Walking away from an obviously agitated, almost violent psychiatric patient takes more than just the actual movement of your legs, one before the other until you reach that door which separates the normal from the not so normal. It also takes a couple of drops of sweat down your brow, a relatively increased heart rate and a span of helplessly infinite seconds. Enough time for your own imagination to run away with you. In your mind you start thinking, “are the nurses watching?”... “is he running after me?”... “Am I expecting someone's hands around my throat any second now?” And when it's past 5 pm in the psych ward and you reach the door to your salvation, you realize it's locked and you can't get out because the nurses have the key and you forgot to tell them you were leaving (twilight zone music in the background).
That was me 15 minutes ago. I started psychiatry training this year and I have a difficult patient at the ward with paranoid thoughts and aggression directed towards his father, who is also his primary caregiver, and during the course of our interview, something inside me ticked, telling me to stop the interview right away before he turns his hostility towards someone else... aka, me.
I've never felt the Fight or Flight phenomenon like this in a long, long time, and it was unnerving. How do you teach yourself to be not afraid when fright is probably one of the most basic instincts innate to man? And if I chose the “fight” option, would it not show cowardice in the same proportion, for why would I challenge someone with an unsound mind? I keep telling myself that between me and my patient, I'm the one without problems with reality testing...well, most of the time and depending on what perspective one is coming from (hehe!), so it's up to me to be the one to figure out the game plan.... But! May I remind you that I'm also just a woman, brought up with 5 able-bodied brothers, by a father who has very sound medical knowledge of exactly where to break someone's bones and permanently incapacitate them, and I have been pampered by a boyfriend, never having to know what it feels like to have my safety threatened. So, my survival instincts are not exactly as sharp as I'd like them to be. Not after watching Way of the Dragon and listening to the boyfriend raving about Bruce Lee's One-Inch-punch and Chuck Norris's round house kick. I can't exactly promise myself I could swerve someone's right upper cut when they're directed at me, if you know what I mean.
But that aside, I also realize that such feelings actually hinder us from establishing rapport. Instead of catering to a healthy doctor-patient relationship, our own fears, real or imagined, can and will hinder us from empathizing with our patients. Instead of me honing in on what my patient was trying to telling me in only so many, many, many words and oh-so-distracting and restless hand gestures, I was busy imagining worst case scenarios in my head. And me suddenly apologizing and terminating the interview just when he probably feels like he was finally arriving at a point,
(and passionately at that) could have built a wall between us that I might not be able to deconstruct anymore.
But, safety first and better safe than sorry a little too late. It's just that it suddenly hit me that damn!...this takes a lot of getting used to.
The advice I was given was in just two powerfully resounding words: “DRUG HIM.”
That may sound crude to some, but it only means increase his antipsychotics and put him in as safe a sedated state as you can until the antipsychotics start working. Sound advice, but in my 2nd week as a psychiatry resident, I'm still honestly getting the hang of maneuvering drug dosages. Our Training Officer, Dr. Vista even laughed at how scared I am of the possibility of extra-pyramidal side effects at a 5 mg dose of Haloperidol. How juvenile I must have seemed when I asked the question... tsk, tsk...But even though I've been moonlighting for a while before deciding to go into training, all I have with regards to managing psychiatric patients is textbook knowledge. And the book says, Haloperidol could already cause EPS at 5 mg in some patients... In some patients... So there. Hahaha! I increased this patient's haloperidol dose and am now praying the Almighty Father would grant us a little improvement and a lot less anxiety-provoking walks from Ward Seven to the door.
On the bright side, not all psychiatric patients are such Stephen King characters. I was endorsed an Out-Patient by our previous chief resident, Dr. Fulgencio, who had the same diagnosis as the troubled patient I have in the ward, except that she is now in remission. Meaning, she's gained herself a new life after her illness. She works and earns her living. She smiles and makes jokes. And, she gave me my first “PF in kind” today (yipeee!) A bag of Mammon from Goldilocks which I shared with my co-resident, Atep, who was bunking with me at the call room at the time. (Tell her to go home and sleep where she belongs, says Trina, another co-resident. Hahah!) But I appreciate the company and I had someone to show and share my Goldilocks Mammons to. (teehee!) I have yet to experience what it's like to see a psychiatric patient recover from such debilitating illnesses and know in my heart that I have helped them achieve that state. If Mr. Character-from-a-Stephen-King-Novel downstairs would one day show up at the Out Patient Clinic, smiling and no longer talking of doomsday theories, I suppose my twilight zone experience a few moments ago would be worth it.
