The Cuckoo's Nest

End of Summer

“Are we ready people?” said Dr Matt Sadlier, our chirpy tutor on the first day of class.

His enthusiasm was met by groans. Summer had ended. Welcome to final med. It’s official.

Ciaran and I were paired up to attach with Dr O’Gara, the addiction team consultant. Yes rugby fans, he is in fact the brother of the legendary full back Colin O’Gara. More about him later.

Psychiatry and the media

Prior to my psych rotation, my perception on what psych really is probably measures up to the general public; crazy people intent on hurting other or themselves. Case and point: Hannibal Lector sprang immediately to mind.

What I found out was that psychiatry deals with a whole load of other “stuff” that are genuinely medically treatable, with both pharmacotherapy and an element of psychotherapy.

My initial first few days in the wards were let down stemming from my over the top imagination on what a psych “facility” should look like. Again I blame the movies.

There wasn’t anyone running around naked. No one set themselves on fire. And they don’t wheel people around in white straps. Overall it has been pretty tame so far. Save for the odd lady who followed me around the hospital because she thought I was a spy. Lol.

Acceptance

The ward rounds in psych are totally different from the medical ones. The patients are interviewed on a one-to-one basis. All cramped in a room consisting of the consultant and his registrars, psychologists, occupational therapist, social worker, nurse, and of course medical students, yeay.

Also different to my previous experiences in medical teams, I actually feel part of the team.

“What just happened in there?” asked Ciaran, looking quite puzzled.

“I’m trying to make sense of it all,” I answered.

“They actually acknowledged us! Oh god, I feel so needed” added Ciaran

Being part of the team really ups your motivation. For a while at least.

My first psych interview

“ I’ve thought about it you know, ending it all,” said PT, who was battling depression

“What do you mean” I asked, taking good care not to put any thoughts into his head.

“I thought about hanging myself. But I never thought I could go through with it” he continued.

The interview went on for almost an hour. We delved into his childhood, relationships, family problems and a whole host of issues that one would never think to share with a stranger. I guess part of the appeal of psych is having that privilege of information, which is why confidentiality is a huge part of it all.

Some of the stuff gets really dark and messed up. For some reason, it affects me more than I’d care to admit.

Suicide in Ireland

Ireland has been a relatively religious country over the last century. Suicide was definitely frowned upon in the old days. In fact ,suicide was a capital offence up to 1993. In other words, if one failed in an attempted suicde, the punishment would be death. I lol-ed so hard. Gotta love the Irish.

“I’m an alcoholic”

MOG was an alcoholic. She didn’t want admit it at first, but the signs were all positive. She even scored 3/4 in the CAGE questionnaire (google it). Throughout our conversation she revealed to me a lot about her torrid past, the abuse she endured as a child and her series of failed relationships with numerous men.

At some level I felt we developed a connection, evidenced by her brutal honesty on what the root of the problem was. Alcohol.

Admitting that you’re an alcoholic is as easy as it is made out to be. It’s a huge first step toward recovery. Most patients take a long time to see that it wasn’t the beatings, or the abuse;or the bullying; or a whole crapload of excuses, until they admit they have a problem with alcohol.

“You know, there must be something about you. I’ve never been so open to anybody before,” admitted MOG.

“You should really consider this as a career,” she added.

I smiled.

Yeah. Right.

Vindication

“Interestingly Dr O’Gara, one of our patients, MOG told me during our one-to-one session that she felt that talking to a certain medical student was more helpful compared to the treatment and counselling she’s been getting during ward rounds with us,” said Roisin the occupational therapist

All eyes focused on me and Ciaran. I looked down not knowing how to react.

“Was it you?” ask Dr O Gara

“Yes I think it was” I answered, still looking down.

“Well ladies and gentleman, I believe someone is starting to show a knack for psychiatry,” he said, winking in my direction.

Old-age psychiatry

I have nothing against the elderly. Let me rephrase that. Excluding family and friends, I feel that I wouldn’t able to tolerate treating old people. If given a choice, I would stay away from any branch of medicine that deals with them.

It’s just simply depressing.

One of the patients, CK, is a 63 year old woman, who just a few weeks ago was swimming in the 40 foot (off the shores of Dun Laghoire), but then developed severe depression due to an unknown cause. Since then, she has regressed to the point of developing hallucinations that she “smells rotten”.

She also has delusions that everyone else is talking behind her back on how smelly she is. I can’t help but feel sorry for the old lady each and every time we meet on the ward. The thing is, for these patients, their experience is undeniably real to them. This means, she wakes up every morning to the stench of rotting flesh; she walks around corridors hearing voices of people talking bad about her. Now how would that make you feel?

Her constant tearful episodes and genuinely sorry state has affected the whole team as well, probably me more than anyone else. Old age psych, another tear jerker.

A conclusion, somewhat

Im in my 5^th week and already feel like a veteran on the wards. With the OSCEs ever so close, it’s a wonder why I haven’t gotten the palpitations I’m so used to by now. The lack of anxiety is proving to be a factor in my general laziness and reduced drive to actually pick a book up to study. Distractions are aplenty and in fact welcomed in order to mask the reality I dread to face each day.

Am I losing the plot? Or is it just the (hopefully temporary) depressive state induced by my time in the psychiatric wards?

I don’t know.