question "Why did you come here today?" was "I don't know who I am. I just want to know who I am." One moment in time when she was happy? "Journalism class in high school. I want to be a writer." And guess what? She can write. I also chose her because no one else is interested. Because I have been standing up for her and her experiences since I got there, because no one else will.

I had my psych mid-clinical evaluation last week. My preceptor said (after you are so wonderful, brilliant, yada yada yada) "I always give students something to improve on. I don't know what it is, but you've got it. I want to tell you that you can't take this stuff home with you, that you can't feel it the way you do because it's not healthy for you. I don't know if you can turn it off. Your heart is big. You shouldn't take all of this in. I don't know what makes you do it..." I know how it sounds cheezy, but I promise it's true.

I wanted to ask if it was really that hard to understand. All of these black patients. No black practitioners. No practitioners who come from the very environments that they criticize on a daily basis. No understanding of how much work it takes to coordinate section 8, food stamps, and utility assistance. No idea what is to stand outside in below zero windchills waiting on a public bus to come to get to those appointments. No understanding of what is to be a black girl in room full of entitled professional white people talking trash about black people and their lives...as if I'm invisible...or maybe they just don't give a damn that I'm sitting there...or maybe I've reached that "different kind of black person" status.

She's right, I'm taking it in - isn't that what we're supposed to do? Or was this supposed to be a game? A way to say "I've served the poor, the disadvantaged. See, I care." She's right, I take it home with me and digest it to the best of my ability because until I take it home and digest it - make some sense of it, I can't move on. I can't not feel it. I can't turn it off, believe me I've tried for so long.

"I don't know what makes you do it."

My heart is big. My heart is big. My heart is big.

2 comments:

SNM YEAH!!! said...

I remember my first day on our psych unit, I really really enjoyed it. I was definitely in the minority with that feeling. For some reason alot of people was scared, i was moreso curious. It made me really analyze life and in so many ways that I am blessed. I really think if maternity wasnt my calling I would probably have gone into psych. I even thought about doing a small part time stint. But I'll definitely be utilizing these therapeutic techniques in my profession. Seeing that I really want to work in a community/public health setting. Now that I think about it, this is the rotation I always have something to talk to my bf about. Anyhoo, much love.

minority midwife said...

I feel the same way about Psych...if midwifery weren't so clearly for me, I'd probably end up in this specialty. The need is so great; it's the first rotation I've had where the RNs and staff are not at all diverse...and you can tell the difference in care because of it.