As a child when I thought of hospitals, images of people bed bound, hooked up to monitors, living through IV lines, and covered in bandages would pop into my head. These are obvious visual cues that someone is unwell, and you can see a physical improvement over time. A first walk again in the hallway. Stable electrolyte lab levels. CT scans of a shrinking tumor.
Psychiatry is more subtle. Healing looks different.
The unit I work on provides acute psychiatric services, so generally the patients I get to work with have been deemed a danger to themselves or others and need 24/7 support until they can get their bearings again. There's the standard set of questions we ask every shift: "How is your mood?", "Have you been sleeping and eating okay?", "Are you hearing anything or seeing anything I might not be?", "Do you ever want to go to sleep and not wake up again?", "Do you have thoughts of hurting yourself or others?", "Any cravings today?"... the list goes on.
Questions aren't enough though. It's really easy for people to try to cover their symptoms out of worries for being a burden and wanting to leave the hospital. Sometimes we have to look for small hints that maybe they still aren't doing okay. Untouched dinner trays on their counter. Subtle changes in voice tone or incongruent body language. Sleeping through activity groups. We have to look closely for change and celebrate the small wins everyday.
It's difficult because unlike many other specialties, healing can't rely primarily on medication. Yes, that is generally a huge component, but there is so much more to it. It's about having somewhere safe to stay after discharge. Mending relationships with those around them. Speaking openly and candidly with others. Having a desire to change. Realizing they're not alone. We see teachers, physicians, those experiencing homelessness, veterans, service industry workers, college students, et cetera: all members of our community just trying their best to make it through the challenges of life.
I don't want to romanticize the mental health care system though. There is a lot of room for change and improvement. We have to do a lot of things that are honestly traumatizing- even if it is in the best interest of the patient. For example, involuntary hospitalization, giving medications against the patient's own will, and use of seclusion rooms. Because of this, there are large gaps in trust that nurses have to bridge every day. The mental health care needs drastic changes to meet the needs of those we serve. I really feel like we're getting ready to see big changes in psychiatric services over the coming years, and I can't wait until we can give patients the quality care that they deserve.
Going into psychiatry truly means the world to me. I do this for the families that have lost someone to suicide and overdose. I do this to give people the happiness and health that they deserve. I do this because people need someone to hold their hand at the most challenging moments of their lives. My goal is that when my patients leave the hospital, they know that they have at least one person that genuinely cares about them. It's a hard job, but seeing the transformation from admission to discharge is unlike anything else.
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