Psychiatry Review 

Well it’s time to wrap up this run and move on! It’s been a quick 6 weeks. But I think I’ve done more reflecting and pondering on this run than any other. Mostly because I had a heck of a lot of free time when my consultants were doing paperwork work for 4 hours of the day.

But anyways!

There’s a lot of philosophy that I’ve learnt on this rotation. My view of people with mental illness has changed. Especially in forensic psychiatry.

The great thing about people with mental illnesses is that they become a complete version of themselves. By that I mean, they can’t be anything else except them. They can’t put on a fake mask or pretend to be someone else. They’re authentically who they are. And I find that so much easier to work with than normal people. xD

Especially in forensic psychiatry where it’s so easy to assume that a criminal is a criminal because they were born a criminal. But only when you see people who have mental illnesses and are treated appropriately, do you realise just how vulnerable many of these “criminals” are. When treated, the patients I have seen are the sweetest, most thoughtful people. There’s nothing really wrong with them. But outside, they’re considered evil, disgraces and are shunned from society without receiving the help they needed early on in life. And a few of them, particularly those considered “antisocial” were those who attacked others and showed no remorse. But when you find out about the people they had assaulted, many of them frankly, had it coming. They were horrible people who said and did horrible things. Many times in my life, I have had the overwhelming urge to punch someone in the face. Multiple times. But I have the inhibitions and the ability to stop my hand from shooting out and catching Mr. Stuck-up in the face, more than once. Even though he would have deserved it. Or how often have you read in the news about a horrible dictator or politician who treated others in a horrific way and thought to yourself “someone ought to teach him a lesson”? Sadly, both you, and those people are “normal” and free to be around in society, where the individuals who actually act on these feelings are locked up and labelled “criminals”, “psychopaths”, “sociopaths”, etc.

Not all of them fit this category of course, but for a while, I was under the impression that none of them fit that category. I thought all of them were fundamentally flawed. They’re normal people just like us if they received the help they needed. I reflected a lot about the circumstances of a person’s environment that predisposed them to ending up with a mental illness. If I had a dollar for every traumatic childhood case I had heard in the Mason clinic, I’d be pretty happy with the amount. It’s quite sad. It’s not really your fault someone bullied you to the point where you began hearing them in your head continuously telling you what a loser you are. And that makes you lash out. At yourself and others. And that means you’re locked up while the bully is probably still out there somewhere.

Whew. So that was pretty philosophical. In terms of this field of medicine, I’m not cut out for it. I can definitely see that. I think I’d like something a bit more fast-paced and with less paperwork. I also think that psychiatrists have a “trait” that I don’t really possess. It’s this detached trait. One of my consultants is actually quite shady. He told me off for laughing at a joke He made in a patient interview. He told me that I must be more self-aware and careful about laughing during patient interviews as it might upset the patient…………… I nodded politely. He also told me that he cannot give me an excellence grade for ‘professionalism and boundaries’ because I expressed some sadness that my patient Mr. PH left back to prison abruptly. I believe my exact words to my other consultant was “aww I didn’t know he had left”. She told my shady consultant I had said this, and so it was decided that I have boundary issues. He then proceeded to lecture me on “Empathy vs Sympathy” and the importance of “do not feel what the patient is feeling“. Eye-opening lecture, that. It was then that I learnt that the real “professionalism” is making sure you don’t say anything at all to your consultant that is not work related. The best part was when he later told me that my performance is great because I have such a great manner towards patients and I make them feel comfortable. By this point I adopted an emotionless face. Determined not to respond to anything he would say anymore. Yeah I definitely do not have the psychiatrist trait. That sounds like I’m being a bit bitter. But truly, I respect all the psychiatrists. Their job is in no way easy at all. They’re all super qualified and brilliant doctors. I just don’t think I can be one of them.

Anyways! It’s time now, finally, to move on to my last rotation! Hopefully it will be a good way to end the year!

The Blogger’s MSE

Mental State Examination:

Appearance/ Behaviour: The blogger is a man/woman aged between 20s and 30s of medium height and normal build. They are dressed in casual clothing and are frequently dishevelled. The blogger establishes good rapport and maintains intense eye contact with their computer or mobile device. They tend to smile stupidly or frown intensely at the screen when blogging 

Speech: Speech is minimal to non-existent when blogging although occasionally seen muttering phrases to themselves with normal rate but low volume. 

Mood: The mood of the blogger is often subjectively variable before blogging and is objectively euphoric following blogging. 

