test 3 (neuro) and psych inteviews

It's been a blur since last exam. We're well into the second half of neuro, and I can't say it's my favorite subject ever. The teaching just isn't up to par - the quality isn't as uniformly good as host defense was, and that's a bit sad.

I can't decide if I want to take the psychologists seriously or not. I think it's more we go over things so superficially that the various diseases sound almost ridiculous, but perhaps that's a result of lack of depth.

* * *

What has been absolutely fascinating is that our first official patient interviews have been on the psychiatry ward. It is literally a locked ward where you have to show ID to enter or leave. It's painted happy colors and has more decorations than anywhere else in the hospital.

We've interviewed schizophrenic, bipolar, and paranoid patients - yet what I found was scariest was not even that they experienced reality in a way most would describe as "crazy." It was that first, I couldn't even describe what was strange about them, and perhaps at first I could not tell why they were in the psych ward. Second, almost universally, they all wanted to leave. I found myself just feeling that yearning, imagining myself locked up somewhere and not being able to leave. It wasn't hard for me to talk to them, although the other students commented that they couldn't even figure out how to converse about something that wasn't real. What was hardest is that I found myself identifying more with them than with us, these six students shifting uncomfortably in white coats.

You could be me, I found myself thinking over and over.

* * *

This week's interview was particularly interesting. We spoke with a man who had checked himself into the hospital because he had run out of medication and was hearing voices.

"What do they tell you?" we asked him.

"To hurt myself and hurt others," he replied.

Who did he want to hurt? Was it a particular person or type of person? Has he ever tried to hurt himself or others? What did they sound like? Does anything make them go away? What did he do about them?

"I just ignore them," he told us. He'd had two suicide attempts because the voices kept telling him to hang himself (once) and throw himself out of a moving car (the second time).

"They also pick out people on the street and say, 'That's the one.'" They were male voices, deep, and at first they would come only every 4-6 hours, but the longer he went without medication, the more frequently they would come, until they spoke constantly, always advocating violence.

We all looked at each other, shuddering. What would it be like to constantly be told to kill yourself or hurt other people? I would probably have listened to them too.

And then the light bulb came on for all of us, and some of my classmates looked rather alarmed. Our preceptor, the actual psychiatrist, asked, "Can you hear any voices right now? What are they telling you right now?"

He reassured us there weren't any voices because he had taken his medication, and we quickly wrapped up the interview and let him go.

Afterward, we asked our preceptor, "Have you ever felt in danger?"

She smiled cheerily and replied, "Several times. One time I asked one man in the ER, 'What are your voices telling you?' He said, 'To hit you.' I took a step back, and just then, he swung."

She looked around the table at all of us. "What I did at the end there was called risk assessment. I wanted to make sure he wasn't being told to hurt us."

On that cheerful note, we all left the psychiatric ward.

* * *

As one of the medical students commented, "I guess he's doing pretty good to only have attempted suicide twice."