Summer Fellowship in Psychiatric ED
Who knew what I thought would be an easy quick summer internship could affect me in so many ways? A short four weeks. A lifetime of change. This experience is one I can never forget, for my medical career and as I grow as a human being. Working with Dr. Lidia Klepacz, I have been exposed to every Race, ethnicity, religious affiliation, age, economic background of life, in presumably their most vulnerable state of life there is- psychiatry emergency. Failed suicide attempts. Crying out for help. Hopeless and this is the only place they could go. Medication overdoses. Homicide attempts. That is, I believe, one of the biggest learning lessons I can take with me forever. No matter the background, every type of person that walked through the ED had their breakdown, and they needed help.
During my first days as a Sidney Frank Fellow, doctor threw us in like a dog not knowing how to swim. But we found our instinctive stride, and with the correct guidance, we were helping people. I remember our very first patient was a lesson learned about counter-transference. The patient was a young teenage black girl. Bullied for her weight and didn't have a close relationship with her family. Saw her getting arrested outside the hospital for running away from her group home. Not the first time one of the nurses informed me. She looked like a family member. Or maybe she reminded me of myself. I instantly felt like it was my duty to protect her, and help out as much as possible. I told everyone to go on lunch break as I stayed with her, trying to get her to say something to me. After hours of episodes throwing tantrums, spinning in the hospital curtains, trying to punch in the walls, I finally got to her. She started crying, and let me know what was going on. I couldn’t believe I got through to her. I felt accomplished, and even got her to laugh a little. I remember what it's like, to feel stuck. We shared some stories, I felt like she could trust me, and I felt like I might have found my "calling".
Counter-transference is one of those defense mechanisms you learn in behavioral sciences, or if you ever took psychology in undergrad. Something you read but never understood the magnitude of it. Dr. Klepacz saw it so clearly, it was embarrassing to admit, and called me out. "In this profession you will be surprised that you learn more about yourself from your patients than they do from you. Watch yourself and your vulnerabilities."My first patient and I am already using defense mechanisms I didn’t think was applicable to me. That lesson seemed to be the theme for the rest of the weeks. Vulnerability.
Logistically, we learned the ins and outs of what it takes to work in the psychiatry emergency department. Some days, it was packed and seemed like anything that could go wrong did go wrong: multiple patients in active psychosis screaming off the top of their heads, "code gray" called, patients eloping and getting hit by cars on the freeway (true story). Other days it was quiet, and we had the privilege of asking any question we wanted about psychiatry to Dr. Klepacz, the residents, 3rd years, and staff working during the shift. I learned about different roles, documentation, politics of the hospital, medications, PCMS training, how to work with different departments like social work, pediatrics, and the medical team. Most importantly I learned the main role of what the psychiatry department has: Do we admit or do we discharge?
I thought this would be a simple answer. There must be some checklist and if you get above or below a certain amount of points the decision is made…right? Wrong! That decision carries so much weight--it is the not so thin line between life and death. The decision to admit is weighted in removing the civil rights of a person (if involuntary) and removing a patient from their family, friends, employment, and any future plans due to them being an imminent danger to either themselves or others, and putting them under lock and key for the intention of healing them from this acute danger. The decision to discharge is just as heavy. I have learned that this decision has to be rooted in the confidence that this patient that came in asking for help is stable enough to not cause imminent danger, and could be treated as an outpatient. Watching the doctors and residents make this decision made me realize how much went into the process, retrieving collateral information, looking at support systems, previous psychiatric and medical history, employment, substance abuse, to make sure the picture was complete before making the decision. It is definitely more of an art than a science. It takes the whole picture to make sense of the 20-minute initial consultation.
I have countless stories and lessons learned. This fellowship not only gave me the confidence to work with patients (something we do not get as a first-year medical student) to lifelong lessons I can apply not only as a future clinician but just a genuine human being. I am so grateful for this opportunity and can only speak highly about this program. I wish everyone as a first year could have an experience like we had in our Sidney Frank Fellowship. I can’t wait to apply the lessons I learned in these short few weeks to my duty as a future physician to serve and advocate for all patients.