1 week in the Psych wards

Psych rotation is going better. It wasn't unpleasant to start with, but I seemed to have been slightly impaired by an unexpected adjustment disorder. Paralyzed by god-knows-where-it-came-from sudden bursts of anxiety, I was unable to present coherently during conferences and had begun to feel more and more inept, especially in contrast to my other teammates, who seemed to have been pleasantly coasting through our first week. Today was better, partially because I was determined that it would be and partially because I am apparently less intimidated by our fiercely intelligent, pierced-nose female attending than by our bowe-tie wearing, very friendly male attending (who happens to be the sole evaluator for the rotation).

My strengths definitely seem to be with the patients: I get cooperative, honest responses from the "combative" older man with a history of head trauma, I am able to ask him about his outbursts without him becoming defensive, and when I leave his room he says "thank you" and "I'm looking forward to you coming back". Psych patients, or at least the ones I have seen with dementia, delirium, and schizophrenia, seem to do very well with honesty, and have a surprisingly positive response to having their behaviors or statements reflected back on them. Which is good, because I really seem to be lacking creativity these days.

On the negative note, I regularly go through moments of feeling discombobulated, insecure and disorganized. Three big bad words you should never own during your 3rd year rotations. I knew when I began my rotations that I would have a hard time "BSing" to my attendings, pretending to learn from them something I already know, or "going that extra (and completely unnecessary) mile" just to look interested - all common practices during 3rd year wards - but I was expecting to be at least somewhat confident in my ability to contribute. Despite those expectations, my continuing episodes of sudden motor aphasia or complete thought blocking (during which time, my mind is screaming: "Oh shit, speak, speak, speak...Stop...think...speak), have done a good job of wearing down that confidence. So I will go home and read articles about my patients but never bring them to our conference meetings to impress upon my attending just how wonderfully committed I am. Don't get me wrong, I would if I could, I just figure that at this point, with my sudden, current disabilities, silence is my only sure defense.