So out of the ~25 people in my class doing their psychiatry clerkship right now, I am the only one at a Veteran Affairs (VA) hospital. I wasn't terribly worried about it being a VA, but being alone on my first clerkship seemed a daunting experience. After two days at the hospital, I think my division of anxiety was spot on.
Everyone I have interacted with at the VA has been wonderful. It might just be culture shock after driving 45 minutes north from my apartment in the Bronx, but I swear every person you walk past in the halls or on the sidewalk makes eye contact and says something to the effect of "Good morning" or "How's it going?" or, at the very least, gives a smile and a nod. If you tried any of that in my neighborhood you would, at best, get weird looks and, at worst, get stabbed*.
Today a veteran with relatively loose restrictions on staying in the building ran away. The psychiatrist I was following was frustrated, bordering on irate throughout the whole ordeal. At first, I was a little put off by the doctor's emotional response and shortness with the police officers that showed up to get information on the missing person. Then I recognised this reaction. It's the reaction of a family member when someone close to them does something stupid and dangerous. It's the "if he survives. I'm gonna kill him" sort of mentality. Everyone at this campus cares about the patients as if they were family. Sometimes family disappoints you or makes you angry, but that doesn't mean you don't care. And when your patient is like family, you can't help but care about them as you care for them.
TIL: A general rule for psychoactive medications is that you have to wait ~5 days for the blood levels to level out before doing a blood test to see how the patient metabolizes the medication. And when you do draw the blood level, it should be as close as possible to halfway between doses (so for a once a day drug, wait 12 hours after the last dose).
If you're ever a psych patient and you have a sarcastic sense of humor, you may want to lay off the jokes during your interactions with the staff. The whole way that sarcasm works is by saying something that is out of character or opposite of the obvious reaction. A sane person might say the same thing sarcastically that a psychotic person might say seriously. You do not want a doctor/nurse to rely on tone of voice to understand which you mean.
The treatment for lithium overdose is emergency dialysis.
*Jenni would like me to point out that this is a bit hyperbolic as our neighborhood is not that bad.
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