Monday, September 19, 2011


“I was walking off into the sunset (or, at least I pretended to be) with a friend of mine from Medical School who I had a bit of a secret crush on then. We had lagged behind our other friends, and he suddenly asked me, “Why are you in Psych, when you know that your patients will never get well?”. In the middle of discreetly getting a whiff of his expensive cologne, I stopped short, and did a double take. Why, indeed?
Six days later, I got a chance to know why, and prove Jerry wrong. He came to me in the form of a patient who was “emo”, and looked the part.  
My case for grand rounds was one of first-episode psychosis, a condition, which, if managed carefully, could get the patient back in remission and/or even better that what he was in his premorbid state. My contention was that young people, who have the rest of their lives ahead of them, should be treated at the first signs of psychosis so that they won’t have to fall down the ugly downward spiral which is mental illness.

First episode psychosis is a hot topic for research in Psychiatry, as the main thrust right now is for primary prevention. Prodromes, the beginnings to mental illness, are actively being studied in order for mental health specialists to know which factors put the patient at risk, and find out what they can do. My patient for grand rounds was a talented, good-looking boy who had a lot of potential…I thought it was a personal challenge for me to do whatever I could to make sure he could “bounce back”.

There are studies that show that psychosis that isn’t treated within 6 months will have a correspondingly poorer prognosis than if they were treated earlier. And by poorer prognosis, I mean that they will just worse and worse…

It’s prevention at the level we are capable of as of this time… be aggressive, and then treat right away. Research has shown that atypical antipsychotics and cognitive behavioral therapy if given within 6 months of onset of symptoms has been shown to have high rates of remission.

It paid off though, and I felt a personal triumph, even though I acknowledge the fact that it wasn’t through my efforts and management alone…his family,other residents, the nurses, the occupational therapists worked with the patient while he was admitted, as well as afterwards.   

It was a lot of work, but the fulfillment I felt when I saw him improve so much from the confused, psychotic state that he was in when I first saw him to the almost “normal” young man who was able to crack jokes and even mentalize just 6 months after. 

Ok, so I admit it was a corny introduction to my presentation… the friend I mentioned above is a Surgery Resident in another hospital. Surgery, being the very concrete specialty that it is, is very, very different from Psychiatry, with all its symbolism and ambiguity. He probably wouldn’t understand why we in Psychiatry feel so strongly about people’s mental health like we do. But of course, I didn’t ask any more. :-)

Grand rounds went ok… and I passed. Smile 

My supervisor handled things really well, although, I wish that there had been more consultants in attendance, as I really wanted to present my case (which wasn't a diagnostic dilemma at all.) and contention, but that's pushing it.
Oh, and my father arrived (he just flew in from the province) in the middle of my discussion, and he even got to see some of the Q&A parts (which I got to answer, of course. ahem ahem.)…
(He said I had the tendency to talk too fast. Haha.)

Which was pretty weird, because the night before, I was paralyzed with anxiety. I wanted “psychotherapy”, and a listening ear…but there was no one who was up to it, at like, one in the morning, except for course, the night owl, JC. 
Someone gave me advice that went something like, “Drink a glass of warm milk, and sleep early.”
And I was like, “WTF, I’m going bonkers here..!!”, not seeing the rationale behind the milk.
But then, I fell asleep, and when I woke up, I was a changed person.


Haha.. Milk.

Who would’ve thunk?

Oh, and guess what my coresidents are calling me nowadays?

“O.L.B.” actually.

(One Lucky Bitch, because of how smoothly MY grand rounds went.)
Open-mouthed smile



1 comment:

  1. Ha! O.L.B.

    But srsly, congratulations on passing your Grand Rounds, Sonia.

    Coming from a long line of nut cases, we really need people like you.



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