Rewards and Frustrations

I've been thinking about my reflection on the psychiatry elective I finished over 2 months ago for a while now. In my last post I was just about to start it ...For 3 weeks I worked in the adolescent female inpatient unit and it was definitely an unexpected experience. I went there with the thought that it will be a nice break from the rigorous clerkship rotations I have been through and a nice transition from studying at home to my current trauma surgery rotation in Florida.
I was wrong and realized something about myself in the process.

I enjoyed my 6 week rotation last year which is why I decided to come back and work in another unit. Adolescent girls I thought would be a great fit - I can relate and it will help in my long term goal to work and advocate for women's health. I fit into the treatment team right away. The social workers, unit staff and my supervising attending all cared for their work and put in long hours. There was no real structure for me to follow which is great because it let me explore working with different people on the unit - from social workers holding family meetings to art and musical therapists. It was really up to me how much I wanted to invest. As I've said before, I learn best by experiencing, so I got involved as much as possible. I started getting to know the girls, their histories, their personalities, how they interact, their families … it was interesting in terms of psychiatry and applying the things we learn in books to real life situations… but also heart breaking to read about their life experiences at just 12 years old. By my second week, the attending doctor encouraged me to take time and talk to some of the girls one-on-one. I did.

I was taught how important 'active listening' is as a skill. We were told about it in my 4th semester on Saba but not until now do I really understand what our prof was trying to tell us. Daily one-on-one sessions with some of the girls were amazing. They began sharing and opening up about their past; stories that weren't even in their social work reports. I was so happy to be able to have an honest discussion … to hear them out, never judging, that's really what they were looking for...but emotionally it was hard. Very hard. The movies about street kids from broken families surrounded by drugs, abuse and prostitution; girls being bullied because of their appearance to the point of harming themselves - unfortunately they are true. These girls have experienced life's hardships at such a young age that they grew up. Fast. What did surprise me was their strength, and resilience - two things that were not obvious when I participated in the group sessions. Most of the girls seemed so different talking to me than in the group. I learnt about their dreams and aspirations and then, in a split second, heard them shutting down those ideas because "it's not possible". That was difficult to swallow. As a person, I am an optimist (if you haven't figured that out yet!); so I asked "why?, why can't you?". their answer was even harder to understand, but it was the truth… "I have no support." " No one cares."  "I have to take care of my siblings."  "I have to provide for my family." Now, I am generalizing as not all the girls were in the same situations… but these were some of the answers I did hear.

I realized how important a nurturing, supportive environment is as a child. Having a family that cares enough to ask about getting homework done, to insert those (sometimes annoying) reminders to clean.. we've experienced them, and they come from our loved ones. But that is support; support that most of these girls were missing.

This elective made my final decision to not apply to psychiatry. NOT because I didn't like it. It's actually the complete opposite. I had the hardest time separating my emotions from acting as their doctor. We are taught about professionalism in the oath we take. As doctors, we are not a patient's friend and I completely understand that. In all my other rotations it is a clear line. In psychiatry, it became very blurred for me. I emotionally invested in my one-on-one sessions. Came up with ideas and ways to talk about difficult topics… and they worked. Great! But I went home and took their stories to heart. I could not separate the medicine from myself. At the end of my rotation, the attending pulled me aside and said I would become a great psychiatrist one day.
I'm sure, in time, I'd learn how to draw that line but I don't want to go through 2, 3 or 4 years bearing all that emotional turmoil with me when I get home. This may sound selfish but I think its the best thing for my own health and my ability to treat my patients.
As medical students we've either said it or heard it: psychiatry is not 'real' medicine. There are never clear cut answers; everything meshes together to provide an emotional response. And, as students, we all have that one thing which we cannot deal with in medicine - whether it be skin rashes, broken bones, surgery or delivering babies. For me, mental health is where it becomes the hardest. I can stand in the OR for 6 hours. I can deal with stabilizing a trauma patient after they got shot. I can stay up for 30+ hours without coffee. I can look at an open abdomen and see the medical complexity and not the patient. Yet, talking to someone through their emotional turmoil, hearing about their past, yes, I can do it. Yes, I can be good at it. Yes, it's very natural for me to just listen. But it's been one of the hardest things for me to go through.

Hats off to anyone who works in the mental health system, I now partially understand the hardships you experience.

Part of a letter I received from one of the girls on my last day of the elective. It's in a safe place to always remind me of my experience and how much they taught me.  

PS. the video is a spoken word poem by Sarah Kay. I found it a great way to reach out and discuss those difficult topics. Needless to say I learnt a lot more amazing poetry slams from the girls… they were very familiar with it!