Affect: The affect is expansive and labile ranging from irritable to blunted to euphoric, and changes frequently depending on the subject of the blog

Thought Form: The Blogger’s thought form is not linear or goal directed. There is often signs of thought disorder including tangentiality and circumstantial writing. There is also frequent flight of ideas evident in the blog posted.

Thought Content: Thoughts consist of grandiose delusions regarding popularity of blog. They also believe they will become a famous author. The blogger is preoccupied with obsessive thoughts regarding their next post and have a compulsive need to log on to WordPress frequently. 

Perception: Blogger has occasional auditory hallucinations of sentences in their next post. Blogger does not report visual hallucinations and is not observed to be responding to non-apparent stimuli.

Cognition: Blogger is alert and oriented to time, place and person. Good recall of previous posts.

Insight & Judgement: Both insight and judgement is impaired as the blogger believes their delusions are reality based and do not believe they need help with their obsession with blogging. 

Risk: The Blogger’s risk of harm to self is deemed moderate and is mostly in the form of procrastination by blogging and hindering their progress and completion of school work. Their risk of harm to others is deemed moderate by causing them to procrastinate also when reading the blogger’s post, and also possibly causing harm by boring them. 

“Look What You Made Me Do” Thoughts

Ladies and gentlemen! Guess who’s back!! Oops. Shouldn’t say she’s back. Because the Old Taylor is dead. 

Yes that’s right, Taylor Swift has just released a new single before her much anticipated album Reputation releasing in November. I heard this song on the radio the day it released, and I have a few thoughts. But of course, many out there are more vocal than me on Twitter and music review websites that I perused before making this post.

Mostly because when I heard this song, I was super confused. Now, I’m not a huge Tay-Tay fan. I never really have been. When her music came out back in 2006, I wasn’t overly impressed with songs like Love story and Fifteen, etc. I didn’t really see the fancy everyone else did at the time. But before you stamp me as a Taylor hater, I have to say that some of her songs are so realistic and resonate with me in a big way. Like some are so perfectly written in a way that echo my thoughts and feelings about a certain subject completely. And her music is so easy on the ears unlike a lot of other artists out there. That’s what I thought Taylor was all about.

Which is why I was confused by this song. The image I have of Taylor Swift is one with her guitar. And by that I mean, her music is something I appreciate about her. This song, lacks a tune. It lacks music. It’s more of a rhythm strip with words put to it. That was my first thought. I was waiting for a build-up to a massive chorus where there would be a melody matched to her voice. I was sadly disappointed. What I got instead was “Look What You Made Me Do” repeated to a two-beat (albeit, catchy) rhythm. People on the internet are calling it a “half-rap”.

The other thing, is the repetition thing. The words. Like I mentioned before, what I adore about Taylor Swift are the words in her songs. Regardless of what she’s writing about, be it her exes, her currents, Mr. And Mrs. West, etc. She always has a lot to say in her songs in that not-so-subtle way that’s priceless. So naturally, I was looking forward to hearing who did what to her in this song and her thoughts on it. But unfortunately, she has all of 4 lines with just a lot of repetition. There was no story, no chapters, no poetry, nothing really. Just the line “Look What You Made Me Do”  and “I don’t trust nobody and nobody trusts me” over and over and over. Not ideal Taylor. But there is a line in the middle of the song that I think explains a lot. She speaks! Although what she says is quite chilling. “Sorry, the old Taylor can’t come to the phone right now. Why? Oh.. Cuz she’s dead”

I found this line just scary. There’s no other word. Just scary. And kinda sad I suppose. There wasn’t anything wrong with the “old Taylor”. But hey, everyone changes, so why shouldn’t she? Just wish she could’ve changed without being “dead”.

Anyway this song doesn’t have much in the way of lyrics. The tone is quite angry. It’s quite dark and focused on a bitter side of Taylor. The video depicts her standing above her former versions of herself, obviously transformed into a higher being. It definitely echoes revenge and rage. Which is also quite a step away from the girl-next-door Taylor. All of this would have been fine if the tone was positive such that she’s happy to have changed into this new person, but it’s not. It’s more about blaming someone for it and seeking revenge and looking down upon who she was previously.

I wanted to know who she was aiming this song at. My top choices were Katy Perry (the betrayal runs deep), her former DJ (who dragged her to court unnecessarily) and of course, Mr. Egregious himself, Kanye West.

I didn’t think she’d still be singing about Kanye West, after all, it’s been years since the first drama and many songs since. You wouldn’t think she’d still be hung up on that would you? Apparently though, a lot of people on the internet believe it is Mr. Kanye who yet again had become the star of her song. And it is him who is “starring in (her) bad dreams”. The line about “tilted stage” is apparently aimed at him. Also, from the video, there are a few people who think that she is insulting Mrs. West and her burglary ordeal.

