Sunday, January 9, 2011

The Human Drama

I had my second, and let me say, very eventful second tour of duty in my new hospital yesterday.

I saw 7 patients in all, 4 of which were admitted in my service, and the other three were in-patients in other departments that I discharged to go home.

I found it hard to talk to my patients at some points during the day. I had to pause few beats before I could go on to say what I had meant to say. I had foreseen this obvious challenge to my current situation. Tagalog (or Filipino, if you wish), is not my first language and it requires a lot more effort on my part that I had initially thought.
( Whining has become a defensive coping mechanism it seems. I don't think I'm that bad, it's just that I just make it a big deal so I don't go overboard and also have people expect too much.)

It puzzles me how a person could think that harming herself or himself is going to become a means to an end. 
The most "popular" (if may call it that) way to attempt to end a life according to my experience here in my new hospital for my patients (some as young as 14) who have decided to, is that of taking in / "drinking" silver jewelry cleaner (there's a case everyday, no fail) or household bleach. They seem to think it's a terrifically good way to end their lives or at the very least, harm themselves enough to get someone's attention.

(Real, hard core suicide patients do not let anyone know, and carry out very detailed plans which are most often fatal enough to succeed. Most often, though, if they just swallow a few gulps or do something rash so that someone might see and stop them, then they are just usually seeking someone's sympathy.)

If I said that I didn't understand the meaning behind all this, it would be unbecoming of my profession and chosen specialty. (This is, however, saying it with the bias of my own experiences.) I'm coming from a different place than my patients so I could say that no man could ever be worth drinking silver jewelry cleaner for (muriatic acid, or heck, any other attempt for that matterà more often than not, they have complained of problems with their significant others as their main reason)

But that's just me. I believe I'll always have someone, or something to fall back on just in case…
There are other people who feel that they don't, however, so their story is a whole different one (and that's where we come in to help.).

Last night, I was amused at how funny it felt to have one's patient's chastise them.

Two of my patients said some stuff that would be totally wounding had I not known that they had "a few screws loose".
For example:
    Patient 1: "Are you sure you're a doctor? How come I know my illness better than you do?"
    Patient 2: "The Divine Master has given me the power to rule over all the world and heal every man. All you doctors don't know anything, you are the Devil's minions and you will all go to hell!!"
(Ouch. That hurt. Not.)

Being a doctor, and a psychiatrist in-training at that is starting to sound like it's getting to be an occupational hazard.
Friendly friends

They say it's good to have friends from other departments. I say, it's good to have friends. Period.
A friend of a friend, a second year resident was also on-duty last night at the ER and he knew me, so when he saw that I had long notes to write (we usually do in psychiatry), he invited me to sit in their station. A native speaker, it also came in pretty handy when in my interview, my patient described himself as "maharot", which I had to note down because I didn't understand what it was. When I later asked, I found out that it meant that the patient meant to say that he was lively and playful (rough translation/connotation in English) as a child.
So that helped.
Oh, and it's easier to refer your cases when you need help when you can greet the Neuro resident with a wave and a smile.
Friends are good. Period.


I had a patient who got agitated at the ER when we were about to bring him to the wards to be admitted. He refused to come.
Long story short, he went wild and 7 men had to hold him down, and an IM injection had to be given.
It's pretty common, especially when the patient is a florid psychotic, but for the naïve first timer, namely moi, it was quite the dramatic moment.
According to my senior resident who went on-duty with me, I should want more of those to come so I can learn more.
(I agree, but maybe in another month, when I will have "mastered" speaking in Tagalog. SO there.)


Talking, really talking to people is not as easy as you think.  


  1. Yes, friends are good!

    I think the strength the mentally challenged can summon is one of the major reasons people fear them. They have sympathy for the illness, but fear getting hurt.

    You cetainly know more than me, but I have thought a lot about people hurting themselves--because of my brother and a friend. I think you're right, if someone really wants to end their life, they will. They won't call people to say goodbye or do it at a time/place where their family/friends will find them in time to save them. They don't want to die, they want attention or to test their friends.

  2. intriguing..patient 1 and 2 cause even here outside health care premises, i see the same type of people living their life normally...and other's abnormally..

  3. I agree and disagree. Yes, I think a lot of self-harming and suicide attempts are cries for attention. But, I also want to point out that there may well be those who believe it's enough. The first time I attempted suicide I read the directions on the bottle of ibuprofen, which were something about no more then 2 pills every 4 hours (I think) so I took 10. I had no idea that would do absolutely nothing. I told no one and was highly surprised when I woke up completely fine the next day.

    I just didn't know.

    Try not being quite so condescending, and perhaps the people you're treating will tell you why they're doing what they are. Then, perhaps, you'll be able to help. Sorry if this sounds caustic. I was just shocked and dismayed to hear an attitude like this from a future psychiatrist.



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