Here's another thing I learned today aside from the sudden re-realization of the Flight or Flight dilemma. For women who must know how to maneuver their males into agreeing to something they otherwise would not, there is what I'd like to call, Game Plan Croon or Cry.
My sisters, I have observed, are experts at this, whether they are conscious of it or not (I think they are and I do believe they are using it to their full advantage, heheh!). One of them has this natural talent for crooning and male ego-nurturing in any situation where the male ends up thinking it was his idea and she ends up allowing him to believe it is so, as long as she gets what she wants. The other sister can bat pretty eyelashes while playing the baby. They say some men find it irresistible when women need them for childish joys, no matter how silly they may seem. Though I think I do need to stress that in both sisters, the male I am referring to is none other than our own dear father who bought a horse for his rice fields because one of them suggested it and he thought it was a good idea, and who would revel in the approach of his other daughter who, as an adult, comes into the gate, flails our her arms in exaggerated embrace and calls “DADDIIEEE!!!!” like she never grew up from two years old.
Needless to say I envy them for such feminine and daughterly talents. When I croon, I give myself the goosebumps and not in a good way. When I cry, I disgust myself. For one thing, I honk instead of sniffle. Like an elephant with the flu. And my after-tears hiccups are never cute. The art of crying prettily is simply beyond me. And me being in a very hormonal state right now puts me in danger of some very embarrassing situations, one of which has already taken place where I jerk off tears for simply being asked by our consultants to commit to three years of psychiatry training... how pathetic is that? I don't even know where that came from. But then, earlier that same day, I also cried in the shower because the water was too cold and I was too lazy to bother with the heater...And the day before that, I cried because I wanted a Special Nino's Pizza all the way from Roxas City and no matter how many times my boyfriend brings me to Pizza Hut or Shakey's, the craving just won't go away. tsk...tsk... Papa God, why did Estrogen have to come with sensitive boobies and a hyper-efficient waterworks system?
But anyway, I can say this much for my dad, he probably likes being the object of the Croon or Cry. I don't think he's as naive as he's allowing us to think in this matter. He's had since our infancy to prepare him for it, after all. I think he's that kind of dad. But I'm not so sure if I won't be feeling sorry for the other men in my sisters' lives who find themselves in the same situation. Will they even be aware that they're being weighed and measured for the Croon or Cry?
The reason why I'm writing about this is because my boyfriend and I recently had a heated discussion about something rather trivial. There comes a time in a long term relationship where trivial things could be discussed in a passionate and heated manner just to keep the fires burning. So we were heatedly discussing something trivial, and at one point in the discussion, I managed to “Croon” and “Cry” at the same time. Non-intentional. I swear. The hormones are the criminal masterminds, I think. I managed to strike a point without sounding too assertive and then, I miraculously managed a sniffle instead of a honk, owing to the state of inexplicably being on the verge of tears but not quite crying yet.... And then staying there for good measure...And he suddenly fell quiet as though something hard and invisible has hit him straight in the guts. And he looks at you. And with that look, you and all the secret knowledge of womanhood the Almighty has instilled in your very DNA, just know that right at that very moment he loves you and will never refuse you anything... (HAH!)
Such power...
This is what Darna's Rock must feel like.
Which sort or reminds me, doesn't legend have it that aswangs pass on their powers through swallowing rocks as well?... hmmm... just a thought, though somewhat tangential. Hahah! Darna must be the FHM babe of the aswang world in that case. Toink!
Anyway, I'm supposed to be on duty. I've had just one admission and no other calls so far. I'm also challenging the Cosmic Joke, pretending that referrals won't make me bat an eyelash for all it's worth. But my heart skips a beat every time the duty phone rings. So there.
But don't worry, I'm not so anxious (or deranged)as to try Gameplan Croon or Cry on Patient Stephen King (wink-wink!). :)
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