Reviews are calling this song, “petty”, “venomous” and frankly, an insult to her singing career. I kind of disagree.

Yeah I have issues with this song, but I do empathise with her. There isn’t a lot of words, but I kind of get it. It talks about the frustration that someone else pushed you to the point of changing a part of you that you may have actually been happy with. And that’s a sucky feeling. Which is what I think her song talks about. People say she should get over it, etc. But hey, this is how she copes and to be honest, it’s a pretty constructive outlet for her to sing songs about the things that bother her. It’s better than turning into a serial killer (as the undertones of this song seem to suggest).

Taylor has been transforming since her album Red into more serious themes in her music, and I suppose this is the peak. Everyone is foreseeing this album as a revenge set of songs about everyone who crossed her in life. Which is fine for her I suppose because the release of this song has broken a few records already apparently. So there’s no shortage of loyalty among Tay-Tay fans.

But I do kind of miss her earlier sound. They were much easier to replicate on my guitar.

Anyway! Verdict: I’ll give this song a 2/5. I do hope the album has some trace of her old stuff though.

Reputation Taylor Swift.jpg

Therapeutic Baking

If you’re a med student, you’re expected to bake something for your team on the last week of every rotation. Some take this as a pressure (they don’t know how to bake), some think this is slavery, some think it’s bribery, some don’t bother and end up buying something from a shop. While some, like me, enjoy this quite a bit.

I find baking therapeutic. It’s almost the perfect way to finish any rotation. Spend a night reflecting on the last 6 weeks while melting butter, mixing sugar and flour, savour the smell of vanilla essence in the air as you create something new and beautiful from nothing. Poetic, no? It’s just therapeutic. The sugar smell in the air literally works like an awesome placebo effect. Plus, the boost to your self-esteem when what you bake turns out well, is priceless.

Of course, there’s the occasional mental breakdown and emotional damage when your cake fails to rise or your cookies crack. It’s heartbreaking really. But with practice, these become fewer… mostly.

Anyway! I am baking one week early because my house officer and one of my consultants are leaving this week, so I thought I would thank them early. And indulge in some therapeutic baking. Sounding familiar?

Hehe. My other favourite thing to do these days when baking, is have a narrative in my head in the voice of none other than the lovely Nigella Lawson.

I’m baking her brownies actually.

Nigella Brownie recipe

I chose to bake brownies because, as stated above, “However much people have eaten, there is always, I’ve noticed, room for a brownie”. And nothing holds more true.

She’s quite great with her flour-less recipes and egg-less cakes. Which works out great for me because I’m out of flour today. My goodness, just read that description. I love how every one of Nigella’s recipes have a description that makes me smile and really excited about going ahead with that recipe. That’s how baking, well, cooking should be. It’s an art! As she would say.

So! Let’s get started!

Brownie choc

Of course all great Nigella recipes calls for gorgeous, Gorgeous, Gorgeous Chocolate! The darker the better. Her recipe calls for atleast 70% cocoa.

Mixing things together yields the perfect brownie mix.

Brownie mix

Here, Nigella would say something like: You’ll know the mix is ready, when you can really feel the silky, velvety, gorgeous richness that chocolate brings. There’s something so satisfying about that beautiful gooey texture in your brownie mixture.

Then, in the pan:

Brownie pan

Isn’t it poifect? Nigella suggested walnuts/almonds, but I’ve learnt in hospital that you never offer someone something with nuts in it without checking if they might be allergic.

And then finally, after it’s done cooking and filling my house with that luscious chocololate-y smell, it comes out all pretty looking:

Brownies

Nigella recommends a hot chocolate sauce, which I would love to make, but since these are for others, I chose icing sugar as decoration instead.

Brownie with icing

They are simply, gorgeous. Gorgeous and indulgent. 

That was a really fun evening. And they taste amazing. Why wouldn’t they? Hopefully there’s enough of them left for my team tomorrow.

Psychiatry may not be right for me, but these brownies definitely are!

 

ECT facts

Abracadabra here, to tell you that electro-convulsive therapy (ECT), or more commonly known as “shock treatment”, is grossly over-dramatised in movies, books, media etc. Emphasis on grossly. 

As part of my psychiatry rotation I get to observe ECT being administered to patients with treatment resistant depression, psychotic depression, etc etc. 

It is NOTHING like they show in the movies. It is not done in a dark dingy room where the patient is forced into the room and strapped down into a chair or table with multiple wires stuck to their head. There is no giant dial that the cruel doctor turns up to increase the amount of voltage entering the patient and watches them scream in pain as they convulse while the nurses and doctors look on with a sadistic satisfaction on their faces. 

