Taste Like Candy, Sweet Like Fruit

My psychiatry rotation was a lot slower than expected, however, it was a welcome change of pace. I noticed there was more time talking with patients, because psychiatry, unlike other medical specialties, has less diagnostic tests to perform. Rather, psychiatry depends on the clinical evidence of a patient history and the collateral history drawn from people closest to them.

I was exposed to the entire gamut of psychiatric conditions, many I had previously only read about. They ranged from mood disorders, like bipolar affective disorder, to psychosis with schizophrenia and personality disorders, e.g. narcissistic personality disorder. So many of these psychiatric conditions are relatively common, but they often don’t get spoken about. They are unfortunately stigmatised to the extent that it is purposefully hidden.

It’s easy to see a physical ailment and treat accordingly. Psychiatric conditions are much more implicit, which compounds the ability to appreciate their importance. For example, a man can come home after surgery, and the obvious outward indicators of visible wounds and bandages warrants his family to take it easy with him and assist in his recovery. They, of course, do this in any way possible; no heavy lifting, modified housework, etc. They are allowed to rest. The same man can return home from the psychiatry department, with no physical evidence of injury, but a plethora of mental bandages, and not receive the same accommodating approach towards his recovery. There’s no easing back into their daily routine, and they’re expected to continue to perform in a similar way as before. It can be very debilitating.

Psychiatry also exemplified the invaluable nature of a multi-disciplinary support team. Psychiatric doctors were working closely with social workers, psychologists, and occupational therapists. The entire team attended review meetings and were all viewed as being equally necessary. They shared the combined goal of ensuring an appropriate transition for a patient back into the community.

A few different experiences coloured my psychiatry rotation. I was reminded of the importance of culturally appropriate and sensitive care. There was a team, including myself, tasked with going to the seclusion area of the department and moving a patient from one room to another. One young man was of African descent and had drug induced psychosis. The treating team consisted of an African nurse leading the consult, two nurse practitioners and nurse unit managers. While we were giving the young man his anti-psychotic medication, he said “taste like candy, sweet like fruit” – a reference to the Moneybagg Yo song ‘Wockesha’. In unison, we broke into laughter, and the young man appeared chuffed that he managed to bypass the professional demeanour that constituted our faces. “Okay now Moneybagg, it’s time to go”, said one of the nurses. It was a special interaction, because the young African man saw that we looked like him and could relate on more levels than just as professionals in his treating team. Essentially, it built a sense of relatability, with at least five of his health practitioners being black – that’s more than the number of black students in my cohort!

I also got the rare opportunity to witness Electroconvulsive Therapy (ECT). ECT is a procedure where electrodes are positioned on the side of the head and small currents of electricity are passed through the brain. I know, it sounds a lot worse than what it looks! The premise of ECT is to induce a seizure, and the brain to kick into action and quieten the brain and seizure. It works quite well for patients with untreatable depression and severe catatonia. The movies significantly dramatise ECT, showcasing a person’s arm flailing everywhere and uncontrolled movements. In real life, however, the procedure takes seconds, while the patient is briefly anaesthetised, and then it’s done. Anti-climactic if you ask me, as my only reference was Hollywood films.

Apart from that, I was also racially abused by one of the psychotic patients. I was minding my business, as I usually do, and a patient knocked on the reception window, asking “Are you on a visa?”. Initially, I thought to myself, damn right I have a Visa card, that’s how I make all my online purchases. Of course, she meant another type of visa… After I realised this, I retorted and said “No”.

Her absolute dissatisfaction with my response was clear. She pushed it further.

“A Humanitarian Partner Visa?”

“No, I don’t have that,” I said. Now she seemed confused, and so she delivered her final line.

“You’re not Australian, you’re black.”

Oh, I didn’t know that black people couldn’t be Australian. I’m sorry to all the black babies born in Australia, but it seems like you’re not a citizen of the country you were born in. Did y’all readers know about this??

What was interesting about this encounter was that the people around me – doctors mostly – seemed overly nonchalant about the experience. It made it seem like abuse from patients was tolerated by the staff working in the psychiatry department. Me, personally, wasn’t too surprised by the racism. I was more disappointed in losing my streak. I really thought I could go this entire year without any racial abuse on any of the rotations—I was so close! Maybe I’ll write another blog about racism 101, ooooh all the things you’d read about that’s happened.

Two more rotations left in the year. Next up is geriatrics at a different hospital, and then finishing off with Obstetrics and Gynaecology. From there, I’ll be done with my penultimate year!

It’s very fitting I had this rotation during lockdown. With half the country staying at home, make sure you check up on your friends and family. Implicit medical conditions do not necessarily mean absent, so ask about someone’s mental today. R U OK?

Stay safe everyone, and continue to eat those pancakes,

Anei