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Marathon of Medicine
Part 6 – Letting go of idealism
by Cassie Boggs
Cassie Boggs, a fourth-year medical student, shares her personal perspective on medical school. Her column appears periodically during the academic year.
Psychiatry was one of my favorite rotations. I even briefly contemplated a career in forensic psych. The hours were great compared to some rotations but there was definitely more to my enjoyment than just that.
My rotation was at an in-patient facility where the sickest patients were sent to be evaluated and stabilized. I was part of a team that helped return control of the patient’s mind back to the patient. I loved the idea that I could one day do that for people – give them back their loved ones, their home, their life.
I also saw the amazing effect medications can have. In 24 hours, a patient who thought he was being tracked by the FBI via a microchip implanted in his brain while he slept regained his grip on reality.
But my rose-tinted glasses were quickly knocked from my face.
One beautiful sunny morning, I noted a new patient had been admitted overnight. After letting myself into the secured unit, while getting the patient’s chart, I heard he had made the evening news and wondered what exactly my new patient had done.
In the treatment room where we interviewed patients, the psychiatrist asked me if I wanted to stay in the room during the consultation. I thought, why wouldn’t I?, not knowing all the facts, thinking I’d be able to cope with whatever this patient had suffered.
As the patient was wheeled into the room, I knew something was “wrong” about him. It wasn’t just that he was in a wheelchair. Some part of me cowered – the part of me that instantly, subconsciously, recognized this man’s disease, even though I couldn’t yet identify it.
The psychiatrist started with an open question: “Why are you here?” The patient calmly proceeded to tell an involved story of how he had planned and attempted to kill a family. He spoke with no emotion, no remorse, no feeling at all as he described how he had stabbed a man in front of his family and how he had attempted to kill himself when he realized he would be captured.
I saw the man for what he was – a predator. When he looked at me, I went cold and wriggled back in my chair to get as far away from him as possible. I felt sick because I knew we would not be able to treat him. He has antisocial personality disorder. He is a psychopath. If killing will get him what he wants, he will try to kill again.
I had imagined I could handle any scenario. In this case, I was wrong on two counts – I was not ready to cope with this patient’s illness, nor had he truly suffered. I had seen the horrible things that people can do to each other while on my forensic pathology rotations, but none of them gave me nightmares to compare with how this man haunts my dreams.
I checked on the father of the family that was attacked; thankfully, he lived. I ended my psychiatry rotation a little wiser, knowing I don’t have what it takes to be a forensic psychiatrist. I’ll stick to my original plan of forensic pathology and help put the bad guys behind bars. The treatment of those people, I’ll leave to others.
Next – Life in the PICU