2.19.2008

Patient Storage



On our last day at the milieu we brought the traditional muffins and donuts for the staff. We do this at the end of med/surg rotations too, and we're simultaneously praised and jokingly admonished for bringing sweets around while people are trying to diet. I sat in the day room and filled out the survey that the hospital gives all its students. For things I liked, I said the staff was super-friendly and knowledgeable. My gripes centered mostly around how "coddled" we were, I didn't get to see any groups, and how short our time was there each day (we were basically on the unit at the times the least amount of people were likely to be there). I suggested in the future the rotation be more individualized according to comfort level and experience. Unreasonable request, maybe, but I had a good time either way.

During my last day there, I thought about something the instructor told us on the first day we were there. One of her patients from her days in maximum-security forensics came up and chatted with us on the first day. He mentioned a few times how he was due to get out of there soon. She told us later that he doesn't have any way of knowing really when he'll get out for sure, but saying that was his way of "letting us know he was ok". I thought about that today as a big (tall) fella around my age wearing orange sweatpants and a sweatshirt walked by with a handheld game, so I chatted with him about that for a while, and he told me about where he was from and how he's "gonna be getting out of here" soon, how he's not "mentally ill" (his chart did mention limited insight).

Later on in the day, that fella (whose Dx includes intermittent explosive disorder and conduct disorder) got into a shouting match with one of the other patients over that DS handheld. The other patient insists other people's belongings are his, it's a feature of his psychosis. When he claimed the guy in the sweats handheld game as his own, he blew up at him. This was the only real behavioral incident I've witnessed the whole time I was there. After that, the guy with the DS didn't talk to me for the rest of the short time I was there. I felt like telling him that he just has to realize that other guy's behavior is just part of his psychosis, and when he gets under his skin to just tell the staff, but it wasn't really my place to do so. Although I felt like I had established a rapport with him, I remained an observer.

The doctor who quizzed me on microbiology was back this time, and he challenged me and my unit-buddy to give him our thoughts on three pages of lab results for one of the patients. Besides being slightly leukopenic, his antibody titers for Hepatitis A, B, and C were positive, with B indicating immunity. He wanted to know what we could deduce from the chart. After a few guesses, and with time running short, he pointed out to us that the risk factors are important to identify, because the antibody titers can positive in the absence of the viruses. The chances of them being positive to a former IV drug user are 95%, whereas the percentage for someone who's just voluntarily donated blood is 25%. In the history, I found no mention of IV drug use, he pointed out the history of cocaine use, and how the virus can be passed on whatever instrument is used to insufflate the cocaine nasally (a dollar, commonly). The point he was trying to make, he said, is that knowing the patient is a lot more important than just the charting data.

After lunch we toured the TBI (traumatic brain injury), ABI (acquired brain injury), geriatric and general psych units. These units were a stark contrast to the forensic psych unit. Whereas the forensic psych unit was set up more or less like a college dorm room, these other four units were more like a sterile office complex. Rooms tended to be separated by cubical walls with no ceiling, up above was an office-style drop-ceiling streaked by bars of fluorescent lighting. There was no color to anything, it was all a bone-white or soft gray. When we arrived on the geriatric unit, the instructor left to find our guide. While she was away from the lobby, we heard one of the assistants raise her voice to one of the patients. This was the first time I had experienced that the whole time I was there, if you can believe that. What we heard was "do you want to go or not?!". The other students and I shot horrified glances at each other before she burst through the door.

On the TBI unit, our guide showed us the padded room..they call it something else, two names hyphenated. E-C I think. Our guide made a point of showing us the part of the unit that was farthest away from visibility by staff. It was at the end of a long row of rooms, ending in the area of refuge for emergency evacuation. He said that's where all the fighting and sex went on. I said "oh, like the back of the bus, right?". Our guide laughed and nodded. There was a parabolic mirror on the wall, but it wasn't positioned to let someone see into that secluded corner, it's hidden by the cubical walls. Strange.

The areas we toured that day seemed like places to store patients. Patient storage. We saw only a limited glimpse of life on that unit, and most of the patients were attending group activities so we only saw the few patients not attending groups, and most of them seemed sick or tired. We got to peak in to one of their groups, "reminiscence therapy", where a therapist showed line drawing pictures of current and former presidents to spur memories and conversation. I studied about this the night before, in preparation for our psych exam the next day.

I'm coming back in March for a make-up day, but I still feel slightly guilty about not going around and saying goodbye to a lot of the patients back on the forensic unit in person. I'll have to make up for that when I come back.

We found out this day that the abominable juvenile detention facility in the backyard was not only no longer being demolished, it's now being EXPANDED. Apparently there was a need for some smaller juvies in the state, and everyone said "not in my backyard!" so the capacity from those three are just being added on as an expansion to the one they were about to close because of inhumane conditions. See what you did, The State? You made one of my classmates pout:

No comments: