1 Year of Working in an Acute Psychiatric Ward — a series

Day 1

Since I started working in Psychiatry, I’ve lived many weird, interesting, fun, sad and (some a little) traumatising episodes. I decided I’ll start to document some of them in the hopes that someone will have a window into a subject that has evolved so much and in a good direction but unfortunately is still full of preconceptions. I am making my own way into it, learning, growing and throughout trying to keep a sense of humor!

So, day 1. My stomach has been turning a bit. I have a bunch of questions in my head. Plus, I have absolutely no experience with acute psychiatric patients. I have seen movies, that’s it. But every psychiatrist has had their first day on set and this is mine. I couldn’t sleep that much yesterday and now I’m arriving to the hospital.

The station is on the ground floor. It’s safer for the patients, windows are closer to the ground and makes it easier if someone comes with the police, the entry is directly to the street. Even though we call it a locked station, patients can have moments of the day where they go out for a bit, get some fresh air, depending on how stable they are. They are also allowed to go home for a few hours or have visits from family or tutors. This all depends on how they are mentally doing or feeling and how much of a support is out there for them (from family members, partners etc.).

It’s really important though to be careful with the door when you open it. Always check if someone is coming in your direction! Don’t open the door too much. Evaluate, open it, close it right behind you. Since the main door has a big glass window, I could see three patients wandering around, in a slow pace with pretty different looks on their faces. Definitely the vibe doesn’t match my previous ward, geriatrics. While writing the last sentence, instead of “ward” I wrote “war”, bit of a freudian slip there.

I come in and in my direction comes a young man in his thirties, talking non-stop in a low voice, directed at me or not at all, I can’t tell. I later learn he has Schizophrenia. He used to have many episodes where he would be in a state of catatonia. This is a neuropsychiatric syndrome where a person isn’t able to properly move or experiences abnormal movements. Typically it is associated with Schizophrenia but can also appear with other conditions. Right now and unexpectedly, he is in a very conversational phase. We apparently can’t explain the switch. But everyone seems to be happy he’s talking again after a few years of not doing it.

The atmosphere is a bit different than in the open wards. There is a heavier air floating around. You can almost feel the unpredictability. Luckily, long gone are the dark days where patients needed to be sedated at all times. We’ve come a long way. There is now a bigger and better control on the legal and social functioning of these types of wards. This also means any situation can escalate rapidly. You’re instructed to deescalate it as much as you can without having to sedate or constrain anyone.

Our patients are people just like any other that are currently in a very heavy, hard and confusing situation. As I get to know them during the day and later read about their life stories my heart shrinks. The suffering one human can endure in their life time has been difficult to imagine until now.

I get to know the team and I’m glad to see they are pretty relaxed. They definitely have a sense of humor. We have the morning meeting where we get handed the details of the night shift. Who is stable, who didn’t take the medication. Who needs blood analyses and any social or legal problems we need to clarify or take care of.

We visit every patient in the ward, everyday. We see if the meds are doing it’s purpose and how the patient is evolving. We are also careful to always ask how they think we can help them better. We ask about their goals for their time with us (of course this doesn’t work with everyone). With psychotic patients it’s important to know if the hallucinations are still there and if the delusional ideas are still strong. We admitted a patient yesterday night with a cannabis induced psychosis. He thought he was being controlled by a chip in his occipital lobe. This chip apparently was sending electromagnetic waves with information about him to a military program called Ultra. His thoughts where very disorganised and since he became agressive with people that he was with at the time, he was admitted into our unit. Today he is doing much better.

Later in the day we get a new patient. It’s a woman from another one of our wards, an open one. She started a commotion upstairs in an open ward. I look in her diagnostic list and it says personality disorder-impulsive type. She comes to us in the hallway as we are on our way to the next room. She asks in a very polite way and in an almost child-like voice if she can go to her sports session upstairs in her old ward. My colleague is busy on the phone so can’t give her much attention. I am also new and don’t know what to respond. I gather a “no” should be the right answer. But before I say anything she raises her voice, the tone and the posture changes. I’m thinking I’m going to get hit with my laptop (I’m just writing our notes)! She yells “asshole” three times and leaves. No one seems fazed. While this is happening there is also another patient, small but in his forties. He has been following us whenever we leave each room of each patient. He is moving like he is flying. I’ll check later his story.

After many notes, consulting calls, 2 blood cultures taken out, one very hard venous access I call it a day! Not bad for a first one!

If you read this until the end, thank you so much for stopping by! I write about my day-to-day as a psychiatrist and hope I can tell my stories with the same emotion I live through them :)