Most third medical students look forward to their psychiatry block. After twelve plus hour days and six day weeks on internal medicine, OB/GYN and surgery, the reasonable hours on psychiatry seems like a dream. While my classmates viewed psychiatry as a break, I dreaded it. This was not my first time on an inpatient psychiatry ward.
My world and fate forever changed when I was twelve years old. Sometimes depression is like standing on a trapdoor that opens suddenly, dropping the world out from under me. Sometimes it is like being stuck as ice cold water slowly drowns me inch by inch. I don’t remember a moment of my adolescent years when I was not in an episode and so I don’t remember much of my adolescence.
Depression is the enemy of memory. I was eighteen when the depths of my despair could no longer be hidden. A trial of antidepressants skyrocketed me into a brilliant high. In hindsight, my life was littered with such episodes. My warped reality had previously written them off as what being “happy” or “not empty and paralyzed” must be like. My psychiatrist identified my high as mania. Apparently believing you can control time isn’t normal.
The first morning of my inpatient psychiatric rotation, I was a wreck. Here were the same questions I had been asked before, only now it was in a different tiny room. Every word the patient uttered was analyzed and pathologized. My heart pounded, and the room tunneled. I excused myself and power walked off the unit, closing the door behind me.
On the worst night of my life, a desperate phone call went straight my best friend’s voicemail before I was taken to the local ED to sit for hours and then transferred alone in the back of an ambulance to a dedicated inpatient hospital. No one would tell me where. My photo was taken for the police if I ran as I sobbed uncontrollably before I was taken to the unit.
I have since spent years trying to suppress these memories. I remember lining up to down for meals, for medications, for headcount, for unhelpful group therapy. I remember the locked door. I remember feeling powerless, completely at the mercy of the staff who could extend my stay with one word.
“Don’t say that or you’re here another week!” the patients warned.
“Careful or they’ll make you involuntary.”
I remember the boredom. We played Uno for so long that we started keeping score.
One thing I hate about psychiatry, even still from the provider side, is that our opinions are not taken seriously. When I explain the state of my life and my illness, the fire and the rain, the medications and their impact, I am describing facts. This is my reality, not part of my pathology though too often it is treated as such. At this point in my journey through mental illness, I know my bipolar. Most of the time I can prevent episodes and course correct. If it gets away from me and my flotation devices of self-care and medications, I can call out for a life raft. My life is a series of checks and balances, but I persist.
Another aspect I hate is that they do not understand our humor. When I meet someone like me, the first thing I do is compare notes about things that rationally are truly ridiculous like staying up for days to design aqueducts for an imaginary city, believing I could teleport objects or mentally singing in case of telepaths. My favorite such conversation was between two friends with OCD/trichotillomania.
“I yanked out my hair into patches.”
“At least you didn’t pull out your eyelashes.”
We laugh because it is sad and funny and we know we’d all experienced it.
“I’ve tried x and y medications. I heard z makes you bug out.”
We compare scars and battle wounds that people who have not fought in our wars do not comprehend. Humor helps us survive, but it terrifies outsiders. “This patient is crazy,” psychiatrists say because they cannot understand.
That first day on the inpatient ward as a medical student, I listened to the “in case of emergency” voicemails from people I loved. They are about ordinary things, a party I attended years ago or what was for dinner. I’d saved these messages for this moment, when I desperately needed to ground myself. I made it back onto the unit, one of the longest walks of my life. I remained by sheer force of will as the interviews continued. The memories came back again and again. I looked for excuses to leave the unit so I could hear freedom as the door closed behind me; I could leave whenever I wished. As the days passed, I needed to leave less often. I could overcome my experience and become an advocate. My peers and attendings could not comprehend why a crossword was vital to survival here, but maybe I could help them understand. The wall of experience and stigma stood in their way, hampering them as much as it does us. My experience from the other side has helped me come to terms with my own time on the psych ward, moving past the experience and regaining my agency.
Unfortunately, attaching my name to this essay would jeopardize my career. Medical students and physicians everywhere struggle a host of other mental illness; a medical school class of doctors is lost every year to suicide. Because we cannot talk about it, we cannot get help, and it stands in the way of our ability to care for patients. The wounded healer is unacceptable.
I hope by writing this, you will understand. I hope you understand why it is hard for me but how it has made me stronger, the storms I’ve weathered and survived. I hope you understand why I need to help people and I hope you can understand why I feel called to be a doctor.
The author is an anonymous medical student.
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