After all the studying, the tests, the sacrifice, the doubt, the resent for medicine, and six weeks of being an M.D. only in title, it was time to be a doctor. I would start with four weeks in the Psychiatric Emergency Department,
When patients in a mental health crisis come to Mount Sinai, they are triaged like any other patient coming to the emergency room. A nurse gets their story, takes their vitals, and decides whether they need to go to the medicine side of the ER to get medically cleared or if they can go straight to Psychiatry. The Psych ED
I walked in through the Staff Only door, introduced myself, and took a seat at one of the computers.
There weren't any patients listed on the whiteboard
No patients. Nada. Four hours as a working doctor and I hadn't seen a single soul. I went to grab lunch, but I couldn't really enjoy it. Without seeing a patient, I was still in doctor limbo.
Someone was waiting for me.
An older woman, her red-dyed hair in disarray, confused and scared. She rocked back and forth and rubbed her legs as if they were stained with her anxiety. You're my first patient, I thought as I saw he sitting there. She would probably forget me by the end of the day but, in some fashion, I'd remember her forever.
Somewhere along the interview I stopped worrying about how I would be evaluated. I was a doctor, and this lady needed my help.
Perhaps more than any other field of medicine, psychiatry relies on more than just the patient before you. Outside information is important.
Another patient stands out in my memory. A young man--still just a kid--coming in with first break psychosis. Though he had been secretly battling with the beginnings of his illness for some time, his family saw him go from a motivated, productive individual to someone scared to death about what was happening to him.
Pretty much everyone who I admitted either didn't want to go up or wasn't sure about it. Everyone I discharged wanted to stay longer. That's the tricky part of the Psych ED. Like a regular ED, our job is to assess risk. Is this patient a harm to his or herself or other people? The patient may not think she is. Or the patient may say yes, but then the
The important thing to remember is that the latter are still sick. They still need help. They still need care. But if someone walks into an Operating Room with indigestion, you don't perform heart surgery on them, even if they really want it.