Seriously. It’s about as exciting as static electricity. 

What really happens is that the patient is brought into the procedure room and asked by multiple people multiple times if they’re happy to be there and go through with the procedure. Everyone is smiling as they explain the procedure again, the patient gets onto the bed and is given general anaesthesia! Yaay!! They’re also given muscle relaxants which means there’s no horrific flopping about. The machine that delivers the shock is about the size of a shoebox and just as complex. Two dials to set the amount of electricity and one button to turn it on. When the patient is asleep, the button is pressed. 

Oh this is the best part. Because I actually missed the “seizure” the first time. The patient looks like they’re squeezing their eyes tight. And their toes curl slightly. I didn’t even notice this until my consultant pointed it out. And this lasted a grand total if 8 seconds. After this, the machine is turned off and then everyone watches as the patient twitches. Not even great big twitches. Just little finger movement. This lasts for about 20-40seconds. And that’s all folks! Wires come off, patient is woken up and wheeled out of the room, still smiling. 

That was definitely not what I was expecting. xD I, like a lot of people had a hugely distorted idea of what ECT was and what it does to people. The stigma around it alone, has prevented patients with treatment resistant conditions from receiving a treatment that’s actually proven to be extremely effective for such conditions. It’s sad, really. This is a pretty good example of how media distorts real facts and stops many advances in medicine and other fields. 

Because of these ideas, even doctors don’t offer ECT as a first-line treatment for many patients who it would be very effective for. Hopefully more people will realise that ECT is not really as bad as movies make it out to be. I actually got a bit bored. 

Ego

Don’t step on a consultant’s ego. You will live to regret it. Just don’t do it. No matter what happens, you’re the student. Play the part. Keep the status quo.

When will I ever learn. 

Unexpected Loss

Today I spent the morning in another hospital for tutorials on psychiatry. When I returned to the Mason clinic where I am based, I saw one of the patients there leaving, surrounded by police. I waved and said hi to him as I usually do. He smiled back at me. I wondered where he was going and resolved to ask him later. I assumed he was leaving to a court hearing. 

Later while I was updating myself on the patient’s notes, I found that the patient (Mr. PH) had been discharged from the Mason clinic back to prison. 

I was shocked and upset. 

Mr. PH was the first patient I had met in the Mason clinic. He introduced himself to me on the first day when I seemed a bit clueless and told me that I would learn a lot there. He was the first patient I had taken a psychiatric history from. He knew it was my first history taking session and was patient and cooperative throughout the 1h it took me to take the entire history. Mr. PH shared many of his life stories and we found we had a few things in common. 

From then on he had always greeted me and asked how I was. He offered to teach me how to play jazz style on the guitar and wanted to have a jam session together. 

Mr. PH has bipolar disorder and had committed a theft during one of his manic episodes. He was facing 7 years in prison. He told me of how scared he was of returning to prison and his worries that he may not get the bail he was moving towards. I had tried to encourage him to keep positive. 

He was a really sweet person who I became quite fond of. So much so that seeing him around everyday was almost comforting. I had no idea he would be sent back to prison so quickly. Apparently, neither did he. He was the reason I first realised how vulnerable patients at the Mason clinic were. Sure, they were big scary criminals to the outside world, but this was mostly due to their mental illness. When treated, they were all just very simple, regular people who had talents and hopes for the future. 

If I had known I had been walking past Mr. PH as he was leaving, I probably would have said goodbye or wished him all the best. I am sad that I wasn’t able to do this.

Every so often, you’ll lose contact with someone you know abruptly. And when that happens, you’ll feel a pang of loss. And a regret. That you didn’t get a chance to tell them you’re grateful to have known them, and for all they had taught you and that you’ll miss them. Well, that’s how I feel anyway. 

I didn’t get a chance to say thanks and goodbye to Mr. PH and I didn’t get to have a guitar jam with him. Both of which I’m deeply upset about. I wish Mr. PH all the best. I hope he gets bail. I hope his life is happier from now on. And I’ll miss seeing him around. 

Sigh. 

Passion 

Some days are hard. You can’t go through a 6 year degree without stopping somewhere and wondering if you’re really cut out for this and if the decision you made in choosing your career path was the right one.

For me, it’s on long days. The dreaded 8am-10(sometimes 11)pm shift spent following a registrar around on their long day that they’re getting paid for, that they really look like they’re enjoying. I’m the little student following them around, counting the hours down ’till they say “hey why don’t you head home?”. I am low on sleep and food, having missed dinner because the nurse on the other side of the hospital was in a predicament that needed immediate attention (a signature from the registrar). 

