Psychiatry posting

"On the outside I seem like a happy go lucky person who has their shit together. On the inside I am breaking down and battling years of hidden depression and just making it all up as I go."-Anonymous 

Dato S sent us the latest covid cpg, reminded us to prepare well in the theory part for the upcoming pro exam. Thanks again, you're always helpful. We're lacking of covid knowledge since IM posting has passed. But that's not what my post is about.

Ward orientation was already 1 hour and 15 minutes duration. Feeling fatigued initially during this holy month of Ramadhan and I missed sahur. Not to forget it was scorching hot outside, hence the reason. It hurts even more when we've to call off our posting at Hospital Permai and Hospital Tampoi, Johor Bahru due to covid restriction. We also can't do home visit for patients who missed their appointments this year. The moment I was complaining, there are others who are less fortunate. Our problems are way too small.

At the end of the briefing, a lovely nurse caught my eyes. She could be my classmate during form 4 & 5. Not really sure due to the mask, I was just wondering...that's all. We've seen each other in the Medical ward on day 2 while I was updating bed. I felt like crap while studying the case file and out of the blue she was walking towards me. We had a chance to talk and laugh happily for a few minutes, she looks as pretty as always.

Next story, I bumped into another schoolmate along the corridor once. How on earth did he end up here? Our eyes riveted on each other and silence fell between us. It was definitely an awkward moment. My classmate who was walking beside me started to wonder :

"Is that your friend?" 

The last one, I also bumped into my senior just at the moment I wanted to enter the lift. No eyes riveting this time, she was rushing to the lab while holding an ice box. Probably she didn't even notice me due to age difference. I can still vividly remember memories during high school after came across these 3 people, what a small world. These 'bumping incidents' happened 2 years ago. Since that moment, I did some research and found that many of my seniors become a dr. What will happen to us in the future? 

My brain whenever I'm thinking about the contract issue: 

"I'm gonna pretend not to care. Don't worry about how it's going to happen, otherwise you'll begin to create limitations."

Moving on, let's go to the most crucial part. I just wasted my time recalling these memories.

Taking a deep breath, started to clerk like always. But I must say psychiatry is beyond...hard to describe. I believe it is hard to combat the stigma. We asked for help to clerk from our very down to earth senior, Kak H who is waiting for her housemanship. First time is always the hardest, everybody does you know. 

 "Just let me know whenever you guys need help". 

Once again we stood there like the fool, watched her clerk while keep on nodding and writing. Feeling grateful we were able to get over that fearful thought but I can't say I was that thrilled.

Along this posting, we managed to watch some movies at Neflix that related to psychiatry. Totally helpful and worth it because studying psychiatry is like learning advanced English, hard to catch on. So these are the movies we've watched. Recommended by my housemate, Dila.

• Words on Bathroom Wall -- Schizophrenia 

• The Woman in the Window-- Anxiety (agoraphobia)

• Split -- Dissociative Identity Disorder (DID) previously known as Multiple Personality Disorder

• Silver Lining Playbook --Bipolar 

Our minds went blank as soon as this question popped out:

Prof H: What surah in the Quran that prevent us from suicide? Haven't you read Quran during this Ramadhan?

This hit so hard omg, so we decided to give it a shot.

Prof H: Wrong, try again. Way too far...try again. 

After multiple attempts, the answer is Surah an-Nisa ayat 29.

Ever feel like impending rejection during clerking? Psychiatry patients have more tendency to stop you from digging into further history. It's challenging due to poor eye contact, timid and quiet, hallucination out of sudden, easy to distract, sleepy and moody mood transition. Some of them are sociable. They're ready to spill the beans and of course drag our time, so hard for us to interrupt. They're the one who lead the conversation, not us. Just wonder how it looks like if we get this kind of patient during exam, how the heck we can finish clerking and all within 1 hour? Kak H reminded us to always cut off the conversation, master that skill because we'll be running out of time during exam. 

Whenever we rechecked our history taking with the case file, lots of hidden stories revealed. Just want to highlight it is good to clerk the other family members as well especially their spouses. 

Prof H: Have you observed electroconvulsive therapy (ECT) at the hospital?

Classmate: Yes, we've.

Prof H: So how do you know that ECT is successful on that patient? 

"Patient will has seizure right after ECT."

Unfortunately, only some of us managed to watch ECT. We keep on delaying things and this lazy attitude is so hard to kick, hence the reason.

Patient: Do you've a phone? Can I borrow it to call my husband? I promise you it won't be long.

Me: Oh I'm sorry, my battery's draining. It's only 5% left.

Patient: Oh I see. Can you ask your other friends for me?

Me: Sure. I'll ask later on.

Sorry for lying. I neither ask my friends nor come back to her. My battery was good, 60% left. They're not allowed to use their phone in other words there are no entertainment and communication to the outside world. I think the tv is broken too, so their entertainment will be talking to the other patients in the same ward or walking around, take some fresh air and enjoying nature unless they're in an isolation room.

They've interesting activities to do according to the schedule I saw on the wall such as washing car, gardening, music therapy, time for self reflection and they've to attend religious event and al-Quran or yassin recitation on every Friday. There are lots of fun activities but I can't recall the rest. One thing for sure is every psychiatry patient has job preservation after they discharge from the hospital. They'll be employed within 2 weeks or after 2 weeks and will be trained for a period of time before working. Gosh my memory...it just slipped my mind. You can refer the image below, from a schizophrenia cpg (2009). They are updating for the latest cpg, but since the status is still updating, I just put it here. If you're interested to learn, you can dig further once it has been updated.

Lots of things happened recently. Covid news was even worse than we expected.

 "So...this is what it looks like during our final year. What a dull year for us."

 "Guys pro exam is around the corner."

Lots of uncertainty you see, this current situation left us in distress. Knowledge is one thing, but experience is another important thing. On the bright side or maybe the best part of this posting is we've plenty of time to finish the work that we keep on postponing which is sharpening our knowledge. 

Pretty sure many people are sick of this situation! So am I. How is your study motivation? Do you still keen to learn or just dragging yourselves to follow your schedule? This is out of topic, but I saw one of my sibling going through their online class for English subject at 8am. Only 6 out of 26 joined the class. 

"Ok we'll wait for another 5 mins for your friends". Sadly the participants were still the same, only 6. 

"It's ok we'll start. Assalamualaikum and good morning class!" The teacher said it cheerfully like in a real classroom, we're all aware of how teachers used to greet before teaching start.

Silent moment for a few seconds, no respond. Waking up to see this kind of  learning literally made my heart wrench. 

 "How many of you will join usually?"

"Usually 19 or 21 out of 26."

Omg seriously? This is worrying to be honest. Maybe some of them already stressed, but they adapt and still make an effort to show up. Feeling stress during childhood is awful, they should play and explore outside instead of focusing in front of the screen. They miss out on all the things that make school fun. Online is tiring compared to face to face, I feel you. But what else can we do? This is hard to swallow but discipline is the key to success, someone told me a few years ago. 

In case you're wondering, our class is conducted by skype during this posting. We settled the ward works including clerking and procedures earlier for several weeks before total lockdown. It was tiring but fun, thanks to to my classmates. Sadly our lecturer is still wondering:

"How come I didn't see you in the ward?"

Okay enough for today, it's time to hit the books. Thank you for reading, I appreciate the time you spent to read my blog.