My second most-dreaded clerkship that turned out to be rather interesting. I have to credit my preceptor for this to a large extent. He immediately took a great deal of pressure off during our first meeting. After the typical, “What do you think you’re interest in doing?” questions, he figured out that I was one of those who were bound for the high-acuity stuff. Dr. Bender told me, "…that he did not expect me to act as if I were driven to become a Psychiatrist and that if I merely paid attention and feigned interest, he’d appreciate it."
In reality, I did not have to feign interest at all. He was an excellent & entertaining teacher – Psychiatrist to the bone! And, he was willing to teach me as much as I was willing to inquire about. Wonderful circumstances!
I worked M~F, 0800~1700, no call & no w/e! 0800 sharp until 1200, we began inpatient psych rounds. Yep, this place had inppatient psych complete with a lock-down area…the PC term for this is now ‘Psych ICU’. I found this fascinating! It amazed me just intensely impaired someone could be in the higher cognitive functions and still be able to function on a fundamental level – name, address, phone, cook, clean & care for themselves. Some of the most psychotic patients, NOT included those in lock-down, were completely aware of how irrational & inappropriate it was for TVs to be broadcasting private messages to them, satanic witches living inside of them, pink-fleshy spider crawling on the walls – they knew that just was not normal & would verbalize that to you…but still contest that that was very real to & for them and that they lived with this sort of stuff continually. The meds made this stuff easier to cope with and diminished the intensity – but usually did not make it go away totally. It was weird to think that there are folks out there, on medications, functioning in society with these sorts of cognitive dysfunctions & distractions.
Lock-down patients – TOTALLY DIFFERENT ANIMAL ALL TOGETHER!! They were completely out of touch with reality! No negotiations, discussion there! Give them large doses of medications, wait for it to soak in and them to become more stable and then the psch process would begin. Even here, though, it was fascinating to see the rapid transition from psychotic, to min functional, to mod and then to their baseline – typically in a few days…usually they got that way thru skipping their meds. Apparently, the psychotic state has pleasurable components?
1200~1300: lunchtime! Dr. Bender loved a place here in Saginaw. It is a ritzy conferenc center that caters wonderful food for its evening clientele. However, as they do not merely want to discard the left over foods…they re-serve them the next afternoon for lunch at $5/head!! We’re talking high-end cuisine!!! In a restaurant, we’re talking food you’d expect at a place where dinner for two would run you a c-note…all for CHEAP! But only for lunch. He took me to lunch there about 2 or 3 times per week!
1300~1700: the time of dread & pentence…this must of been where I was being repaid for some past transgression! Out patient counseling…OMG! After a heavy, satisfying lunch to sit and chat in a warm room over very boring stuff…it was waaaaaay hard to not snooze. On several occasions, out of respect for the patient and Dr. Bender, I had excuse myself to prevent falling out in the floor dead asleep! Everyone tells the same story. I hate to sound so dispassionate…but I just could not help myself. I have the utmost respect for people who can & choose to do this…Lord know, society needs them! And, they perform an immensely valuable service – I just could not handle it. I have the attention span of a 5…no, a 3 year old. Me and that just do not mix!!!
All in all, it was a surpisingly solid learning experience. I would not repeat it, but I am appreciative to have undergone the experience. And, I gained a new understanding of the phrase, “fine line b/t normal and insanity”…it is unsettlingly true!

Hi Dave
What same story does everyone tell that was hard to listen to/boring? Just curious as I'm interested in psychiatry. Also - I'm wondering - since I noticed on another thread that you did a neuroscience degree when you went back to do your undergraduate - whether you at any point ever thought about doing neurology or psychiatry.

Hi Folks,
Now you all know how “hard core” I am about loving General Surgery but my experience in Psychiatry was totally great. I worked with one of the best clinicians ever in Dr. Bennie Franklin Carter who now works at St. Elizabeths Psychiatric Hospital. I encountered Dr. Carter first when he came to lecture us on schizophrenia. He walked into the lecture room wearing a light jacket and a baseball cap. One of my fellow medical students assumed that he was one of the environmental services workers and pointed to some trash that needed to be emptied.
He took off his cap and quietly introduced himself to the group of about 8 people. My classmate was stunned at this point. Here was this tall, bald, very large African-American gentleman with silver rings dressed in sandles and a T-shirt with jeans about to lecture us on Being Crazy 101. I knew that I was in for a treat. He locked the door and asked us to imagine that he was an alian captor who had just kidnapped us and transported us to a place with no windows or doors. He started to act the part of a captor who would not allow us to speak. He totally changed in personality and started to question each of us in a menacing manner. He went from totally interesting to terrifying as he turned to me and wanted me to negotiate for food. I couldn’t get a word in. He abruptly interrupted me. He rolled into my face and shouted at me. He shook his fist at me and violated my 18-inch personal space. I could feel the adrenalin start to pump and fear.
We each started to take on different roles as he went around the room. An hour has passed and we were all stunned but he easily stepped out of the alian captor role and back into the role of professor. He told us that we had just entered the everyday world of a schiziphrenic. He described each of our behaviors when he was challenging us as the alian captor. He told us that each of us acted similiar to a schizophrenic in our responses to him. He even named the type of schizophrenia that each of us mimicked. It was great learning.
After two hours of facinating lecture, I knew that I was in for a great learning experience working with him in the large public hospital DC General. He ran the Substance Abuse ward and the Prison Ward at the “General”. My Psychiatry rotation turned out to be one of my best. I ended up with a 96 and easy Honors because Dr. Carter could breakdown the most complicated psychiatric disorders so that we could understand them. I learned to use psychodrama in group therapy. I learned when to medicate and when to use therapy. I learned to recognize Substance Abuse in almost any individual, even some of my fellow classmates!
Even better, I came to understand why a young woman would sell her body, her baby, her mother for a hit of cocaine. I learned from first-hand accounts what the other side of substance abuse involves. I learned that there is llittle difference between the suburban “recreational drug user” who drives into the ghetto and the " crack-whore" of the inner city except geography. " People drug to their feelings" is a quote or Dr. Carter’s.
I also learned that mentally ill individuals are as sick as any brittle diabetic or lung cancer patient. There is no visible pathology but the mental pathology can take its toll quickly. I learned that schizophrenics are some of the sickest individuals that will challenge your medical talents. I never forget the lessons that Dr. Carter taught me.
Dr. Carter was trained at USC and did Internal Medicine at UCLA before going into a residency at Howard University. He also did a residency in Emergency Medicine so he is triple-boarded. Did I say that this man could teach? He had been a faculty physician in Psychiatry and Emergency Medicine at Morehouse and Emergency Medicine faculty at UCLA.
Did I come out of this experience wanting to do Psychiatry? No, but I came out of the experience knowing what good psychiatry is all about. It is hard and it takes a huge personal toll. I learned how to take some downtime for myself, something that I try to do at this phase of my learning. I really learned how to love the humanity of medicine from the experiences and teachings of Dr. Carter in the Substance Abuse Unit of DC General Hospital.
Natalie smile.gif