Let Me Show You A Glimpse of My World

I’m 1 week away from being done with Psych. 1 week away from being done with 3rd year. I can't quite grasp the full impact of what this means...

I find myself starting to get quite reflective...

As I get ready to finish up Psych, it dawns on me that I occupy a really weird space right now…

I currently work at a Veteran’s Administration (VA) Hospital. The one here in Richmond is supposed to be one of the best in the country. If this is the case, there needs to be a War Crime Tribunal convened to discuss the pathetic services we provide our veterans. To start with… when I walk through the doors every morning, I am greeted by the smell of stale urine. It is everywhere. How is this possible? HOW is this possible? How does someone not stop one day and say… it smells like pee? We should do¨ something about that? I can tell you this… if I owned a hospital… that’s probably something I would NOT be able to deal with… my hospital smelling like pee. And it’s not like the place is dirty per se… it just… smells. It's a bad way to start off the day.

The other odd part of VA Hospitals is that it’s a perfect example of why a communist/socialist system doesn’t work. Everyone here is a government employee with guaranteed salary and benefits. No one gets fired. No one gets raises based on how good a job they do. Promotions are based primarily on time served and not having killed anyone. So, there is no incentive to work hard or efficiently. If you just sit around and suck at your job… you’ll get paid just as much as if you work your butt off. So no one works hard. This becomes a vicious cycle, too. Because then, anyone who IS a good worker doesn’t come here. Why would they? There’s no gain for them. They are better off going someplace where if they do well, they will get paid better based on performance. So… the people that end up being employed at the VA… not exactly what you would call the 5th string all american team. As a result, the entire building just has an air of… lazyness? slowness? dysfunction?

So, then I head to my student office. To get there, I have to walk through the lobby… down a hallway that takes you past the primary care clinics, the ER, the outpatient pharmacy, the outpatient psychiatry offices. To say that this results in my walking by some strange individuals would be the understatement of the year. There are wheelchairs everywhere. There are also the spinal injury boards, where the person lies on it like they’re getting a back massage and use a joystick to drive the board like a wheelchair. There are hats on just about everyone I walk by. Most of the hats have some military reference on them. There is the occasional ridiculously flash suit… complete with incredibly bright colors, shoes so shiny that you could blind God, and of course… the pimpin’ hat that I secretly covet but know I could never pull off. There is the cross-dresser that I walk by almost every other day. He’s kind of in… transition? He’s got the weird wig, the eye makeup, and the jewelry… but then he wears a randy travis baseball tee, jeans, and boots. He just looks… so off… It’s as if he decided to cross dress and after putting on the wig and eye makeup called it quits. There are the old couples that walk through the hallway arm in arm… not so much out of love but out of desperation and a need for stability. There are a lot of people, both employees and patients alike that walk the halls dressed circa 1982. This is what I experience every day… just getting to my office… before I even see a single patient of my own.

My patients… Hmmm… I think the one thing that Psych has been if nothing else is… eye-opening to the full extent of people’s problems. We learn about psychiatric diagnoses in very straightforward terms. This patient has (schizophreniform disorder/ bipolar I/ borderline personality/narcisstic disorder/ major depressive disorder/ substance abuse/ post traumatic stress disorder). Take your pick. Any one of these diagnoses could be the flavor the day. We learn about the specific criteria that must be met in order for each diagnosis to be true. And obviously… this is how we need to learn it… clear cut definitions… well suited for categorization and classification.

But… these patients are almost never just that diagnosis. You start to talk to them… and you realize there’s an entire world of pain and hurt and scars and misery underneath it all… that you just don’t know what to do with… You start to hear their stories and as each layer unfolds, you find yourself internally thinking, WHAT??? I saw a 65 year old gentleman who was newly diagnosed with ALS or Lou Gehrig’s disease. For those that don’t know what ALS is… it basically involves this degeneration of the nerves that control body movements of all kind. It’s an absolutely awful disease. Because it keeps progressing to the point where your mind is perfectly intact, but you can’t move at all… and eventually die from respiratory failure. I had to evaluate him for depression. And when I met him and his wife, it was clear that he was depressed. I originally thought it was due to his disease… because if I had it… I would be inconsolably depressed I think. But then it turns out that he has been depressed for quite a while. After digging some more it comes out that he’s had a serious alcohol problem for the past 40 years. After digging even more, it turns out he served in Vietnam and was shot 3 times, and saw a convoy of his friends die after driving over a cliff. They drove over the cliff because his truck was in front and had caused so much dust, they didn’t see the turn. And now he was riddled with guilt. On top of all this, he was abused when he was younger. Add insult to injury, before he was diagnosed, he had started to do some serious home repair to replace structures due to termite infestation. Now that he can’t move, his entire house is gutted open like a fish.

So, on paper, he’s a patient with Post Traumatic Stress Disorder, Alcohol Abuse, and Depression. But how do you help him? Nothing is going to take away the ALS. Nothing is going to take away the long-term effects of alcohol abuse. Nothing is going to really help him stop feeling guilty about his friends that died. What do you do? What pill do you give him that makes all this better? What therapy is going to help someone who can't talk anymore because his mouth muscles don't work?

I think Psychiatry is an important field. I respect the hell out of those that choose to work in this environment. I couldn’t do it. It breaks me up to see these folks in so much frustration and pain. It breaks me up to not be able to truly help them. I wonder how one holds on to their faith as a Psychiatrist? I really do.

I go home having done less work in one day than I would have done in an HOUR of surgery or medicine… and yet I’m completely drained and find myself unable to do anything productive.

I really live in a weird world right now. I'm just grateful that in one week I get to leave it.