I am envious of my registrar who has all the energy in the world, and I am annoyed at myself for not having that passion for my job. Granted, being a student is not much of a job, but at the time I wouldn’t have wanted to be my registrar either. I was fantasising about my bed at home and whatever food was left over to eat. At this point, I realised that this is what my life will consist of from next year onwards. I didn’t know if I was up for it. I began to wonder why I hadn’t taken accounting or business as my subjects in highschool… (Probably because I was no good at statistics, but you know.)

It was heading up to the end of the shift. 15 minutes to handover. If I leave now, I would miss out on the pointless half an hour that a group of doctors and nurses share going through the list if patients. In which I have no part at all, so will most likely be falling asleep. 

But I never got to leave. 

There was a phone call about a new admission. An interesting/difficult patient to manage. The registrar asked me to accompany her, and I did. As the history was being taken, I was impressed. The registrar diagnosed the patient with a condition I had never heard of. And started her on the appropriate treatment. The patient was so grateful. Suddenly, I was full of curiosity and fully awake. I asked my registrar lots of questions about the disease and its management, etc. I was no longer hungry or tired. I suddenly had the energy to write notes, chase the nurse down to explain the diagnosis and treatment, and order tests she needed. 

By then, we had both missed handover, and she finally told me to go home. But it didn’t matter to me. It was super late, but I was buzzing with excitement. I was glad to be there. 

I may not always have the energy or the enthusiasm within me for my job, but I think I know that I atleast have the passion. The passion to learn something new and help someone in need. The passion that makes me forget about being tired/hungry or any other difficulties I was having. That’s what my life will consist of in the years to come.

Thank goodness for that. 

The Voices 

“you’re pathetic” said Jona as he loomed over me in the corner behind the dumpster at the back of the school. I could smell the chocolate and chips on his breath. He shoved his hand in my pocket and pulled out my 3 cookies I had for lunch. I tried to grab his arm and take them back, but Jona’s other arm came crashing into my chest and knocked the wind out of me as I fell back onto the concrete. My back aching from the force and my arms burning from where they scraped the ground. I looked up. I couldn’t see Jona as my eyes filled with tears. But I heard his voice. “you’re a loser!”

“Do as you’re told. You stupid dickhead” said the man that was my new dad. I looked up at him. His clothes had the stink of cigarettes and vinegary smell of alcohol. “eat it” he said. Shoving the orange ends of his smoked cigarettes into my small mouth. I turned my head away and squirmed to run. But his hand was holding my thin arm with a grip that was as strong as a vice and just as deadly. “eat it!” he repeated, successfully stuffing a handful of the cigarette butts into my mouth. They tasted of ash and poison. I choked and spat them out, feeling a warmth spread in my pants where I had peed myself. “you pathetic mess! Look at the mess you’ve made!!” said the man as he raised his hand above my head. I couldn’t see him as my eyes filled with tears. “you’re nothing but a loser” his voice rang in my ears.

“you loser. Why don’t you just go kill yourself?” I woke with a start from my bed. I sat up and saw only darkness. As my eyes adjusted to the dim flickering tubelight in the hallway, I saw that I was alone. “you stupid useless idiot” the Voice rang in my ears and I pressed my hands to the side of my head. I told myself It’s in my head. The doctor with the kind eyes told me it’s just Voices in my head. Before he gave me the pills to put me to sleep. Now I’m awake. “yeah you’re awake, dickhead”. I can still hear their Voices…. Then what’s real? “you’re crazy. That’s what’s real. Loser.” I looked down at my arms. Even in the dark I could see the linear gashes and scars criss-crossing all the way down on my forearm. Some still raw, bandaged by the doctor. Marks I had given myself. “see that? Loser scars.” I smiled to myself. They’re not. I slid my hand under the pillow of my bed and extracted the lone object that lay there. The paperclip that Steve from the room opposite my own had given me. The one that I had bent out of shape until it was a thin rod and sharpened on one end by the dinner cutlery. I pulled off the bandage that was wrapped just below my elbow. I felt the air touch the still healing wound. I pressed the sharp end of the paperclip at the top of the wound and ran it down the length of the old cut. I savoured the burning pain that shot through my arm. The sound of my heart in my chest as it began to beat rapidly. The cool sensation of the blood leaking out of the wound. I did it again and again. As I did, the Voices got quieter and quieter. And then they stopped. 

Pain is good. I don’t know what’s real. But atleast I know I’m alive.